GP Clinics


Triple Therapy for COPD Exacerbations Bests Dual Therapy

Triple therapy—comprised of fluticasone furoate, umeclidinium, and vilanterol—may be more effective than dual therapy in reducing moderate to severe exacerbations among patients with chronic obstructive pulmonary disease (COPD), according to a new study.
The authors of the study also found that the triple therapy reduced the rate of hospitalization for COPD compared with umeclidinium-vilaterol.
In the study, 10,355 patients with COPD were assessed for 52 weeks. Patients were treated with either triple therapy (a once-daily combination of 100 μg fluticasone furoate, 62.5 μg umeclidinium, and 25 μg vilanterol) or dual therapy (100 μg fluticasone furoate-25 μg vilanterol or 62.5 μg umeclidinium-25 μg vilanterol).
All therapies were administered in a single Ellipta inhaler.
Results of the study indicated that the rates of moderate to severe exacerbations per year were 0.91, 1.07, and 1.21 for patients treated with triple-therapy, fluticasone furoate-vilanterol, or umeclidinium-vilanterol, respectively. The rate ratio for triple therapy was 0.75.
The yearly rates of severe exacerbations resulting in hospitalizations were found to be 0.13 and 0.19 in the triple therapy group and the umeclidinium-vilanterol group, respectively (rate ratio 0.66).
The researchers noted a higher incidence of pneumonia associated with inhaled glucocorticoid treatment vs umeclidinium-vilanterol, as well as a significantly higher risk of clinician-diagnosed pneumonia with triple therapy vs umeclidinium-vilanterol (hazard ratio 1.53).
“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,” the researchers concluded.

Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD [Published online April 18, 2018]. N Eng J Med. doi:10.1056/NEJMoa1713901