Written by Mary Marschner
Spoon Feed
Prescribing triple therapy* in COPD as a single inhaler was associated with lower mortality when compared to using multiple inhalers.
*inhaled corticosteroid, ICS/ long-acting beta agonist, LABA/ long-acting muscarinic antagonist, LAMA
Two isn’t always better than one
This retrospective cohort study evaluated the effectiveness of single-inhaler triple therapy (SITT) versus multiple-inhaler triple therapy (MITT) in reducing mortality and cardiopulmonary risk in COPD patients. SITT was associated with a 22% lower all-cause mortality risk (hazard ratio, HR 0.78, 95%CI 0.72–0.84) and a 19% reduction in cardiopulmonary events (HR 0.81, 95%CI 0.75–0.87) compared to MITT. Findings suggest SITT may improve outcomes by enhancing adherence and reducing disease-related complications. This study is limited because it is observational and based on coded billing data. However, I feel they did a good job identifying primary and secondary endpoints and excluding patients that were only briefly prescribed triple therapy. It was also sponsored by AstraZeneca, who makes a triple inhaler (ICS/LABA/LAMA).
COPD continues to be a big part of clinical practice, and while this study doesn’t change clinical guidelines, it is a good reminder that the best regimen is often the simplest, which may even have a mortality benefit. Notably, triple therapy is generally reserved for COPD patients with multiple exacerbations, which was not an inclusion criterion.
How will this change my practice?
Although this wasn’t a perfect study, it will still change my practice. If I can prescribe one inhaler rather than two, I will – cost permitting.
Source
Effectiveness of Single Versus Multiple Inhaler Triple Therapy on Mortality and Cardiopulmonary Risk Reduction in COPD: The SKOPOS-MAZI Study. Am J Med. 2024 Nov 18:S0002-9343(24)00759-9. doi: 10.1016/j.amjmed.2024.11.007. Epub ahead of print. PMID: 39566703
