Triple Therapy for COPD Tied to Fewer Exacerbations, More Pneumonia

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Triple therapy for chronic obstructive pulmonary disease is associated with fewer moderate or severe exacerbations compared with dual therapy or long-acting muscarinic antagonist (LAMA) monotherapy — but it's not without risk — according to a meta-analysis in The BMJ.

Researchers examined 21 randomized trials that compared triple therapy (LAMA, long-acting beta-2 agonist [LABA], inhaled corticosteroid) with either dual therapy or monotherapy in patients with stable, moderate-to-very-severe COPD.

Triple therapy was associated with a lower rate of moderate or severe exacerbations, compared with LAMA monotherapy (rate ratio, 0.71), LAMA/LABA dual therapy (RR, 0.78), and LABA/corticosteroids (RR, 0.77). Triple therapy did not confer a survival benefit, and it was associated with higher risk for pneumonia, relative to LAMA/LABA.

The authors conclude: "Triple therapy should be limited to patients with more severe COPD symptoms that cannot be adequately managed by dual therapy. Attempts should be made to identify patients with COPD phenotypes (e.g., eosinophil levels, patient characteristics, and exacerbation history) most likely to respond to the triple therapy."