Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial

Vestbo, Jørgen; Papi, Alberto; Corradi, Massimo; Blazhko, Viktor; Montagna, Isabella; Francisco, Cristina de Oliveira; Cohuet, Géraldine; Vezzoli, Stefano; Scuri, Mario; Singh, Dave

doi:10.1016/s0140-6736(17)30188-5

Cited by 368 publications

(382 citation statements)

References 21 publications

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“…The studies TRILOGY (Single Inhaler Triple Therapy versus Inhaled Corticosteroid plus Long-acting β-Agonist Therapy for Chronic Obstructive Pulmonary Disease) and TRINITY (Single Inhaler Extrafine Triple Therapy versus Long-Acting Muscarinic Antagonist Therapy for Chronic Obstructive Pulmonary Disease) both showed a reduction of exacerbations with triple therapy compared to LABA/ICS [61,62]. There are no data yet on triple therapy versus LABA/LAMA, but it is expected that two large trials will publish data later this year.…”

Section: Combination Therapiesmentioning

confidence: 99%

Exacerbations of COPD

2018

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, longterm antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

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Section: Combination Therapiesmentioning

confidence: 99%

Exacerbations of COPD

2018

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“…Post-hoc scrutiny of these results suggested that there was benefit from continuing the ICS if the eosinophil count was above 300 cells/mm 3 , 45 . Prospective confirmation of these findings was seen in the recently published Single Inhaler Extrafine Triple Therapy versus long-acting Muscarinic Antagonist Therapy for Chronic Obstructive Pulmonary Disease (TRINITY) study albeit the "cut-off" point remains unclear 46 . .…”

Section: Barcelona Respiratory Networkmentioning

confidence: 79%

Chronic Obstructive Pulmonary Disease: Lessons from the Important Treatment Trials

Calverley¹,

Walker²

2017

BRN

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Since 1999, clinical trials have more precisely defined the impact of various treatments on important patient-centred outcomes, allowing the development of treatment guidelines and leading to personalised treatment. The use of larger populations, seen in the Toward a Revolution in COPD Health (TORCH), Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) and The Study to Understand Mortality and Morbidity (SUMMIT) trials, has allowed hypotheses to be answered clearly albeit not always positively. Notwithstanding, each study has provided important information, often through secondary outcomes, which have been prospectively tested in other trials. Nearly two decades on, we are clearer as to the role of lung volume reduction procedures, who should and shouldn't be prescribed inhaled steroids and long-acting bronchodilators and in what combinations, and who may benefit from roflumilast. Unexpected findings such as pneumonia risk from inhaled steroids and use of eosinophil count to direct their use have an important clinical impact now and in the future. (BRN Rev. 2017;3:286-98)

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“…Existing guidelines advocate the use of long-acting bronchodilators as the frontline therapy for COPD, followed by dual combination long-acting bronchodilation if symptoms persistent and regular inhaled corticosteroid therapy is administered as an adjunct in patients experiencing frequent exacerbations. However, the latest longterm data reports that a single inhaler triple therapy with ICS/LABA/long-acting anti-muscarinic agent (LAMA) is superior to standard therapy with a dual combination ICS/LABA or LAMA therapy [43] or tiotropium alone in stable COPD patients [43,44]. Moreover, escalation from an ICS/LABA or LAMA combination to triple therapy (ICS/LABA/LAMA) using a single inhaler could improve patient adherence to treatment [43,44].…”

Section: Pharmacological Management Of Stable Copdmentioning

confidence: 99%

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018

et al. 2018

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The Swiss National Guidelines 2013 for chronic obstructive pulmonary disease have been revised in order to acknowledge recent progress in diagnosis and management of this disease. The resulting new Swiss recommendations are based on best evidence from the literature, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report and other published national guidelines. Misdiagnosis of chronic obstructive pulmonary disease is common and means that patients do not always receive optimal treatment. To improve the management of patients with chronic obstructive pulmonary disease in Switzerland, these recommendations encourage a more comprehensive assessment of patients, based on the combined assessment of symptoms, degree of airflow limitation, risk of exacerbation and the presence of comorbidities. Recommendations for evidence-based preventive measures, as well as pharmacological and non-pharmacological strategies for the management of both stable and acute exacerbations of chronic obstructive pulmonary disease are provided in this update.

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Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial

Cited by 368 publications

References 21 publications

Exacerbations of COPD

Exacerbations of COPD

Chronic Obstructive Pulmonary Disease: Lessons from the Important Treatment Trials

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018

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