OBJECTIVES : This systematic literature review (SLR) aims to present the most updated published evidence related to the clinical efficacy of triple therapy for patients with moderate to severe COPD.

METHODS : The key biomedical databases MEDLINE^® and Embase^®, along with the Cochrane Library, were searched from 2016 to January 2021.

RESULTS : A total of 18 studies from 166 publications met the inclusion criteria of the review. No head-to-head trials of single-inhaler triple therapy (SITT) have been performed yet. Triple therapy resulted in the significant reduction of the annual rate of moderate or severe exacerbations in a rate ratio of 0.48–0.85 compared with LAMA/LABA, 0.58–0.77 compared to LABA/ICS and 0.80 compared to LAMA. Additionally, triple therapy significantly improved lung function (p<0.05) along with reducing St. George's Respiratory Questionnaire (SGRQ) score, which is a preferred measurement of COPD control. Regarding mortality, a reduced risk of all-cause mortality in patients treated with triple therapy versus LAMA/LABA had been demonstrated.

CONCLUSIONS : The findings of the current review showed that triple therapy is effective in the management of COPD and was associated with a significant reduction of moderate-to-severe COPD exacerbations, improved lung function and improved quality of life when compared to dual single-inhaler therapy.