Triple Therapy for COPD: How Does It Compare to Dual Therapy?

Triple therapy for chronic obstructive pulmonary disease (COPD) was associated with fewer exacerbations compared with dual therapy and long-acting muscarinic antagonist (LAMA) monotherapy, according to the results of a recent study.

However, survival was not improved with triple therapy, and an increased risk of pneumonia was observed.

While the Global Initiative for Obstructive Lung Disease (GOLD) management strategy recommends triple therapy for COPD, the comparison of triple therapy vs dual therapy for the prevention of exacerbations has not been well documented.

The researchers conducted a systematic review and meta-analysis of randomized controlled trials comparing triple therapy with dual or monotherapy in patients with COPD.

Overall, they found that triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71), LAMA and LABA (0.78), and ICS and LABA (0.77). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favorable with triple therapy.

While the overall safety profile of triple therapy was reassuring, according to the researchers, the risk of pneumonia was significantly higher with triple therapy than with dual therapy with LAMA and LABA (relative risk 1.53).

“Use 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.”

—Michael Potts

Reference:

Zheng Y, Zhu J, Liu Y, et al. Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis [published online October 6, 2018]. BMJ. doi: https://doi.org/10.1136/bmj.k4388.