Cochrane Database Syst. Rev.

COPD: Is triple therapy better than double therapy?

January 2, 2024

Quality of life was improved with triple inhaled therapy (ICS + LABA + LAMA) compared with dual therapy (combo LABA + LAMA), in this analysis of studies of involving mostly severe COPD patients with a history of a moderate-to-severe exacerbation in the previous 12 months. Researchers were moderately confident that triple therapy resulted in symptom reduction compared with combo bronchodilator inhalers—and that triple therapy also upped the risk of pneumonia.

• 4 studies (N=15,412) involving inhaled corticosteroids (ICS), long‐acting beta2‐agonists (LABA), and long‐acting muscarinic antagonists (LAMA) were assessed.
• Patient characteristics. Mean patient age was around 65, proportion of females 28-40%. Most had symptomatic COPD (CAT Score ≥ 10) with FEV1 <50% predicted and 1+ moderate-to-severe exacerbation over the previous 12 months.
• Other patient types. Researchers found limited data on triple vs. dual therapy in patients with mild‐moderate COPD or without history of a recent COPD exacerbation.
• Pneumonia risk: Triple therapy is likely associated with higher pneumonia risk compared with LABA+LAMA inhalers (3.3% vs. 1.9%).
• COPD exacerbations. Researchers had little confidence that triple therapy reduced COPD exacerbation rates, reduced mortality, or improved lung function, compared with combo bronchodilator inhalers.

Source:

van Gheffen, W. (2023, Dec. 6). Cochrane Database Syst. Rev. Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for chronic obstructive pulmonary disease. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011600.pub3/full