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Triple therapy superior to dual therapy for COPD exacerbations

Triple therapy administered once-daily in an inhaler reduced moderate or severe COPD exacerbations and improved lung function to a greater extent than dual therapy regimens, according to findings published in NEJM.

“The benefits of triple therapy for COPD with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid–LABA or LAMA–LABA), are uncertain,” David A. Lipson, MD, from GlaxoSmithKline, and colleagues wrote.

Lipson and colleagues conducted a randomized trial to compare once-daily single-inhaler triple therapy versus dual therapy for reducing moderate or severe COPD exacerbations. The researchers enrolled 10,355 patients with COPD.

The triple-therapy regimen consisted of 100 g of fluticasone furoate, 62.5 g of umeclidinium and 25 g of vilanterol. Two dual-therapy regimens were studied: a combination of 100 g of fluticasone furoate and 25 g of vilanterol, and a combination of 62.5 g of umeclidinium and 25 g of vilanterol. All therapies were administered once-daily in a single Ellipta inhaler for 52 weeks.

The researchers found that the rate of moderate or severe exacerbations was 0.91 per year in the triple-therapy group, 1.07 per year in the fluticasone furoate–vilanterol group (RR with triple therapy, 0.85; 95% CI, 0.8-0.9) and 1.21 per year in the umeclidinium–vilanterol group (RR with triple therapy, 0.75; 95% CI, 0.7- 0.81).

In the triple-therapy group, the annual rate of severe COPD exacerbations that led to hospitalization was 0.13, compared with 0.19 in the umeclidinium–vilanterol group (RR = 0.66; 95% CI, 0.56-0.78).

Pneumonia occurred more often in the triple therapy group and fluticasone furoate–vilanterol group than the umeclidinium–vilanterol group. Patients in the triple therapy group had a significantly increased risk of clinician-diagnosed pneumonia than those in the umeclidinium–vilanterol group (HR = 1.53; 95% CI, 1.22-1.92).

“The results of the IMPACT trial show that a once-daily combination of fluticasone furoate, umeclidinium and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations and better lung function and health-related quality of life than dual therapy with fluticasone furoate–vilanterol or umeclidinium–vilanterol,” Lipson and colleagues concluded. “Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol in this symptomatic patient population.” – by Alaina Tedesco

Disclosure: Lipson reports being employed by and a shareholder in GlaxoSmithKline. Please see study for all other authors’ relevant financial disclosures.