Triple vs. dual therapy in patients with COPD: systematic review and meta-analysis

Introduction: There is uncertainty about the best risk-benefit profile for treatment with triple therapy in patients with COPD. Objective: Identify the available scientific evidence on the effectiveness and safety of triple therapy compared to dual therapy in patients with COPD. Method: A systematic review of the literature was conducted according to the Cochrane methodology using the Medline, Embase and Central databases. Results: Acute exacerbations were evaluated in six studies, rate ratio of 0.74 (0.68-0.81), representing a reduction of 26% and mortality was evaluated in six studies showing a decrease of 29%, relative risk of 0. 71 (0.56-0.91) with triple therapy. Pneumonia was evaluated in seven studies, showing an increase in events with triple therapy, relative risk of 1.54 (1.30-1.81). Adverse events were evaluated in ten studies with no differences found. Discussion: Triple therapy reduced exacerbations and mortality consistent with what was described in previous reviews. Adverse events were similar between both therapies. An increase in pneumonia episodes, a worsening of dyspnea and FEV1 was found with the use of triple therapy. Conclusion: Triple therapy is an important alternative in patients with persistent exacerbations and highly symptomatic despite dual therapy. It is a safe therapy, but the occurrence of pneumonia must be monitored specifically.