Triple therapy is linked with fewer asthma exacerbations in pediatric and adult populations, according to a new meta-analysis.

“International guidelines recommend medium- or high-dose inhaled corticosteroids and long-acting beta agonists combinations (dual therapy), delivered from the same inhaler, as the preferred controller options for patients aged 6 years or older with persistent, moderate to severe asthma,” Lisa H. Y. Kim, MD, clinical scholar in the department of medicine at McMaster University in Hamilton, Ontario, Canada, and colleagues wrote in JAMA.

“When patients’ symptoms remain uncontrolled despite this approach, the precise efficacy and adverse events of adding long-acting muscarinic antagonists is uncertain, contributing to existing weak (conditional) recommendations.”

Kim and colleagues performed a systematic review and meta-analysis to evaluate outcomes and adverse events associated with triple therapy compared with dual therapy.

Researchers reviewed MEDLINE, Embase, CENTRAL, International Clinical Trials Registry Platform (ICTRP), FDA and European Medicines Agency (EMA) databases from November 2017 to December 2020 and selected 20 randomized clinical trials that compared triple therapy vs, dual therapy. In total, the trials included 11,894 children and adults with moderate to severe asthma (mean age, 52 years; 57.7% female). Two reviewers extracted data and assessed risk for bias and used random-effects meta-analyses and the GRADE approach to assess the quality of the evidence.

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