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.

Keywords:

• COPD
• triple therapy
• randomized controlled trials
• single inhaler

View correction statement:

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 [Corrigendum]

Acknowledgment

This study was supported by grants from Cardinal Tien Hospital (CTH-104-1-2C01 and CTH-104-1-2A08).

Author contributions

CYW and CCL assessed the eligibility of studies for inclusion in the meta-analysis. CCL, CHC, CYHL, CYW, and YHW were all directly involved in the acquisition of data for analysis. All statistical analyses were performed by YHW. CCL and CYW wrote the first draft of the manuscript. All authors revised the manuscript critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the manuscript, ensuring that questions related to the accuracy or integrity of any part of the manuscript were appropriately investigated and resolved.

Disclosure

The authors report no conflicts of interest in this work.