The effects of single inhaler triple therapy vs single inhaler dual therapy or separate triple therapy for the management of chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Background:

This study aims to compare the effects of single inhaler triple therapy comprised of inhaled corticosteroids (ICSs), long-acting β2-agonists (LABAs), and long-acting muscarinic receptor antagonists (LAMAs) with dual therapies comprised of either LABA/LAMA, ICS/LABA or separate ICS/LABA plus LAMA triple therapy.

Methods:

The Pubmed, Embase, and Cochrane databases were searched up to October 31st 2018. Only randomized controlled trials were included in the meta-analysis. The primary outcome was the rate of moderate-to-severe chronic obstructive pulmonary disease (COPD) exacerbations.

Results:

Seven studies fulfilling the inclusion criteria were included in the meta-analysis. Single inhaler triple therapy was associated with a significantly lower risk of COPD exacerbation compared with LABA/LAMA (rate ratio, 0.69; 95% confidence interval [CI] 0.55 to 0.87, I2 =85%), and ICS/LABA (rate ratio, 0.81; 95% CI 0.73 to 0.89, I2 =29%) dual therapy. Single inhaler triple therapy led to a more significant improvement in lung function and quality of life compared with LABA/LAMA and ICS/LABA dual therapy. Single inhaler triple therapy was associated with a higher risk of pneumonia compared with LABA/LAMA (risk ratio, 1.38, 95% CI 1.14 to 1.67, I2 =0) dual therapy.

Conclusions:

The use of single inhaler triple therapy for COPD patients can result in lower rates of moderate or severe exacerbations of COPD as well as improved lung function and quality of life compared with dual therapy with LABA/LAMA or ICS/LABA.

• Authors: Chih-Cheng Lai, Cheng-Hsin Chen, Charlotte Yu Hsuan Lin, Cheng-Yi Wang, Ya-Hui Wang
• Journal: International journal of chronic obstructive pulmonary disease (Int J Chron Obstruct Pulmon Dis) Vol. 14 Pg. 1539-1548 ( 2019) ISSN: 1178-2005 [Electronic] New Zealand
• PMID: 31371939 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Adrenal Cortex Hormones
• Adrenergic beta-2 Receptor Agonists
• Drug Combinations
• Muscarinic Antagonists

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (administration & dosage, adverse effects)
• Adrenergic beta-2 Receptor Agonists (administration & dosage, adverse effects)
• Aged
• Disease Progression
• Drug Combinations
• Drug Therapy, Combination
• Female
• Humans
• Lung (drug effects, physiopathology)
• Male
• Middle Aged
• Muscarinic Antagonists (administration & dosage, adverse effects)
• Nebulizers and Vaporizers
• Pulmonary Disease, Chronic Obstructive (diagnosis, drug therapy, physiopathology)
• Quality of Life
• Randomized Controlled Trials as Topic
• Recovery of Function
• Treatment Outcome