Ongoing studies are examining the role of triple therapy in less severe symptomatic patients with COPD and asthma-COPD overlap.Īdrenergic β2 receptor agonists chronic obstructive exacerbations glucocorticoids muscarinic antagonists pulmonary disease review safety.ĭisclosure LV reports grants and personal fees from AstraZeneca, grants from Philips, and Fisher and Paykel, and personal fees from Chiesi, GSK, Pulmonx, Menarini, and Boehringer-Ingelheim, all outside the submitted work. The evidence suggests that triple therapy is the most effective treatment in moderate/severe symptomatic patients with COPD at risk of exacerbations, with marginal if any risk of side effects including pneumonia. Furthermore, triple therapy showed a promising signal in terms of improved survival. Overall, compared to LAMA, ICS/LABA, or LAMA/LABA, triple therapy decreased the risk of exacerbations and improved lung function and health status, with a favorable benefit-to-harm ratio.
Of the five main fixed triple studies completed so far, three evaluated the efficacy and safety of an extrafine formulation of beclometasone dipropionate, formoterol fumarate, and glycopyrronium the other two studies evaluated fluticasone furoate, vilanterol, and umeclidinium. This review presents the clinical evidence that led to the approval of these triple therapies, discusses the role of ICS in patients with COPD, and presents data on the relative efficacy of "fixed triple" (ICS/LAMA/LABA) therapy vs LAMA, ICS/LABA, and LAMA/LABA combinations, and summarizes studies in which ICS/LABAs were combined with LAMAs to form "open triple" combinations. Recently, two "fixed triple" single-inhaler combinations of an inhaled corticosteroid (ICS), a long-acting β 2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) have become available for patients with COPD.
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