What question did this study set out to answer?

This research aims to compare the effectiveness of BUD/GLY/FOR and FF/UMEC/VI in managing uncontrolled asthma.

May 20, 2026

A32-18 An Indirect Comparison of Budesonide/ Glycopyrrolate/ Formoterol Fumarate Versus Fluticasone/ Umeclidinium/ Vilanterol in Adults With Uncontrolled Asthma From a US Perspective: A Systematic Review and Network Meta Analysis

ABA BourdinUniversité de Montpellier JKJ KnagenhjelmAstraZeneca (Spain)IAI ArticoAstraZeneca (Spain)

Key Points

This research aims to compare the effectiveness of BUD/GLY/FOR and FF/UMEC/VI in managing uncontrolled asthma.
Conducted a systematic literature review of randomized controlled trials
Performed a network meta-analysis to evaluate clinical efficacy of SITTs
Endpoints included trough FEV1 at 24 weeks and severe exacerbations at 52 weeks.
BUD/GLY/FOR showed a 28% reduction in severe exacerbations compared to FF/UMEC/VI (100/62.5/25), RR 0.72 (95% CI: 0.55, 0.95)
BUD/GLY/FOR had an 18% numerical reduction in severe exacerbations versus pooled FF/UMEC/VI but not statistically significant, RR 0.82 (95% CI: 0.65, 1.03)
No significant differences in lung function between BUD/GLY/FOR and FF/UMEC/VI were found.

Abstract

Abstract Rationale Budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FOR 320/36/9.6 µg), delivered via Aerosphere inhaler, was evaluated in the KALOS and LOGOS trials which included a comparison with the marketed Symbicort® pressurized MDI in uncontrolled asthma patients with or without recent exacerbation history NCT04609878, NCT04609904. BUD/GLY/FOR demonstrated superiority to Symbicort® for improving lung function and in reducing severe exacerbations. In CAPTAIN, adding umeclidinium (UMEC) to fluticasone/vilanterol (FF/VI) improved lung function versus FF/VI alone but did not lead to a significant reduction in severe exacerbations. However, the comparative efficacy between approved single inhaler triple therapies (SITTs) remains unknown. Methods A systematic literature review identified randomized controlled trials of single-inhaler triple therapies (SITTs) in uncontrolled asthma. This network meta-analysis (NMA) compared the clinical efficacy budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FOR) with SITTs containing medium-dose inhaled corticosteroids (MD-ICS) including fluticasone/umeclidinium/vilanterol (FF/UMEC/VI), which is the only currently marketed SITT for asthma in the US. Analyses were conducted compared to pooled FF/UMEC/VI doses (100/62.5/25 and 200/62.5/25) and for FF/UMEC/VI 100/62.5/25 alone. Endpoints included trough FEV1 at 24 (±4) weeks and severe exacerbations at 52 weeks. A Bayesian framework was applied, and fixed-effect models were selected due to the limited number of studies per outcome. Results BUD/GLY/FOR demonstrated an 18% numerical reduction in severe exacerbations RR, (95%CI): 0.82 (0.65,1.03) and no significant difference in lung function mean difference, (95% CI): -13.99 (-55.23, 27.55) compared to pooled FF/UMEC/VI (100/62.5/25 & 200/62.5/25). BUD/GLY/FOR demonstrated statistically significant reduction of 28% in severe exacerbations versus FF/UMEC/VI (100/62.5/25) RR, (95%CI): 0.72 (0.55,0.95) and no significant difference in lung function mean difference, (95% CI): -17.17 (-65.46, 31.16). Conclusions This study suggests that treatment with BUD/GLY/FOR leads to greater reduction in severe exacerbations compared with FF/UMEC/VI for uncontrolled asthma patients with or without recent exacerbation history and can inform clinical and treatment decision making. This abstract is funded by: AstraZeneca

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