OBJECTIVES:  To assess the relative efficacy of umeclidinium bromide 62.5 mcg OD (UMEC) versus tiotropium bromide 18 mcg OD (TIO), aclidinium bromide 400 mcg BID (AB) and glycopyrronium bromide 50 mcg OD (GLYCO). METHODS: A systematic literature review was performed to identify RCTs ≥ 12 weeks duration comparing TIO, AB, GLYCO or UMEC to placebo in adult patients with COPD. Random effects meta-analyses were performed by pooling results of each treatment vs. placebo on change from baseline at 12 and 24 weeks in trough FEV1, SGRQ total score, TDI focal score and rescue medication use. The results were synthesized by using an indirect treatment comparison (ITC) within a frequentist framework based on the Bucher method. Scenario analyses were performed to evaluate the robustness of the results to variations in the included studies and assumptions. RESULTS: At 12 weeks, ITC results show that treatment with UMEC resulted in a comparable but numerically higher change from baseline in trough FEV1 compared to TIO [18.06mL (95%CI: -19.11, 55.23, p=0.341)],  AB [35.77mL (95%CI: -7.84, 79.38, p=0.108)] and GLYCO [27.86mL (95%CI: -8.74, 64.45, p=0.136)]. At 24 weeks, UMEC resulted in comparable trough FEV1 values vs. TIO (p=0.854), AB (p=0.663) and GLYCO (p=0.777).  UMEC also resulted in comparable TDI focal scores and rescue medication use at both time points compared with TIO, AB and GLYCO. UMEC resulted in numerically lower (better) change from baseline at 12 weeks in SGRQ total score compared with TIO [-2.65 (95%CI: -7.09, 1.79, p=0.242)], AB [-2.68 (95%CI: -7.12, 1.75, p=0.235)] and GLYCO [-2.15 (95%CI: -6.60, 2.31, p=0.345)]. At 24 weeks there was no statistically significant difference in change from baseline in SGRQ total score between UMEC, TIO, AB and GLYCO. CONCLUSIONS: UMEC showed comparable efficacy to TIO, AB and GLYCO on trough FEV1, SGRQ, TDI and rescue medication use at 12 and 24 weeks.