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Data Mining in Genomics & Proteomics
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E
Earth Science & Climatic Change
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Epidemiology: Open Access
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F
Family Medicine & Medical Science Research
Fermentation Technology
Fertilization: In Vitro - IVF-Worldwide
Fisheries and Aquaculture Journal
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Food Processing & Technology
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Forest Research: Open Access

G
Gastrointestinal & Digestive System
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Hematology & Thromboembolic Diseases
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I
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Intellectual Property Rights: Open Access
Infectious Diseases and Therapy
Integrative Oncology
Internal Medicine
International Journal of Advance Innovations, Thoughts & Ideas
International Journal of Economics & Management Sciences
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L
Liver
Leukemia

M
Marine Science: Research & Development
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Nanomedicine & Biotherapeutic Discovery
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Novel Physiotherapies
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Neurological Disorders
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Nutritional Disorders & Therapy
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0
Obesity & Weight Loss Therapy
Occupational Medicine & Health Affairs
Oceanography-Open Access
OMICS Journal of Radiology
Osteoporosis and Physical Activity
Oral Health and Dental Management
Oral Hygiene & Health
Biological Systems- Open Access
Organic Chemistry: Current Research
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Otolaryngology

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Pain & Relief 
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political Sciences & public affairs
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Primary Health Care: Open Access  
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R
Reproductive System & Sexual Disorders
Rheumatology: Current Research
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S
Sleep Disorders & Therapy
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Spine
Stem Cell Research & Therapy
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Single Cell Biology
Sociology and Criminology-Open Access
Surgery: Current Research

T
Telecommunications System & Management
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Trauma & Treatment
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Vaccines & Vaccination
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Women's health Care

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Yoga & Physical Therapy
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Clinical
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Clinical Case Reports
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Clinical Toxicology
Clinical Trials
Communication Disorders, Deaf Studies & Hearing Aids
Cytology & Histology
Forensic Research
Integrative Oncology
Neurology & Neurophysiology
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Pharmaceutical Sciences
Advances in Pharmacoepidemiology & Drug Safety
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Cardiovascular Pharmacology: Open Access
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Developing Drugs
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Pharmaceutica Analytica Acta
Pharmaceutical Regulatory Affairs: Open Access
Pharmacovigilance
Vaccines & Vaccination

Omics
Data Mining in Genomics & Proteomics
Ergonomics
Glycomics & Lipidomics
Health & Medical Informatics
Metabolomics:Open Access
OMICS Journal of Radiology
Pharmacogenomics & Pharmacoproteomics
Phylogenetics & Evolutionary Biology
Proteomics & Bioinformatics
Transcriptomics

Chemistry
Analytical & Bioanalytical Techniques
Chemical Sciences Journal
Chromatography & Separation Techniques
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Modern Chemistry & Applications
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Theoretical and Computational Chemistry:Open Access

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Advance Research in Meteorological Sciences
Anthropology
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Astrobiology & Outreach
Biodiversity & Endangered Species
Earth Science & Climatic Change
Ecosystem & Ecography
Environmental & Analytical Toxicology
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Geography & Natural Disasters
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Oceanography-Open Access
Petroleum & Environmental Biotechnology
Pollution Effects & Control
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Accounting & Marketing
Arts and Social Sciences Journal
Business and Economics Journal
Business and Financial Affairs
Civil & Legal Sciences
Defense Management
Entrepreneurship& Organization Management
Hotel & Business Management
Intellectual Property Rights: Open Access
International Journal of Economics & Management Sciences
Mass Communication & Journalism
political Sciences & public affairs
Stock & Forex Trading
Socialomics
Tourism & Hospitality

Life  Sciences
Advanced Techniques in Biology & Medicine
Advancements in Genetic Engineering
Advances in Crop Science & Technology
Advances in Dairy Research
Aging Science
Agrotechnology
Air & Water Borne Diseases
Antivirals & Antiretrovirals
Autism-Open Access
Bacteriology & Parasitology
Biochemistry & Physiology: Open Access
Biochemistry and Analytical Biochemistry
Bioenergetics
Bioengineering & Biomedical Science
Biofertilizers & Biopesticides
Biological Systems- Open Access
Biometrics & Biostatistics
Biomolecular Research & Therapeutics
Bioremediation & Biodegradation
Biosafety
Biosafety & Health Education
Biosensors & Bioelectronics
Biotechnology & Biomaterials
Bioterrorism & Biodefense
Cell & Developmental Biology
Current Synthetic & Systems Biology
Entomology, Ornithology & Herpetology
Enzyme Engineering
Fermentation Technology
Fertilization: In Vitro - IVF-Worldwide
Fisheries and Aquaculture Journal
Forest Research: Open Access
Fungal Genomics and Biology
Gene Technology
Glycobiology
Horticulture
Homeopathy & Ayurvedic Medicine
Marine Science: Research & Development
Membrane Science & Technology
Microbial & Biochemical Technology
Molecular Biology
Molecular Imaging & Dynamics
Nanomedicine & Biotherapeutic Discovery
Nanomedicine & Nanotechnology
Nutrition & Food Sciences
Plant Pathology & Microbiology
Primatology
Probiotics & Health
Rice Research: Open Access
Single Cell Biology
Sociology and Criminology-Open Access
Tissue Science & Engineering
Tropical Diseases
Transcriptomics: Open Access
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Vitamins & Minerals
Virology & Mycology

Engineering
Advances in Automobile Engineering
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Applied & Computational Mathematics
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Architectural Engineering Technology
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Bioprocessing & Biotechniques
Chemical Engineering & Process Technology
Civil & Environmental Engineering
Computer Science & Systems Biology
Electrical & Electronics
Food Processing & Technology
Geology and Geosciences
Geophysics & Remote sensing
Industrial Engineering & Management
Information Technology & Software Engineering
International Journal of Advance Innovations, Thoughts & Ideas
Irrigation and Drainage Systems Engineering
Material Sciences & Engineering
Powder Metallurgy & Mining
Telecommunications System & Management
Textile Science & Engineering

Medical Sciences
Addiction Research & Therapy
Allergy & Therapy
Alternative & Integrative Medicine
Alzheimer’s Disease & Parkinsonism
Anaplastology
Anatomy & Physiology
Ancient Diseases & Preventive Remedies
Andrology
Arthritis
Autacoids
Bioceramics Development and Applications
Biology and Medicine
Blood & Lymph
Blood Disorders & Transfusion
Bone Marrow Research
Brain Disorders & Therapy
Cardiovascular Diseases & Diagnosis
Cloning & Transgenesis
Community Medicine & Health Education
Dentistry
Depression and Anxiety
Diabetes & Metabolism
Emergency Medicine
Endocrinology & Metabolic Syndrome
Epidemiology: Open Access
Family Medicine & Medical Science Research
Gastrointestinal & Digestive System
General Medicine
General Practice
Genetic Syndromes & Gene Therapy
Gynecology& Obstetrics
Global Economics
Gerontology & Geriatrics Research
Hematology & Thromboembolic Diseases
Hair: Therapy & Transplantation
Health Care : Current Reviews
Hereditary Genetics
Human Genetics & Embryology
Hypertension-Open Access
International Journal of Genomic Medicine
Internal Medicine
International Journal of Physical Medicine & Rehabilitation
Leukemia
Liver
Medical & Surgical Urology
Medical Diagnostic Methods
Medical Microbiology & Diagnosis
Metabolic Syndrome
Molecular Biology
Molecular Biomarkers & Diagnosis
Molecular and Genetic Medicine
Mycobacterial Diseases
Neonatal Biology
Nephrology & Therapeutics
Neurological Disorders
Novel Physiotherapies
Nuclear Medicine & Radiation Therapy
Nursing & Care
Nutritional Disorders & Therapy
Obesity & Weight Loss Therapy
Occupational Medicine & Health Affairs
Oral Health and Dental Management
Oral Hygiene & Health
Orthopedic & Muscular System
Osteoporosis & Physical Activity
Otolaryngology
Pain & Relief
Palliative Care & Medicine
Pancreatic Disorders & Therapy
Pediatrics & Therapeutics
Primary Health Care: Open Access
Psychological Abnormalities in Children
Psychology & Psychotherapy
Reproductive System & Sexual Disorders
Rheumatology: Current Research
Sleep Disorders & Therapy
Spine
Sports Medicine & Doping Studies
Steroids & Hormonal Science
Surgery: Current Research
Thyroid Disorders & Therapy
Translational Medicine
Trauma & Treatment
Tropical Medicine and Surgery
Vascular Medicine & surgery
Women's Health Care
Yoga & Physical Therapy
» Conferences
 
Upcoming Conferences

2nd International Conference and Exhibition on Pathology, August 05-07, 2013 Las Vegas, USA

International Conference on Integrative Biology Summit, August 05-07, 2013 Las Vegas, USA

2ndInternational Conference on Translational Medicine, August 05-07, 2013 Chicago, USA


International Conference and Exhibition on Predictive, Preventive and Personalized Medicine & Molecular Diagnostics, August 05-07, 2013 Chicago, USA
2nd International Conference on Biodiversity & Sustainable Energy Development, August 12-14, 2013 Raleigh, USA

International Conference on Genetic Engineering & Genetically Modified Organisms, August 12-14, 2013 Raleigh, USA

4th World Congress on Diabetes & Metabolism, August 14-16, 2013 Chicago, USA

International Conference on Radiology and Imaging, August 14-16, 2013 Chicago, USA

2nd International Conference and Exhibition on Orthopedics & Rheumatology, August 19-21, 2013 Las Vegas, USA

International Conference on Dental & Oral Health, August 19-21, 2013 Las Vegas, USA

International Conference and Exhibition on Physical Medicine & Rehabilitation, August 19-21, 2013 Las Vegas, USA

International Conference on Molecular Epidemiology and Evolutionary Genetics, August 21-23, 2013 Miami, USA

International Conference on Oceanography, August 21-23, 2013 Orlando, USA

International Conference on Biodefense & Natural Disasters, August 21-23, 2013 Miami, USA

World Congress on Endocrinology, August 26-28, 2013 Raleigh, USA

2nd International Conference on Hydrology and Groundwater Expo, August 26-27, 2013 Raleigh, USA

2nd International Conference on Tissue Science & Regenerative Medicine, August 26-28, 2013 Raleigh, USA

International Conference on Omics Studies, September 04-06, 2013 Orlando-FL, USA

International Symposia on Entomology , September 04-06, 2013 Miami, USA

2nd International Conference on Surgery & Anesthesia, September 16-18, 2013 Las Vegas, USA

2nd International Conference on Clinical Microbiology & Microbial Genomics , September 16-18, 2013 Las Vegas, USA

2nd International Conference and Exhibition on Biowaivers & Biosimilars, September 23-25, 2013 Raleigh, USA

4th World Congress on Biotechnology, September 23-25, 2013 Raliegh, USA

International Conference on Hematology & Blood Disorders, September 23-25, 2013 Raliegh, USA

International Conference on Psychology, Autism and Alzheimer's Disease, September 30-October 01, 2013 San Antonio, USA

International Conference and Exhibition on Mechanical & Aerospace Engineering, September 30-October 02, 2013 San Antonio, USA

2nd International Summit on Toxicology, October 07-09, 2013 Las Vegas, USA

International Conference and Exhibition on Biochemical & Molecular Engineering, October 07-09, 2013 San Antonio, USA

International Conference and Exhibition on Lasers, Optics & Photonics, October 07-09, 2013 San Antonio, USA

2nd International Conference and Exhibition on Materials Science & Engineering, October 07-09, 2013 Las Vegas, USA

2nd International Conference on Forensic Research & Technology, October 07-09, 2013 Las Vegas, USA

2nd International Conference on Clinical & Cellular Immunology, October 15-17, 2013 Las Vegas, USA

2nd International Conference on Medicinal Chemistry & Computer Aided Drug Designing, October 15-17, 2013 Las Vegas, USA

4th International Conference and Exhibition on Analytical & Bioanalytical Techniques, October 15-17, 2013 Las Vegas, USA

International Conference and Exhibition on Pharmacognosy, Phytochemistry and Natural Products, October 21-23, 2013 Hyderabad, India

3rd World Congress on Cancer Science & Therapy, October 21-23, 2013 California, USA

3rd International Conference on Pharmaceutical Regulatory Affairs, October 21-23, 2013 California, USA

2nd International Conference and Exhibition on Cell & Gene Therapy October 23-25, 2013 Orlando, USA

2nd International Conference and Exhibition on Probiotics & Functional Foods, October 23-25, 2013 Orlando, USA

International Conference on HIV/AIDS, STDs, & STIs October 24-25, 2013 Orlando-FL, USA

International Conference on Fermentation Technology, Bioprocess and Cell Culture, October 28-30, 2013 Kansas City, USA

2nd International Conference and Exhibition on Food Processing & Technology, October 28-30, 2013 Kansas City, USA

International Conference on Functional and Comparative Genomics & Pharmacogenomics, November 12-14, 2013 Chicago, USA

2nd International Conference and Exhibition on Cosmetology & Trichology, November 12-14, 2013 Chicago, USA

2nd International Summit on GMP, QA & QC, November 12-14, 2013 Chicago, USA

2nd International Summit on GLP, GCP & Clinical Pharmacology, November 12-14, 2013 Chicago, USA

2nd International Conference and Exhibition on Pharmacovigilance & Clinical Trials, November 18-19, 2013 San Antonio, USA

International Summit on Clinical Pharmacy & Dispensing, November 18-20, 2013 San Antonio, USA

World Congress on Petrochemistry and Chemical Engineering, November 18-20, 2013 San Antonio, USA

3rd World Congress on Virology, November 20-22, 2013 Baltimore, USA

International Congress on Bacteriology and Infectious diseases, November 20-22, 2013 Baltimore, USA

3rd World Congress on Cell Science & Stem Cell Research, November 20-22, 2013 San Antonio, USA

2nd International Conference and Exhibition on Obesity & Weight Management, December 02-04, 2013 Las Vegas, USA

International Conference on Nursing & Emergency Medicine, December 02-04, 2013 Las Vegas, USA

3rd International Conference on Nanotek & Expo, December 02-04, 2013 Las Vegas, USA

International Conference and Exhibition on Traditional & Alternative Medicine, December 09-11, 2013 Hyderabad, India

2nd International Conference on Agricultural & Horticultural Sciences, February 03-05, 2014 Hyderabad, India





Previous Conferences Organized/Co-organized
2nd International Conference on Nephrology & Therapeutics, July 29-31, 2013 Las Vegas, USA
3rd International Conference on Vaccines & Vaccination, July 29-31, 2013 Las Vegas, USA

2nd International Conference on Earth Science & Climate Change, July 22-24, 2013 Las Vegas, USA

2nd International Conference and Exhibition on Addiction Research & Therapy, July 22-24, 2013 Las Vegas, USA

International Conference on Animal & Dairy Sciences, July 23-24, 2013 Las Vegas, USA

3rd International Conference on Proteomics & Bioinformatics, July 15-17, 2013 Philadelphia Center City, USA

2nd International Conference and Exhibition on Nutritional Science & Therapy, July 15-17, 2013 Philadelphia, USA

4th International Conference on Biomarkers & Clinical Research, July 15-17, 2013 Philadelphia, USA


2nd International Conference and Exhibition on Biosensors & Bioelectronics, June 17-19, 2013 Chicago, USA

2nd International Conference and Exhibition on Neurology & Therapeutics, June 17-19, 2013 Chicago, USA

2nd International Conference on Gastroenterology & Urology, June 10-12, 2013 Chicago, USA

2nd International Conference and Exhibition on Biometrics & Biostatistics, June 10-12, 2013 Chicago, USA

2nd International Conference and Exhibition on Occupational Health & Safety, May 21-22, 2013 Beijing, China

4th World Congress on Bioavailability & Bioequivalence, May 20-22, 2013 Beijing, China

3rd International Conference on Clinical & Experimental Ophthalmology, April 15-17, 2013 Chicago, USA

3rd International Conference on Clinical & Experimental Cardiology, April 15-17, 2013 Chicago, USA

3rd International Conference on Clinical & Experimental Dermatology, April 15-17, 2013 Chicago, USA

2ndInternational Conference and Exhibition on Metabolomics & Systems Biology, April 08-10, 2013 Chicago, USA

3rd International Conference and Exhibition on Pharmaceutics & Novel Drug Delivery Systems, April 08-10, 2013 Chicago, USA

International Exhibition and Conference on Water Technologies, Environmental Technologies & Renewable Energy, February 13-14, 2013 Mumbai, India

International Conference and Exhibition on Obesity and Weight Management, December 03-05, 2012 DoubleTree by Hilton Philadelphia, USA

International Summit on GMP & GCP: USA, Europe, Japan, Asia Pacific, December 03-05, 2012 DoubleTree by Hilton Philadelphia Center City, USA

International Conference on QA, QC and Validation, December 03-05, 2013 DoubleTree by Hilton Philadelphia Center City, USA

2nd International Conference on Nanotek and Expo, December 03-05, 2012 at DoubleTree by Hilton Philadelphia Center City, USA

International Conference on Hair Transplantation & Trichology November 26-28, 2012 San Antonio, USA

International Conference on Anesthesia & Perioperative Care November 26-28, 2012 San Antonio, USA

International Toxicology Summit & Expo November 26-28, 2012 Hilton San Antonio Airport, USA

International Conference and Exhibition on Surgery & Transplantation November 26-28, 2012 San Antonio, USA

International Conference and Exhibition on Food Processing and Technology November 22-24, 2012 Hyderabad, India

3rd International Conference and Exhibition on Analytical & Bioanalytical Techniques November 22-24, 2012 Hyderabad International Convention Center, India

2ndInternational Conference and Exhibition on Pharmaceutical Regulatory Affairs November 23-24, 2012 HICC Hyderabad, India

International Conference and Exhibition on Cosmetology & Cosmetics November 23-24, 2012 HICC Hyderabad, India

Global Biofuels and Bioproducts Summit November 19-21, 2012 San Antonio, USA

International Conference on Genetic Syndromes & GeneTherapy November 19-21, 2012 at Hilton San Antonio Airport, USA

International Conference and Exhibition on Probiotics-2012, November 19–21, 2012, Hilton San Antonio Airport, USA

2nd World Congress on Cell Science & Stem Cell Research November 12-14, 2012 San Antonio, USA

International Conference on Clinical Microbiology & Microbial Genomics November12-14, 2012 San Antonio, USA

International Conference on Regenerative and Functional Medicine November 12-14, 2012 San Antonio, USA

International Conference and Exhibition on Computer Aided Drug Design & QSAR October 29-31, 2012 Chicago, USA
International Conference on Pulmonary & Respiratory Medicine August 27-29, 2012 Philadelphia, USA.

International Expo & Conference on Analytrix & HPLC October 22-24, 2012 Hilton Northbrook, Chicago, USA

International Conference and Expo on Material science and Engineering October 22-24, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Clinical and Cellular Immunology October 22-24, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Forensic Research & Technology October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference and Exhibition on Otolaryngology October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International conference on Biothreats and Biodefense October 15-17, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Tissue Science and Engineering October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International conference and Exhibition on Pharmacovigilance and Clinical Trials October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

International Conference on Emerging Cell Therapies October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

Omics International Integrative Biology summit October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA

3rdWorld Congress on Diabetes & Metabolism September 24-26, 2012 Marriott Convention Center, Hyderabad, India

2ndInternational Conference on Pediatrics & Gynecology September 24-26, 2012, Hyderabad Marriott Hotel & Convention Centre , Hyderabad, India

International Conference on Translational medicine September 17-19,2012 Holiday Inn San Antonio, Texas, USA

3rd World Congress on Biotechnology September 13-15, 2012 HICC, Hyderabad, India

International Conference on Biodiversity & Sustainable Energy Development September 14-15, 2012 Hyderabad, India

International Conference on Hotel and Business Management September 14-15, 2012 Hyderabad International Convention Center, India

International Conference on Agricultural & Horticultural Sciences September 14-15, 2012 Hyderabad International Convention Center, India

International Conference on Hydrology and Groundwater Expo September 10-12, 2012 San Antonio, USA

2nd World Congress on Cancer Science & Therapy September 10-12, 2012 San Antonio, USA

International Conference and Exhibition on Biowaivers and Biosimilars September 10-12, 2012 San Antonio, TX, USA

International Conference on Central Nervous System September 5-7, 2012 Double by Hilton Philadephia, USA.

International Conference on Occupational Health and Safety Summit September 5-7, 2012 Philadelphia, USA

International Conference and Exhibition on pathology August 27-29, 2012 Philadelphia, USA

International Conference and Exhibition on Nutritional Science & Therapy-2012 August 27-29, 2012 Philadelphia, USA

International Conference and Exhibition on Addiction Research & Therapy Aug 20-22, 2012 Las Vegas, USA

2nd World Congress on Virology Aug 20-22, 2012 Las Vegas, USA

International Conference and Exhibition on Nephrology and Therapeutics August 20-22, 2012, Chicago Chicago, USA

2nd International Conference on Vaccines & Vaccination August 20-22, 2012 at Chicago, USA.

World Congress on Earth Science & Climate Change 21–22 Aug 2012, Chicago, USA 20-22 Aug 2012 Las Vegas, USA

International Conference and Exhibition on Orthopedics Aug 13th–15th, 2012 Chicago, USA

International Conference and Exhibition on Rheumatology and Therapeutics Aug 14–15, 2012 at Chicago, USA

3rd International Conference on Biomarkers & Clinical Research July 2-4, 2012 Las Vegas, USA

2nd International Conference on Proteomics & Bioinformatics July 2-4, 2012 Las Vegas, USA

International Conference and Exhibition on Neurology & Therapeutics May 14-16, 2012 Las Vegas, USA

International Conference and Exhibition on Biosensors & Bioelectronics May 14-16, 2012 Las Vegas, USA.

3rd World Congress on Bioavailability & Bioequivalence: Pharmaceutical R & D Summit March 26-28, 2012 Marriott Hotel, Hyderabad, India

International Conference & Exhibition on Nanotechnology and Nanomedicine March 12-14, 2012 Omaha, USA

World Congress on Gastroenterology and Urology March 12-14, 2012 Omaha, USA

International Conference & Exhibition on Biometrics & Biostatistics March 5-7, 2012 Omaha, USA

2nd World Congress on Clinical & Experimental Dermatology March 5-7, 2012 Omaha Marriott, USA

2nd World Congress on Clinical & Experimental Cardiology March 5-7, 2012 Omaha Marriott, USA

2nd World Congress on Clinical & Experimental Ophthalmology March 5-7, 2012 Omaha Marriott, USA

International Conference and Exhibition on Metabolomics & Systems Biology February 20-22, 2012 San Francisco, USA

2nd World Congress on Pharmaceutics & Novel Drug Delivery Systems February 20-22, 2012 San Francisco, USA

2nd world Congress on Analytical and Bioanalytical Techniques 16-17 December 2011San franscico, USA.

2nd World Congress on Diabetes & Metabolism 6-8 December 2011 Philadelphia, USA.

International Conference on Pediatrics & Gynecology 6-8 December 2011 Philadelphia, USA.

International Conference and Exhibition on Cell Science & Stem Cell Research 29 Nov-1 Dec 2011 Philadelphia, USA.

2nd World Congress on Biotechnology 29 Nov -1 Dec 2011 Philadelphia, USA.

International Conference and Exhibition on Vaccines & Vaccination 22-24 November 2011 Philadelphia, USA.

2nd World Congress on Biomarkers & Clinical Research 12-14 September 2011 Baltimore, USA.

International Conference and Exhibition on Virology 5-7 September 2011 Baltimore, USA.

International Conference and Exhibition on Pharmaceutical Regulatory Affairs 6-7 September 2011 Baltimore, USA.

International Conference and Exhibition on Cancer Science & Therapy 15-17 August 2011 Las Vegas, USA.

International Conference on Clinical Research: Dermatology, Ophthalmology and Cardiology 5-6 July 2011 San Francisco, USA.

International Conference & Exhibition on Proteomics & Bioinformatics 6-8 June 2011 HICC, Hyderabad, India.

International Conference & Exhibition on Pharmaceutical Biotechnology 6-8 June 2011 HICC, Hyderabad, India.

2nd World Congress on Bioavailability & Bioequivalence: Pharmaceutical R & D Summit 6-8 June 2011 Las Vegas, USA.

International Conference on Pharmaceutics & Novel Drug Delivery Systems 7-8 June Las Vegas, USA.

World Congress on Biotechnology 21-23 March 2011 Hyderabad, India.

International Conference on Diabetes and Metabolism 13-14 December 2010 Santa Clara, USA.

International Conference on Biomarkers & Clinical Research 22-23 November 2010 Santa Clara, USA

International Conference and Exhibition on Analytical and Bioanalytical Techniques: Pharmaceutical R & D Summit 01 - 03 November 2010 Hyderabad, India

International Conference & Exhibition on Bioequivalence & Bioavailability 2010, Pharmaceutical R & D Summit March 01-03, 2010.

Integrating Glycomics with other Omics in Cancer Detection and Diagnosis, January 19-20, 2010, Stanford University School of Medicine.

3rd World Congress of Gene-2009, December 1-7, 2009.

7th Annual World Congress of International Drug Discovery Science & Technology, October 22-25.

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1Sunovion Pharmaceuticals Inc. Marlborough, MA, USA Vamsi K Bollu1*, 1Sunovion Pharmaceuticals Inc. Marlborough, MA, USA John Karafilidis1, 2RTI Health Solutions, USA Ann Colosia2, 2RTI Health Solutions, USA Lee Bennett2 and 3Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA Nicola Hanania3
 
Corresponding Author : Vamsi Bollu
Sunovion Pharmaceuticals Inc. 84 Waterford Drive
Marlborough MA 01752, USA
Tel: 508-357-7704
Fax: 508-357-7662
E-mail: Vamsi.Bollu@sunovion.com
 
Received January 15, 2013; Accepted February 01, 2013; Published February 04, 2013
 
Citation: Bollu VK, Karafilidis J, Colosia A, Bennett L, Hanania N (2013) Comparison of Efficacy and Safety Outcomes in Randomized Trials of Long- Acting and Short-Acting ?2-Agonists for Chronic Obstructive Pulmonary Disease: A Review. J Pulmon Resp Med 3:137. doi:
 
Copyright: © 2013 Bollu VK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
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Abstract
 
 
Keywords
 
Pulmonary disease; Chronic obstructive; Adrenergic beta-agonists; Randomized controlled trials; Bronchodilators
 
Abbreviations
 
COPD: Chronic Obstructive Pulmonary Disease; LABA: Long Acting Beta Agonist; SABA: Short Acting Beta Agonist; FEV1: Forced Expiratory Volume (in 1 second); BDI: Baseline Dyspnea Index; TDI: Transitional Dyspnea Index; SGRQ: St. George’s Respiratory Questionnaire; CRDQ: Chronic Respiratory Disease Questionnaire
 
Introduction
 
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease affecting more than 24 million people in the United States [1,2]. It is the fourth-leading cause of death in the United States, with more than 121,000 deaths due to COPD reported in 2009 [3]. In 2002, the direct costs to treat COPD in the United States were estimated at $18 billion and this value has been projected to climb to $29.5 billion in 2010 [4]. Some of the burden of COPD is related to certain comorbid conditions such as cardiovascular disease, respiratory infections, and osteoporosis. In addition, COPD reduces quality of life by limiting the functional and exercise capacity of affected individuals.
 
Because no medications have been shown to alter the progression of COPD, the aims of current pharmacotherapy are to decrease symptoms, reduce the incidence and severity of exacerbations, and improve quality of life and exercise tolerance [5]. Inhaled bronchodilator medications constitute the cornerstone of symptom management in COPD. Inhaled β2-agonists work by activating the β2-adrenoceptor which relaxes the smooth muscle cells of airways. These agents are further classified based on duration of action into short-acting β2-agonists (SABAs) (e.g., levalbuterol, albuterol) and Long-Acting β2-Agonists (LABAs) (e.g., formoterol, arformoterol, indacaterol, and salmeterol). The duration of action for most SABAs is 4 to 6 hours (for levalbuterol, up to 8 hours for some patients), whereas the duration for LABAs is 12 or more hours.
 
For maintenance therapy in patients with moderate to severe COPD, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the use of long-acting bronchodilators (including LABAs) because they are effective and convenient [6]. However, research has shown that many patients do not receive maintenance therapies and primary care physicians are often unfamiliar with the guidelines [7,8]. Some physicians or payers may consider LABAs and SABAs to be functionally equivalent and interchangeable as maintenance therapies.
 
Randomized Controlled Trials (RCTs) of COPD treatments differ in study design depending on the outcome variables. For RCTS examining maintenance outcomes in COPD, the primary outcome variables are related to the prevention of exacerbations or altering disease progression. However, most COPD RCTsexamine improvement in airflow obstruction and symptom relief (chronic cough, excess sputum, and dyspnea). The Food and Drug Administration (FDA) in the United States has offered guidance on primary outcome measures and study durations depending on the indication sought for a COPD treatment. For studies measuring improvement in airflow, the recommended primary outcome variable is post-dose FEV1 (forced expiratory volume in 1 second) and the recommended study duration is 3 to 6 months. For studies assessing the prevention of exacerbations, whether based on severity, duration, frequency of exacerbations or time to first exacerbation, the recommended study duration is 1 year. Finally, for studies examining disease progression alteration the recommend outcome variable is the reduced trajectory of serial FEV1 measured over a 3-year period [9].
 
Although both SABAs and LABAs appear to be used for long-term treatment of COPD in usual clinical care [10], there have been no comprehensive reviews or meta-analyses comparing the use of LABAs versus SABAs for maintenance therapy. The objective of this study was to summarize the evidence for LABAs and SABAs in maintenance management of patients with COPD based on available published RCTs. This review examined RCTs of LABAs and SABAs in patients with stable COPD to compare their effects on lung function (FEV1), incidence of exacerbations, and use of rescue medications, β-mediated adverse events, and symptoms such as dyspnea and exercise-tolerance measures.
 
Methods
 
The focus of this review was published, RCTs involving adult patients with stable COPD without asthma who received a LABA or a SABA either alone or combined with other therapies. The outcomes of interest were lung function as measured by FEV1, incidence of exacerbations, use of rescue medications, dyspnea, exercise tolerance, quality of life, and β-mediated adverse events (especially cardiovascular events).
 
A systematic literature search was conducted using PubMed/ Medline, Embase, and the Cochrane Library to identify relevant studies published and indexed between January 1, 1990 and July 16, 2010. Multiple search terms were used and the reference sections in other literature reviews or meta-analyses were examined to identify additional studies. Maintenance therapy was broadly defined as 2 or more weeks of regular dosing of a LABA or SABA; studies with durations of less than 2 weeks were excluded. Based on a preliminary review of the literature, few direct comparative studies of SABAs versus LABAs were expected and the most common comparators for indirect meta-analysis were placebo and ipratropium. Studies that did not directly compare a LABA versus a SABA or compare a LABA or SABA with placebo or ipratropium were excluded.
 
Data abstraction was performed by a single investigator using a prespecified extraction form. The following information was abstracted from each study: (1) author identification, (2) year of publication, (3) study design (parallel or crossover) and quality, (4) sample size, (5) key inclusion criteria and exclusion criteria, (6) drug and dosing for each treatment arm, and (7) baseline characteristics (mean age, gender, and predose FEV1/forced vital capacity [FVC]). The quality assessment examined the blinding of patients, care providers, and outcome assessors; similarity of treatment groups at baseline; imbalances between treatment groups in dropout rates; completion rates; whether the analysis was on the intention-to-treat patient set; how missing data were addressed; and selective reporting of outcomes [11].
 
For each outcome of interest, abstracted data included the outcome definition, the analysis time point, sample size, and reported summary measures (e.g., mean, standard deviation). For the outcomes with highly variable definitions, such as FEV1, Area Under the Curve (AUC), and rescue medication use, we extracted values for a broad range of definitions. Other outcomes extracted included: exercise tolerance and related dyspnea scores on the Borg scale [12]; dyspnea as measured by Baseline Dyspnea Index (BDI) and Transitional Dyspnea Index (TDI) [13]; incidence of exacerbations; quality of life assessments measured by the St. George’s Respiratory Questionnaire (SGRQ) [14] or the Chronic Respiratory Disease Questionnaire (CRDQ) [15]; and incidence of beta-mediated adverse events, cardiac adverse events, and metabolic abnormalities.
 
Results
 
The initial search yielded 938 studies. Following abstract review, 873 studies were excluded based on criteria specified in the study protocol (Figure 1). Full-text review of the remaining 65 studies resulted in 3 additional exclusions, leaving 62 studies for data extraction. Among these 62 studies, only one study directly evaluated a SABA versus a LABA [16], 49 studies evaluated a LABA versus placebo or ipratropium [17-65], and12 evaluated a SABA versus placebo or ipratropium [66-77]. There was insufficient data to complete a direct meta-analysis of SABA versus LABA. Due to the variations in outcomes and definitions and the small number of SABA studies, there was also insufficient data to allow meaningful indirect comparisons of LABAs and SABAs on the extracted endpoints. Below is a description of the limitations for FEV1 and exacerbations, which were the most common outcome variables. A brief summary follows for other outcome variables.
 
FEV1
 
Thirty-one studies reported numerical FEV1 outcomes [20,22-24,26,27,29,30,33-36,38-40,42,44-46,48,49,51,56,58,59,61,63,66,67,72-77], but only 17 studies reported change in peak FEV1 (occurring within 1-4 hours after dosing) from baseline [16,27,34-36,40,44,45,48,58,63,66,67,70,74,77]. None of these 17 studies included an analysis of a LABA versus ipratropium, eliminating the possibility of an indirect comparison through ipratropium. Among the placebocontrolled studies, 10 LABA [34-36,45,48,58,63] studies and 5 SABA studies [66,67,74,75,77] reported change in peak FEV1, but only 2 of the SABA studies (both 2-weeks in duration) reported the variance for the outcome variable. Similarly, for serial measurements of FEV1 after bronchodilator administration, there was only a single placebo controlled SABA study [69].
 
Exacerbations
 
Definitions for the incidence of exacerbations varied across the 35 studies reporting this outcome [16,19-21,23-30,32-34,37,41,43,47,49,50,52,56,58-60,62,64,66-70,74,76]. However, 33 studies included definitions of exacerbations that were moderate to severe based on the requirement for a change in the baseline medication regimen to improve respiration [16,19-21,23-30,32-34,37,41,43,47,49,50,52,58-60,62,64,66-70,74]. Among the 27 studies reporting the percentage of patients experiencing exacerbations: 21 studies evaluated LABA therapy versus placebo [19-21,23,27,29,30,32-34,37,41,43,47,49,50,52,58,60,62,64], but only 3 studies evaluated SABA therapy versus placebo [66,67,74]. The 3 SABA studies were all 12 weeks in length and changes in exacerbation frequency for studies shorter than 24 weeks in duration are not considered clinically meaningful.
 
Other outcome variables
 
Among the other outcome variables there were insufficient SABA studies for indirect comparisons. The number of SABA studies for each variable was dyspnea (1), use of rescue medications (1), tremor (2), sixminute walking test (2), CDRQ (4, but only 1 with sufficient numerical information), and SGRQ (1).
 
Discussion
 
The goal of this review was to complete a meta-analysis of published randomized clinical trials comparing LABAs and SABAs for maintenance treatment in COPD. Unfortunately, only a single study was found preventing the completion of a direct meta-analytic comparison. The single study was a 3-week randomized, double blind crossover trial comparing the addition of formoterol or salbutamol to ipratropium [16]. The primary outcome variable, peak expiratory flow, as well as post-dose FEV1 and the SGRQ symptom score improved significantly more during the formoterol/ipratropium treatment period than the salbutamol treatment period. There were no significant differences on SGRQ total, activity, or impacts sores, exacerbation rates, rescue medication use, or adverse events. The single RCT directly comparing SABA versus LABA found better outcomes for adding LABA to ipratropium than SABA to ipratropium
 
The direct meta-analytic comparison was not possible due to the lack of studies, so the possibility of an indirect comparison was examined. Indirect comparisons meta-analyses have a greater potential to produce biased results due to uncontrolled differences between patients or procedures in the different studies [78]. However, there was an insufficient number of SABA studies of two or more weeks in duration, with a placebo or ipratropium comparator, and with a relevant outcome variable reported with sufficient detail to allow for even an indirect meta-analysis. Further efforts to increase the number of SABA papers (such as including non-English publications, contacting authors to get variances or numeric estimates, adding the most recent publications) may have allowed an indirect meta-analysis on one or more outcome variables to be completed, but it is unlikely to yield particularly relevant information. In addition to the limitations of indirect comparisons, the SABA treatments were not used in any trials longer than 12 weeks rendering any findings for maintenance outcomes suspect. Because the goal of this research was to compare LABAs versus SABAs for use as maintenance therapy for COPD; we included only studies with duration of 2 weeks or longer. This restriction eliminated many of the studies of SABAs identified in the initial literature search, which were only 2- or 3-day studies.
 
The GOLD treatment guidelines for COPD recommend the use of long-acting bronchodilators (including LABAs) because they are effective and convenient [6]. Due to their longer duration of action, LABAs can control COPD symptoms throughout the night, whereas SABAs would lose effectiveness. In this review, we did not find any data supporting the use of SABAs for maintenance therapy. The single RCT that compared adding a LABA (formoterol) or a SABA (albuterol) to ipratropium, found better airflow outcomes for the LABA treatment [16].
 
Conclusions
 
LABAs have been studied extensively as maintenance therapies in patients with COPD and have long-term safety and efficacy evidence. Although many patients with COPD are only treated with SABAs in usual clinical care, there is an absence of empirical support for the use of SABAs as maintenance therapy. This review supports the current evidence-based guidelines for COPD, which recommend the preferential use of LABAs for maintenance treatment of COPD and reserves the use of SABAs for rescue treatment.
 
Acknowledgement
 
Funding for this study was provided by Sunovion Pharmaceuticals Inc. Technical writing support was provided by Michael Stensland of Agile Outcomes Research Inc, Rochester, Minnesota, USA.
 
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