en
Scientific article
Meta-analysis
Open access
English

Single-inhaler triple vs single-inhaler dual therapy in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized control trials

Published inRespiratory research, vol. 22, no. 1, 209
Publication date2021-07-23
First online date2021-07-23
Abstract

Background: In some RCTs comparing triple therapy with dual therapy in COPD, there might be a bias resulting from the use of multiple inhaler devices. This meta-analysis included only RCTs that compared ICS/LABA/LAMA vs. LABA/LAMA or ICS/LABA using a single device.

Methods: We systematically reviewed randomized controlled trials (RCTs) of single-inhaler triple therapy in patients with COPD. We searched the 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 compared with single-inhaler dual therapy on all-cause mortality, the risk of acute exacerbation of COPD (AECOPD), and some safety endpoints. The Cochrane Collaboration tool was used to assess the quality of each randomized trial and the 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 LABA/LAMA FDC (risk ratio, 0.70; 95% CI 0.56-0.88). Single-inhaler triple therapy reduced the risk of exacerbation and prolonged the time to first exacerbation compared with single-inhaler dual therapy. The FEV1 increased significantly more under single-inhaler triple therapy than under ICS/LABA FDC (mean difference, 103.4 ml; 95% CI 64.65-142.15). The risk of pneumonia was, however, significantly higher with ICS/LAMA/LABA FDC than with LABA/LAMA FDC (risk ratio, 1.55; 95% CI 1.35-1.80).

Conclusions: This meta-analysis suggests that single-inhaler triple therapy is effective in reducing the risk of death of any cause and of moderate or severe exacerbation in COPD patients. However, the risk of pneumonia is higher with ICS/LAMA/LABA FDC than with LABA/LAMA FDC. Trial registration PROSPERO #CRD42020186726.

eng
Keywords
  • COPD
  • Meta-analysis
  • Mortality
  • Triple therapy
  • Administration, Inhalation
  • Bronchodilator Agents / administration & dosage
  • Drug Therapy, Combination
  • Humans
  • Mortality / trends
  • Nebulizers and Vaporizers / trends
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Randomized Controlled Trials as Topic / methods
Funding
  • Beijing Hospital Clinical Research 121 Project - [BJ-2018-199]
Citation (ISO format)
LONG, Huanyu et al. Single-inhaler triple vs single-inhaler dual therapy in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized control trials. In: Respiratory research, 2021, vol. 22, n° 1, p. 209. doi: 10.1186/s12931-021-01794-w
Main files (1)
Article (Published version)
Secondary files (1)
Identifiers
ISSN of the journal1465-9921
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Creation03/25/2022 3:01:00 PM
First validation03/25/2022 3:01:00 PM
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