Fluticasone 125micrograms/dose / Formoterol 5micrograms/dose inhaler CFC free

Recent literature has shown that triple therapy is more effective than dual therapy for individuals with uncontrolled asthma. However, the comparative efficacy between different triple therapies remains unclear. The objective of this study was to determine the comparative efficacy of extra-fine single-inhaler medium-dose (MD) or high-dose (HD) of beclometasone/formoterol/glycopyrronium bromide (BDP/FOR/GLY) compared to other triple therapies in patients whose asthma remains uncontrolled with MD or HD inhaled corticosteroids and long-acting β2-agonists. A systematic literature review identified randomized control trials on adult patients with uncontrolled asthma. Two separate networks were constructed according to patients' previous inhaled-corticosteroid dosage. Network meta-analyses evaluated severe and moderate-to-severe exacerbations, pre-dose forced expiratory volume, and asthma control questionnaire responses at 52 (± 3) weeks. Among single-inhaler triple therapies, MD BDP/FOR/GLY significantly reduced the risk of severe exacerbations (RR [95% CrI] compared to MD fluticasone/umeclidinium/vilanterol: 0.65 [0.49, 0.89]), while HD BDP/FOR/GLY demonstrated an improved trend in reducing severe and moderate-to-severe exacerbations versus HD indacaterol acetate/glycopyrronium bromide/mometasone, fluticasone/umeclidinium/vilanterol, and salmeterol/fluticasone + tiotropium. HD BDP/FOR/GLY and HD BDP/FOR + tiotropium did not differ significantly. Compared to relevant single-inhaler triple therapies, MD and HD BDP/FOR/GLY are associated with a significant benefit or trend for improvement in terms of reducing the rate of severe and moderate-to-severe exacerbations.

Abstract licence: CC BY-NC-ND

Background: Asthma remains a major global health burden with high morbidity and costs, requiring effective treatment to prevent exacerbations. ICS/LABA combinations are widely used for their bronchodilation and anti-inflammatory effects, yet uncertainties persist about their optimal use, safety, and cost-effectiveness, especially in resource-limited settings. Prior reviews have not fully integrated efficacy, safety, and economic impact or explored patient-related factors through meta-regression. Therefore, this study aims to comprehensively evaluate ICS/LABA regimens compared to alternative treatments using a network meta-analysis and meta-regression, incorporating effectiveness, safety, and cost-effectiveness to guide optimal asthma management strategies. Methods: This systematic review and network meta-analysis, registered on OSF, followed PRISMA guidelines to evaluate ICS/LABA versus alternative asthma treatments in terms of efficacy, safety, and cost-effectiveness. Randomized controlled trials from 2013–2024 were included if they reported relevant outcomes. Databases searched were Scopus, PubMed, ProQuest, ScienceDirect, SagePub, and Cochrane. Data extraction, risk of bias assessment (RoB-2), and evidence certainty (GRADE) were conducted independently by multiple reviewers. Statistical analyses used a random-effects network meta-analysis with meta-regression and cost-effectiveness modeling in RStudio, ensuring robust comparisons and exploring modifiers such as age, gender, and follow-up duration. Results: Eleven randomized trials were analyzed. Budesonide–formoterol was most effective in reducing moderate-to-severe exacerbations (OR 0.33, SUCRA 0.99), followed by budesonide maintenance and fluticasone–salmeterol. No significant differences were observed in FEV₁ or ACQ-5, though combination therapies ranked higher. Budesonide–formoterol and olodaterol (20 µg) showed the greatest PEFR gains (MD 68.4 and 42.9, p < 0.001). Cost analysis ranked terbutaline as the least expensive ($40) and ICS/LABA combinations as the most expensive ($150). Incremental analysis showed that albuterol ($43/exacerbation avoided) and budesonide maintenance ($364) were cost-efficient, while budesonide–formoterol offered the greatest benefit at a higher cost ($500), underscoring the need to balance efficacy with affordability. Conclusion: ICS/LABA combinations, particularly budesonide–formoterol, provided the greatest efficacy but with the highest incremental cost ($500 per exacerbation avoided). Albuterol and terbutaline were the most affordable options, with albuterol showing a low incremental cost ($43) suitable for milder cases.

Abstract licence: CC BY 4.0

PurposeChronic obstructive pulmonary disease (COPD) is associated with a substantial economic burden in the UK. Although previous analyses have compared the cost-effectiveness of single-inhaler triple therapy (SITT) versus dual therapy or multiple-inhaler triple therapy, there are no studies investigating the cost-effectiveness of individual SITTs versus other SITTs. This study assessed the cost-effectiveness of SITT with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus other SITTs for the treatment of COPD from a UK National Health Service perspective.Patients and methodsThe validated GALAXY-COPD model was populated with patient baseline characteristics from the IMPACT study and treatment effect data from a network meta-analysis, which compared FF/UMEC/VI with budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FOR; both 320 µg and 160 µg dosing; BUD320 and BUD160, respectively) and beclometasone dipropionate/formoterol fumarate/glycopyrrolate (BDP/FOR/GLY). UK healthcare resource unit and drug costs (Great British Pound, 2022) were applied, with costs and outcomes (except life years [LYs]) discounted at 3.5% annually. The base case was probabilistic (5000 iterations) with a lifetime horizon.ResultsFF/UMEC/VI provided an additional 0.620 (95% range: 0.255, 1.025) LYs and 0.283 (0.080, 0.501) quality-adjusted LYs (QALYs) with a cost saving of £1620 (£158, £3243) versus BUD320/GLY/FOR, an additional 0.627 (0.261, 1.053) LYs and 0.309 (0.097, 0.533) QALYs at a cost saving of £1721 (£261, £3345) versus BUD160/GLY/FOR, and an additional 0.328 (0.063, 0.654) LYs and 0.230 (0.035, 0.437) QALYs at a cost saving of £1221 (-£541, £2796) versus BDP/FOR/GLY. FF/UMEC/VI was less costly and showed higher QALYs in 98.2%, 98.9%, and 93.6% of simulations versus BUD360/GLY/FOR, BUD160/GLY/FOR, and BDP/FOR/GLY, respectively. At a willingness-to-pay threshold of £20,000 per QALY, the probability of FF/UMEC/VI being cost-effective was 99.9%, 100%, and 99.3% versus BUD320/GLY/FOR, BUD160/GLY/FOR, and BDP/FOR/GLY, respectively.ConclusionBased on this analysis, FF/UMEC/VI is a dominant (improved outcomes with cost savings) treatment option compared with other SITTs for the treatment of patients with COPD in the UK.

Abstract licence: CC BY-NC