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September 10, 2025Open Access

Comparing Major COPD Triple Therapy Trials Using a Structured Multi-Criteria Decision Analysis: A Deep Dive into Patient Populations and Outcomes

Key Points

FF/VI/UMEC consistently showed efficacy across various clinical domains in COPD trials.
BUD/FOR/GLY reduced exacerbations and mortality, especially in patients with prior LABA/LAMA treatment.
Assessments utilized a multi-criteria decision analysis framework synthesizing data from pivotal COPD trials.
Individualized treatment based on patient history is crucial for optimizing COPD management across therapies.

Abstract

Triple inhaled therapy (ICS/LABA/LAMA) is widely recommended for managing COPD in patients with persistent symptoms or frequent exacerbations. However, variability in trial designs, populations, and pharmacologic formulations complicates direct comparison between regimens. To evaluate the comparative performance of three triple therapies, FF/VI/UMEC, BUD/FOR/GLY, and BDP/GLY/FOR, using a multidimensional comparative decision analysis (MCDA) across key clinical domains. Data from pivotal trials (IMPACT, FULFIL, TRINITY, TRIBUTE, TRILOGY, ETHOS, and KRONOS) were synthesized using an MCDA framework encompassing lung function, symptom control, exacerbations, mortality, safety, and device usability. Analyses considered variations in enrolled populations, prior ICS use, and inhaler characteristics. FF/VI/UMEC showed consistent efficacy across multiple domains and populations, particularly in patients at high risk of exacerbations. BUD/FOR/GLY was associated with reductions in exacerbations and mortality, particularly in patients previously treated with LABA/LAMA. BDP/GLY/FOR may be suitable for ICS-maintained patients. Trials like FULFIL and KRONOS showed symptom and lung function gains even in non-exacerbators, though ICS use in this group warrants always caution due to pneumonia risk. Findings are based on indirect comparisons across heterogeneous trials. Relative changes from dual therapy comparators were evaluated, and pharmacological and device-related differences may have influenced outcomes. Among the therapies evaluated, FF/VI/UMEC achieved the highest composite MCDA score. However, the need to prescribe individualized treatment based on history of exacerbations, previous ICS use, inhaler preference, and adherence potential to optimize COPD management may require consideration of using another of the available triple therapies, highlighting the importance of aligning triple therapy selection with individual clinical profiles and treatment goals.

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