The following article is a part of conference coverage from the American Thoracic Society International Conference, being held virtually from May 14 to May 19, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the ATS 2021 .

Both dual bronchodilation and triple therapy demonstrated similar rates of mortality in patients with moderate to severe chronic obstructive pulmonary disease (COPD) at low risk for exacerbations, according to research presented at the American Thoracic Society (ATS) 2021 International Conference, held virtually from May 14 to May 19, 2021.

Using pooled data from 6 phase 3 or phase 4 clinical trials — TONADO 1/2, DYNAGITO, WISDOM, UPLIFT, and TIOSPIR — researchers compared the time to all-cause mortality with triple therapy (long-acting muscarinic antagonist/long-acting b2-agonist/inhaled corticosteroids [LAMA/LABA/ICS]) vs dual bronchodilation (LAMA+LABA) in patients with moderate to severe COPD and lower exacerbation risk.

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The cohort included 11,891 patients receiving LAMA/LABA/ICS therapy and 3156 receiving LAMA+LABA therapy. To compensate for any imbalances between treatment groups, analyses were performed in a propensity-score matched cohort that included age, sex, smoking status, postbronchodilator forced expiratory volume in 1 second (FEV1), and exacerbation history, among others, as covariates.

Following propensity score matching, there were 3133 patients in both treatment groups, with well-balanced baseline characteristics between the groups (LAMA/LABA/ICS vs LAMA+LABA: men, 72% vs 71.7%; mean age, 65.5±8.7 vs 65.5±8.8 years; mean FEV1 percent predicted, 48.4±13.3% vs 48.6±13.2%) and the groups primarily included patients who had infrequent exacerbations (19.0% vs 19.1% of patients with ≥2 COPD exacerbations in the prior year).

Investigators noted 45 and 41 deaths in each group, respectively, with no statistically significant difference in time to death between groups (hazard ratio, 1.06; 95% CI, 0.68-1.64; P =.806). Sensitivity analyses with 3 models and different covariates demonstrated similar results.

“This pooled analysis of over 6000 [propensity score]-matched patients showed no differences in mortality between LAMA+LABA and triple therapy in patients with moderate to very severe COPD and predominantly low risk of exacerbations,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Miravitlles M, Calverley PMA, Verhamme K, et al. A pooled analysis of mortality in patients with COPD receiving triple therapy versus dual bronchodilation. Presented at: the American Thoracic Society (ATS) 2021 International Conference; May 14-19, 2021. Abstract A2251.

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