scholarly journals Single-inhaler Triple vs Single-inhaler Dual Therapy in Patients with Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Control Trials

2021 ◽  
Author(s):  
Huanyu Long ◽  
Hongxuan Xu ◽  
Jean-Paul Janssens ◽  
Yanfei Guo
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Triple Therapy ◽  
Pulmonary Disease ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Dual Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
All Cause Mortality ◽  
Long Acting

Abstract BACKGROUND: A meta-analysis was performed to compare the efficacy and safety of single-inhaler triple therapy combining long-acting beta2-agonist (LABA), long-acting muscarinic antagonist (LAMA), and inhaled corticosteroids (ICS) versus single-inhaler dual therapy (ICS/LABA and LABA/LAMA) in patients with chronic obstructive pulmonary disease (COPD).METHODS: We used the following search terms in PubMed, MEDLINE (OvidSP), EMBASE and Cochrane Library databases to investigate the effect of single-inhaler triple therapy in COPD. The primary end points were the effect of single-inhaler triple therapy on all-cause mortality, risk of acute exacerbation of COPD (AECOPD), and some safety endpoints, compared with single-inhaler dual therapy. Cochrane Collaboration's tool was used to assess quality of each randomized trial and risk of bias. RESULTS: A total of 25,171 patients suffering from COPD were recruited for the 6 studies. This meta-analysis indicated that single-inhaler triple therapy resulted in a significantly lower rate of all-cause mortality than single-inhaler dual therapy (risk ratio, 0.83; 95% CI 0.71‐0.98). Single-inhaler triple therapy reduced the risk of exacerbation (rate ratio, 0.78; 95% CI 0.73‐0.83), prolonged time to first exacerbation (hazard ratio, 0.86; 95% CI 0.84-0.89), improved trough FEV1 (mean difference, 81.35 ml; 95% CI 45.6–117.06) and St George Respiratory Questionnaire (SGRQ) Score (mean difference, -1.48; 95% CI -1.75–-1.22) vs. single-inhaler dual therapy. Risk of pneumonia was however significantly higher with ICS/LAMA/LABA than with LABA/LAMA (risk ratio, 1.25; 95% CI 1.04‐1.50). CONCLUSIONS: This meta-analysis suggests that single-inhaler triple therapy is effective in reducing the risk of moderate or severe exacerbations and death of any causes in COPD patients, compared with single-inhaler dual therapy. However, risk of pneumonia is higher with ICS/LAMA/LABA combination than with dual therapy of LABA/LAMA.TRIAL REGISTRY: ClinicalTrials.gov; No.: CRD42020186726; URL: www.clinicaltrials.gov.

scholarly journals Costs, exacerbations and pneumonia after initiating combination tiotropium olodaterol versus triple therapy for chronic obstructive pulmonary disease

2019 ◽  
Vol 8 (15) ◽  
pp. 1299-1316 ◽  
Author(s):  
Swetha R Palli ◽  
Ami R Buikema ◽  
Mary DuCharme ◽  
Monica Frazer ◽  
Shuchita Kaila ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Triple Therapy ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inverse Probability ◽  
Copd Patients ◽  
Baseline Characteristics ◽  
Long Acting ◽  
Medicare Database

Aim: To compare health plan-paid costs, exacerbations and pneumonia outcomes for patients with chronic obstructive pulmonary disease (COPD) initiating combination tiotropium olodaterol (TIO + OLO) versus triple therapy (TT: long-acting muscarinic antagonist + long-acting β2 agonists + inhaled corticosteroid). Patients & methods: COPD patients initiating TIO + OLO or TT between 1 January 2014 and 30 June 2016 were identified from a managed care Medicare database and balanced for baseline characteristics using inverse probability of treatment weighting before assessment of outcomes. Results: Annual COPD-related and all-cause costs were US$4118 (35%) and US$5384 (23%) lower for TIO + OLO versus TT (both p ≤ 0.001). TIO + OLO patients had nearly half the severe exacerbations (8.3 vs 15.5%; p = 0.014) and pneumonia was also less common (18.9 vs 30.9%; p < 0.001). Conclusion: TIO + OLO was associated with improved economic and COPD health outcomes versus TT.

scholarly journals Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

BMJ ◽  
2018 ◽  
pp. k4388 ◽  
Author(s):  
Yayuan Zheng ◽  
Jianhong Zhu ◽  
Yuyu Liu ◽  
Weiguang Lai ◽  
Chunyu Lin ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Dual Therapy ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
Randomised Controlled

AbstractObjectiveTo compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD).DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesPubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018.Eligibility criteriaRandomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available.Data extraction and synthesisData were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation).Results21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).ConclusionsUse of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.Study registrationProspero CRD42018077033.

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