Fluticasone furoate 184micrograms/dose / Vilanterol 22micrograms/dose dry powder inhaler

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.

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BackgroundUMEC/VI administered via a combination inhaler is associated with a clinically significant improvement in lung function and health-related quality of life in patients with mild-to-moderate COPD. However, their efficacy compared to other bronchodilator mono or dual therapies still remains unclear.ObjectiveThe objective of this research was to evaluate the therapeutic efficacy of UMEC/VI dual and UMEC/VI/FF triple therapies versus alternative bronchodilator regimens in COPD patients.MethodsA systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. The odds ratio (OR) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I [2] statistics and the appropriate p-value. The analysis used RevMan 5.4.ResultsThe current meta-analysis includes 31,814 COPD patients from 17 RCTs. The meta-analysis results demonstrate that the combination of LABA and LAMA provides additive bronchodilation and improved lung function in COPD patients. We found that UMEC/VI dual therapy significantly improved FEV1 (OR 1.98 [95% CI 1.70-2.30]), TDI values (OR 1.97 [95% CI 1.72-2.26]), and reduced SGRQ total scores (OR 1.99 [95% CI 1.71-2.32]), with fewer drug-related adverse events (RR 0.58 [95% CI 0.53-0.64]). Similarly, UMEC/VI/FF triple therapy also showed similar benefits, with significant improvements in FEV1 (OR 1.93 [95% CI 1.73-2.15]), TDI values (OR 2.37 [95% CI 2.15-2.61]), and reduced SGRQ total scores (OR 1.83 [95% CI 1.63-2.05]), and fewer drug-related adverse events (RR 0.53 [95% CI 0.49-0.58]).ConclusionThis systematic review and meta-analysis concludes that UMEC and VI combinations are an efficacious treatment option for symptomatic COPD patients.

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BackgroundThe optimal role of triple therapy (ICS/LAMA/LABA) versus dual therapy in COPD remains uncertain, particularly given the trade-off between modest efficacy gains and potential safety concerns. In particular, whether triple therapy provides additional benefit over dual regimens consisting of either ICS/LABA or LABA/LAMA remains an important clinical question. This study aimed to evaluate the comparative effectiveness and safety of triple versus dual inhaled therapies in COPD using a network meta-analysis.MethodsA systematic search of PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases was conducted from inception to July 2023. Randomized controlled trials comparing triple inhaled therapy with either ICS/LABA or LABA/LAMA dual inhaled therapy in COPD were eligible. Outcomes included moderate-to-severe exacerbations, forced expiratory volume in one second (FEV₁), St. George's Respiratory Questionnaire (SGRQ), Transition Dyspnea Index (TDI), and pneumonia incidence. Data were synthesized using a frequentist random-effects NMA. Treatment hierarchies were estimated using surface under the cumulative ranking curve (SUCRA).ResultsSeven RCTs (n = 9,968 participants) were included. Triple therapy did not consistently reduce exacerbation rates compared with dual therapy, while dual regimens such as FF/VI and BUD/FORM ranked favorably for exacerbation prevention (SUCRA 75.6% and 71.4%). Triple therapy and selected dual regimens improved lung function, though SUCRA rankings unexpectedly favored BUD/FORM. Improvements in SGRQ and TDI were modest and often below the minimal clinically important difference. Pneumonia risk tended to be higher with fluticasone-containing regimens, though differences did not reach statistical significance.ConclusionTriple therapy was associated with improvements in some outcomes, particularly lung function, but did not show consistent statistically significant superiority over dual therapy across all endpoints in this network meta-analysis. Given the small number of included trials and limited power for some comparisons, these findings should be interpreted cautiously and should not be taken as evidence of equivalence. Dual regimens remained effective options, while triple therapy may still be beneficial in selected high-risk patients. Personalized treatment based on exacerbation history, eosinophil count, and pneumonia risk remains essential.Trial registrationNot applicable.

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