In some RCTs comparing triple therapy with dual therapy in COPD, there might be a bias resulting from the use of multiple inhaler devices. This meta-analysis included only RCTs that compared ICS/LABA/LAMA vs. LABA/LAMA or ICS/LABA using a single device. We systematically reviewed randomized controlled trials (RCTs) of single-inhaler triple therapy in patients with COPD. We searched the PubMed, MEDLINE (OvidSP), EMBASE and Cochrane Library databases to investigate the effect of single-inhaler triple therapy in COPD. The primary end points were the effect of single-inhaler triple therapy compared with single-inhaler dual therapy on all-cause mortality, the risk of acute exacerbation of COPD (AECOPD), and some safety endpoints. The Cochrane Collaboration tool was used to assess the quality of each randomized trial and the risk of bias. A total of 25,171 patients suffering from COPD were recruited for the 6 studies. This meta-analysis indicated that single-inhaler triple therapy resulted in a significantly lower rate of all-cause mortality than LABA/LAMA FDC (risk ratio, 0.70; 95% CI 0.56‐0.88). Single-inhaler triple therapy reduced the risk of exacerbation and prolonged the time to first exacerbation compared with single-inhaler dual therapy. The FEV1 increased significantly more under single-inhaler triple therapy than under ICS/LABA FDC (mean difference, 103.4 ml; 95% CI 64.65‐142.15). The risk of pneumonia was, however, significantly higher with ICS/LAMA/LABA FDC than with LABA/LAMA FDC (risk ratio, 1.55; 95% CI 1.35–1.80). This meta-analysis suggests that single-inhaler triple therapy is effective in reducing the risk of death of any cause and of moderate or severe exacerbation in COPD patients. However, the risk of pneumonia is higher with ICS/LAMA/LABA FDC than with LABA/LAMA FDC. Trial registration PROSPERO #CRD42020186726.

中文翻译：

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慢性阻塞性肺疾病患者单吸入器三联疗法与单吸入器双联疗法：随机对照试验的荟萃分析

在一些比较三联疗法和双联疗法治疗 COPD 的 RCT 中，使用多种吸入装置可能会产生偏差。该荟萃分析仅包括使用单个设备比较 ICS/LABA/LAMA 与 LABA/LAMA 或 ICS/LABA 的 RCT。我们系统地回顾了 COPD 患者单吸入三联疗法的随机对照试验 (RCT)。我们检索了 PubMed、MEDLINE (OvidSP)、EMBASE 和 Cochrane Library 数据库，以研究单吸入三联疗法对 COPD 的影响。主要终点是单吸入器三联疗法与单吸入器双联疗法相比对全因死亡率、COPD 急性加重风险 (AECOPD) 和一些安全性终点的影响。Cochrane Collaboration 工具用于评估每项随机试验的质量和偏倚风险。一共25个，6 项研究招募了 171 名患有 COPD 的患者。该荟萃分析表明，单吸入器三联疗法的全因死亡率显着低于 LABA/LAMA FDC（风险比，0.70；95% CI 0.56-0.88）。与单吸入器双联疗法相比，单吸入器三联疗法降低了恶化的风险并延长了首次恶化的时间。与 ICS/LABA FDC 相比，单吸入器三联疗法的 FEV1 增加显着更多（平均差，103.4 ml；95% CI 64.65-142.15）。然而，ICS/LAMA/LABA FDC 的肺炎风险显着高于 LABA/LAMA FDC（风险比，1.55；95% CI 1.35–1.80）。该荟萃分析表明，单吸入三联疗法可有效降低 COPD 患者的任何原因死亡和中度或重度恶化的风险。然而，ICS/LAMA/LABA FDC 的肺炎风险高于 LABA/LAMA FDC。试用注册 PROSPERO #CRD42020186726。