IMPACT
Informing the Pathway of COPD Treatment
Patient / Population Intervention / Exposure Comparison Outcome
In 10,355 symptomatic COPD patients with ≥1 exacerbation per year, single-inhaler triple therapy (fluticasone furoate / umeclidinium / vilanterol) reduced moderate-or-severe exacerbations and mortality compared with the LAMA/LABA or LABA/ICS components.
N
10,355
Design
Multicentre RCT, 3-arm
Endpoint
Annual rate of moderate or severe exacerbations
Relevance
2
Result0.91 (triple) vs 1.07 (FF/VI; RR 0.85) and 1.21 (UMEC/VI; RR 0.75). Final all-cause mortality 1.20% vs 1.88% (HR 0.58; p=0.011) vs UMEC/VI.
Lipson DA, et al. N Engl J Med. 2018;378(18):1671-1680. 10.1056/NEJMoa1713901
Discussion & critique
Established single-inhaler triple therapy. ICS-withdrawal at randomisation in ~70% of the UMEC/VI arm may bias exacerbation and mortality results.