Once-Daily Triple Therapy Bests Dual Therapy for COPD

A once-daily triple therapy resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol, according to a study in the New England Journal of Medicine.

“Although studies have shown that triple inhaled therapy has positive effects on lung function and COPD symptoms as compared with dual therapy, its use until recently has required patients to use multiple inhalers several times per day,” David A Lipson, MD, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote.

The researchers conducted a randomized trial of once-daily combination of fluticasone furoate vs fluticasone furoate–vilanterol or umeclidinium–vilanterol among among 10,355 patients with COPD for 1 year. The patients were given their combination medications with Ellipta inhalers. The researchers measured for moderate or severe COPD exacerbations during the study period.

Study results showed that moderate or severe exacerbations were lower in the once-daily combination of fluticasone furoate group at 0.91 per year, compared with 1.07 in the fluticasone furoate–vilanterol group and 1.21 per year in the umeclidinium–vilanterol group.

Additionally, they found that the annual rate of COPD exacerbations resulting in hospitalizations was lower in the once-daily combination of fluticasone furoate group, at 0.13, compared with umeclidinium–vilanterol, at 0.19.

The researchers noted that the incidence rate for pneumonia was higher in the triple therapy group compared with umeclidinium–vilanterol.

“Safety results showed a higher incidence of pneumonia in the inhaled-glucocorticoid groups than in the umeclidinium–vilanterol group, as would be expected,” they wrote. “However, the rate of pneumonia was 95.8, 96.6, and 61.2 events per 1000 patient-years with triple therapy, fluticasone furoate–vilanterol, and umeclidinium–vilanterol, respectively…”

They concluded that triple therapy was more effective at reducing both exacerbations and hospitalizations for COPD.

“Triple therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol in this population,” Dr Lipson and colleagues wrote. “Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol.”

This study used data from the IMPACT trial which was funded by GlaxoSmithKline.

—David Costill