Journal Information
Vol. 61. Issue 10.
Pages 594-602 (October 2025)
Share
Download PDF
More article options
Vol. 61. Issue 10.
Pages 594-602 (October 2025)
Original Article
All-Cause and Cardiovascular Mortality With Single Inhaler Triple Therapy Versus Double Therapies for COPD: A Systematic Review and Metanalysis
Visits
2375
Ayoub Hammadia,
, Clara Hoyas-Sáncheza, Alejandro Romero-Linaresa, Lucia Álvarez-Muroa, Antonio Menéndez-Loboa, Damaris Romeral-Navarroa, Andrea Jiménez-Antóna, Angel Almansa-Lópeza, Laura Casares-Martin-Morenoa, Esther Sánchez-Álvareza, Pedro Jose Romero-Palaciosb, Bernardino Alcázar-Navarretea,b,c
a Respiratory Department, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
b Medicine Department, University of Granada, Granada, Spain
c CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Podcast
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (5)
Show moreShow less
Tables (2)
Table 1. Studies Included in the Systematic Review and Baseline Patient Characteristics.
Tables
Table 2. Risk of Bias (RoB 2) Assessment Among the Included Studies.
Tables
Show moreShow less
Additional material (3)
Abstract
Introduction

COPD is a major public health concern, often complicated by cardiovascular comorbidities. Single inhaler triple therapy (SITT) has been proposed as a superior treatment option compared to single inhaler double therapies (SIDT) as LABA/LAMA and LABA/ICS. This systematic review and meta-analysis aim to evaluate the comparative efficacy of these therapies in reducing cardiovascular mortality, major adverse cardiovascular events (MACEs), and all-cause mortality (ACM).

Methods

We conducted a systematic review and metanalysis including RCT studies comparing SITT with LABA/LAMA or LABA/ICS with mortality as efficacy or safety endpoints. Articles were selected after reviewing PubMed, SCOPUS, Embase, Scielo and clinicaltrials.gov and clinicaltrialsregister.eu from May’24 to Jul’24. Random-effects models were used to estimate the pooled odds ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality, MACEs, and ACM. Heterogeneity and publication bias were assessed using standard statistical methods.

Results

The systematic review yielded 568 studies of which 11 were finally included, with 25,774 COPD patients. SITT was superior to LABA/LAMA on ACM (pooled HR 0.727; 95% CI 0.574–0.921, p=0.008) and cardiovascular mortality (pooled HR 0.455; 95% CI 0.292–0.710, p<0.001), with no effect on MACEs. SITT showed no difference versus LABA/ICS on ACM, cardiovascular mortality or MACEs.

Conclusions

SITT significantly reduces cardiovascular and all-cause mortality compared to LABA/LAMA. Compared to LABA/ICS, SITT does not show a significant difference.

PROSPERO IDENTIFIER: CRD42024510253.

Keywords:
Single inhaler triple therapy
Chronic Obstructive Pulmonary Disease
Cardiovascular mortality
Major adverse cardiovascular events
All-cause mortality
Meta-analysis
Graphical abstract

Article

These are the options to access the full texts of the publication Archivos de Bronconeumología
Member
If you are a member of SEPAR:
  • Go to >>>SEPAR<<< website and sign in.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?