Evidence map›Paper›PMID 30401700›Full record

SynthesisBMJ (Clinical research ed.)2018

Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis.

Yayuan Zheng, Jianhong Zhu, Yuyu Liu, Weiguang Lai, Chunyu Lin, Kaifen Qiu, Junyan Wu, Weimin Yao

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05862545 (Outcomes in Real-life After Initation Of treatmeNt With Trixeo), which is not on this map. Cited by 64 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 12 pooled it
11.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05862545 completednot on this mapstarted 2023, after this paper: background citation

Outcomes in Real-life After Initation Of treatmeNt With Trixeo (Budesonide / Glycopyrronium / Formoterol), a Non-interventional, Multi-centre, Prospective Cohort Study in Italian Routine Care Setting

TypeobservationalSponsorAstraZenecaRan2023 to 2025Enrolled250ConditionsChronic Obstructive Pulmonary DiseaseArmsBGF (budesonide/glycopyrrolate/formoterol fumarate)
3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 12 syntheses or guidelines pooled it, 114 citations in OpenAlex.

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  2. Application of Discrete Event Simulation Models for COPD Management: A Systematic Review.International journal of chronic obstructive pulmonary disease · 2025
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4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Yayuan ZhengLaboratory of Physiological Sciences and Department of Pharmacy of the Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.
Jianhong ZhuDepartment of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Yuyu LiuDepartment of Pharmacology, Guangdong Medical University, Zhanjiang, China.
Weiguang LaiDepartment of Respiratory Medicine, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, No 57, South of Renmin Avenue, Zhanjiang 524001, China.
Chunyu LinDepartment of Respiratory Medicine, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, No 57, South of Renmin Avenue, Zhanjiang 524001, China.
Kaifen QiuDepartment of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Junyan WuDepartment of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Weimin YaoDepartment of Respiratory Medicine, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, No 57, South of Renmin Avenue, Zhanjiang 524001, China yaoweimin2014@yeah.net.
Guangdong Medical College · CNSun Yat-sen Memorial Hospital · CNSun Yat-sen University · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD).

designSystematic review and meta-analysis of randomised controlled trials. DATA SOURCES: PubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018. ELIGIBILITY CRITERIA: Randomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available. DATA EXTRACTION AND SYNTHESIS: Data were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation).

results21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

conclusionsUse of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD. STUDY REGISTRATION: Prospero CRD42018077033.

Indexed as

Adrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsDrug Therapy, CombinationForced Expiratory VolumeHumansMuscarinic AntagonistsPulmonary Disease, Chronic ObstructiveQuality of LifeAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsMuscarinic Antagonists

Identifiers

PMID30401700
PMCPMC6218838
OpenAlexW2899919480

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.