There are more single
inhaler device triple
therapy available for
COPD patients now. However, the effect of long-term triple
therapy fixed dose combination (FDC) on mortality remains unclear. This study aimed to evaluate the impact of one-year single
inhaler device triple
therapy, including long-acting β2-agonists (LABAs), long-acting
muscarinic receptor antagonists (LAMAs), and inhaled
corticosteroids (ICSs), with dual
therapies, comprised of either LABA/LAMA or ICS/LABA, on the mortality of patients with
COPD. We searched the PubMed, Cochrane library, Web of Science, Embase databases, and clinical trial registry of clinicaltrials.gov and WHO ICTRP. Randomized controlled trials (RCTs) compared single
inhaler device triple and dual
therapies for 52 weeks were selected for the meta-analysis. The primary endpoint was all-cause mortality. A total of 6 RCTs were selected for the meta-analysis, including 10,274 patients who received single
inhaler device triple
therapy (ICS/LABA/LAMA FDC) and 12,395 patients who received ICS/LABA or LABA/LAMA dual
therapy. Risk of death was significantly lower in the ICS/LABA/LAMA FDC group compared to the LABA/LAMA group (RR = 0.69, 95% CI = 0.53-0.90, p = 0.007). There was no significant difference in mortality between the ICS/LABA/LAMA FDC and ICS/LABA
therapy groups (RR = 0.94, 95% CI = 0.72-1.24, p = 0.66). In addition, patients receiving ICS/LABA/LAMA FDC
therapy had less moderate or severe exacerbations compared with the dual
therapy groups (RR = 0.76, 95% CI = 0.73-0.80, p < 0.001 for LABA/LAMA; RR = 0.84, 95% CI = 0.78-0.90, p < 0.001 for ICS/LABA). By contrast, the risk of
pneumonia in the ICS/LABA/LAMA FDC group was higher than in the LABA/LAMA group (RR = 1.43, 95% CI = 1.21-1.68, p < 0.001). In conclusion, ICS/LABA/LAMA FDC
therapy could help improve the clinical outcomes of patients with
COPD. However, triple
therapy could increase the risk of
pneumonia in comparison with LABA/LAMA dual
therapy.