The Impact of 52-Week Single Inhaler Device Triple Therapy versus Dual Therapy on the Mortality of COPD Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lai, Chih‐Cheng; Chen, Chao-Hsien; Chen, Kuang-Hung; Wang, Cheng Yi; Huang, Tsan-Ming; Wang, Yahui; Wang, Hao-Chien

doi:10.3390/life12020173

Cited by 6 publications

(5 citation statements)

References 43 publications

(88 reference statements)

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“…Although the therapeutic effects of ICS containing therapies such as ICS/LAMA/LABA and ICS/LABA increase with the increase of blood eosinophil count, the exact mechanism of this benefit in patients with COPD is still unclear [15].A RCT was conducted to explore theefficacy of single inhalation,triple inhalation and double inhalation therapy for 52 weeks.The primary end point was all-cause mortality.They found that the risk of death was apparently lower in the triple inhalation FDC group than in the double inhalation therapy group(p=0.006),but in mortality,there was no apparent difference between the triple inhalation FDC and double inhalation therapy treatment groups(p=0.66).Besides,patients treated with triple inhalation FDC had less moderate or severe exacerbation than those in the dual treatment group.However, the risk of pneumonia of the triple inhalation FDC group is higher than the double inhalation therapy group [16].…”

Section: Triple Therapy Of Copdmentioning

confidence: 84%

Combination Therapy for COPD: Efficacy and Prospects of Multiple Therapy

Wei¹,

Wang²,

Zhao³

2022

HSET

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Chronic obstructive pulmonary disease (COPD) is one of the most popular respiratory diseases among the world.Due to the unclear pathogenesis of COPD,the current treatment direction is mostly to prevent and relieve the existing symptoms.The current direction oftreatment for COPD is to control the disease and delay its progression through medication,physical therapy,and surgery in severe cases. Inhaled glucocorticoids,long-acting β agonists (LABA) and long-acting muscarine anticholinergic (LAMA) are widely used in the treatment of COPD.This article discusses the specific symptoms of COPD,and discusses the feasibility and development level of combined therapy combined with the current situation of relevant drug therapy.

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Section: Triple Therapy Of Copdmentioning

confidence: 84%

Combination Therapy for COPD: Efficacy and Prospects of Multiple Therapy

Wei¹,

Wang²,

Zhao³

2022

HSET

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“…), conference abstract, article comment, protocols, and ineligible comparator or outcomes ( Supplemental File 3 ). Finally, we judged 18 SRs 22 – 39 as eligible for inclusion in this overview ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews

Zhang,

Wang,

et al. 2024

Ther Adv Respir Dis

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Background: Some systematic reviews (SRs) on triple therapy (consisting of long-acting β2-agonist, long-acting muscarinic antagonist, and inhaled corticosteroid, LABA/LAMA/ICS) for chronic obstructive pulmonary disease (COPD) have reported conflicting results. As the number of syntheses increases, the task of identifying and interpreting evidence becomes increasingly complex and demanding. Objectives: To provide a comprehensive overview of the efficacy and safety of triple therapy for COPD. Design: Overview of SRs. Methods: Two independent reviewers conducted comprehensive searches in PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant SRs that compared triple therapy with any non-triple therapy for COPD, from the inception of these databases until 1 June 2023. The AMSTAR 2 and GRADE tools were utilized to assess the quality of the included studies and the evidence for each outcome. Results: Eighteen SRs encompassing 30 original studies and involving 47,340 participants were analyzed. The overall AMSTAR 2 rating revealed that 3 SRs were of low quality, 13 SRs were of critically low quality, and 2 SRs were of high quality. No high-certainty evidence revealed a significant advantage of triple therapy in improving lung function or reducing acute exacerbations. However, all evidence, including one high certainty, supported the benefits of improving quality of life. Regarding all-cause mortality, no significant difference was found when compared to LAMA or ICS/LABA; however, high-certainty evidence confirmed its effectiveness when compared with LABA/LAMA. Notably, high-certainty evidence indicated that triple therapy was associated with a significant increase in the risk of pneumonia compared to LABA/LAMA. Conclusion: Triple therapy demonstrated notable benefits in improving lung function, reducing exacerbations, improving quality of life, and reducing all-cause mortality. However, it is important to note that it may also significantly increase the risk of pneumonia. Trial registration: This overview protocol was prospectively registered with PROSPERO (No. CRD42023431548).

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“…31,32 Triple therapy also demonstrated a significant impact on mortality and frequency of moderate or severe exacerbations compared with LABA/LAMA. 2,33,34 Our observations showed that patients treated with triple therapy remained on triple therapy throughout the study, whereas patient prescribed ICS/LABA were often stepped up to triple therapy. In spite of the recommendation for ICS treatment only in patients that experience exacerbations, 2 in our real life study we observed that the prevalence of ICS prescription in clinical practice reaches 50% of the patients enrolled, suggesting the possibility of overtreatment or inadequate disease control despite maximized bronchodilation in a proportion of patients.…”

mentioning

confidence: 79%

Exacerbation Burden in COPD and Occurrence of Mortality in a Cohort of Italian Patients: Results of the Gulp Study

Santus,

Di Marco,

Braido

et al. 2024

COPD

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Objective To describe the burden of moderate to severe exacerbations and all-cause mortality; the secondary objectives were to analyze treatment patterns and changes over follow-up. Design Observational, multicenter, retrospective, cohort study with a three year follow-up period. Setting Ten Italian academic secondary- and tertiary-care centers. Participants Patients with a confirmed diagnosis of COPD referring to the outpatient clinics of the participating centers were retrospectively recruited. Primary and Secondary Outcome Measures Annualized frequency of moderate and severe exacerbations stratified by exacerbation history prior to study enrollment. Patients were classified according to airflow obstruction, GOLD risk categories, and divided in 4 groups: A = no exacerbations; B = 1 moderate exacerbation; C = 1 severe exacerbation; D = ≥2 moderate and/or severe exacerbations. Overall all-cause mortality stratified by age, COPD category, and COPD therapy. A logistic regression model assessed the association of clinical characteristics with mortality. Results 1111 patients were included (73% males), of which 41.5% had a history of exacerbations. As expected, the proportion of patients experiencing ≥1 exacerbation during follow-up increased according to pre-defined study risk categories (B: 79%, C: 84%, D: 97.4%). Overall, by the end of follow-up, 45.5% of patients without a history of exacerbation experienced an exacerbation (31% of which severe), and 13% died. Deceased patients were significantly older, more obstructed and hyperinflated, and more frequently active smokers compared with survivors. Severe exacerbations were more frequent in patients that died (23.5%, vs 10.2%; p-value: 0.002). Chronic heart failure and ischemic heart disease were the only comorbidities associated with a higher odds ratio (OR) for death (OR: 2.2, p-value: 0.001; and OR: 1.9, p-value: 0.007). Treatment patterns were similar in patients that died and survivors. Conclusion Patients with a low exacerbation risk are exposed to a significant future risk of moderate/severe exacerbations. Real life data confirm the strong association between mortality and cardiovascular comorbidities in COPD.

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The Impact of 52-Week Single Inhaler Device Triple Therapy versus Dual Therapy on the Mortality of COPD Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 6 publications

References 43 publications

Combination Therapy for COPD: Efficacy and Prospects of Multiple Therapy

Combination Therapy for COPD: Efficacy and Prospects of Multiple Therapy

Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews

Exacerbation Burden in COPD and Occurrence of Mortality in a Cohort of Italian Patients: Results of the Gulp Study

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