![]() A network of evidence is linked, allowing both direct and indirect comparisons (through direct RCT evidence and indirect evidence via a common comparator). Ī network meta-analysis (NMA) allows comparison of different therapies in the absence of head-to-head studies, based on the assumptions of similarity, exchangeability, and transitivity of studies. Further to this, RCTs are often conducted in strictly defined patient populations in terms of inclusion criteria and disease severity, and trial participation may increase patient adherence to therapy. There are several randomized controlled trials (RCTs) comparing SITT to dual therapy or monotherapy but RCTs comparing different triple therapy regimens are limited and there are no head-to-head trials for SITT. Both of these SITTs require twice-daily dosing. A second SITT comprising beclomethasone dipropionate, formoterol fumarate, and glycopyrronium bromide (BDP/FOR/GLY) was approved for use in Europe in 2017 and a third SITT comprising budesonide, glycopyrrolate, and formoterol fumarate (BUD/GLY/FOR) was approved for use in the USA and Europe in 2020. FF/UMEC/VI was approved for use by the European Medicines Agency in November 2017, followed by approval in other major markets. In 2017, once-daily single-inhaler triple therapy (SITT) with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) was approved by the US Food and Drug Administration (FDA) for the long-term maintenance of COPD in adult patients. Historically, triple therapy was administered via the use of multiple inhalers. Previous studies have demonstrated the benefits of triple therapy versus dual therapy in improving lung function and reducing the risk of exacerbation for patients with COPD. Triple therapy with an inhaled corticosteroid (ICS), a long-acting β 2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic, and at risk of exacerbation, despite dual maintenance therapy (LABA/LAMA or ICS/LABA). Further analysis should be conducted as additional evidence becomes available. The findings of this NMA suggest favorable efficacy with SITT comprising FF/UMEC/VI versus long-acting β 2-agonist (LABA)/long-acting muscarinic antagonist, LABA/inhaled corticosteroid, multiple-inhaler triple therapy, and other SITTs. This network meta-analysis (NMA) investigated the comparative efficacy of SITT with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI 100/62.5/25 µg) versus other triple and dual therapies in patients with COPD.įF/UMEC/VI showed significant improvement in trough forced expiratory volume in 1 s, and a significant reduction in combined annualized moderate and severe exacerbations, when compared with other therapies.Īs expected, there were some differences in the study design and inclusion/exclusion criteria of the trials included in the analysis, the estimates used as inputs (due to availability in the publications), and definitions of events between trials however, the similarity assumption held, confirming that the variability was not too high to prevent pooling of the data. Randomized controlled trials comparing different triple therapy regimens for the treatment of chronic obstructive pulmonary disease (COPD) are limited and there are no head-to-head trials for single-inhaler triple therapies (SITTs).
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