Clinical trial on combined therapy for COPD: Triple better than double

Klaus F. Rabe

A number of pharmaceuticals (or combinations thereof) are available for COPD treatment. The ETHOS trial – headed by Prof. Klaus F. Rabe – compared combinations with two and three of them. The positive outcome of this study is documented in a paper published in the current issue of the renowned New England Journal of Medicine.

There is no curative therapy for chronic obstructive pulmonary disease (COPD). But there are several inhaled drugs which ameliorate symptoms, improve life quality and reduce mortality. Pulmonologists can choose combinations of drugs fitting for a patient and adjust therapy stepwise in case of changing health status.

Within the ETHOS trial (in collaboration with AstraZeneca), physicians tested triple combinations of drugs in comparison with double combinations. The triple therapy consisted of the inhaled glucocorticoid budesonide (two different doses were tested), a long-acting muscarinic antagonist (glycopyrrolate) and a long-acting β2-antagonist (formoterol). The double therapies were combinations of glycopyrrolate and formoterol or  budesonide and formoterol, respectively. Patients with moderate-to-very-severe COPD were treated for 52 weeks. The researchers found that COPD patients benefitted from triple in contrast to double therapies: Besides a reduced number of exacerbations, they saw an improved quality of life. Finally, the high-dose budesonide triple treatment regime led to a reduction of overall mortality by 46%.

This paper is already the seventh New England Journal of Medicine publication of Klaus Rabe, Medical Director of LungenClinic Grosshansdorf, since 2017.


Source and further information: Rabe KF, Martinez FJ, Ferguson GT, Wang C, Singh D, Wedzicha JA, Trivedi R, St. Rose E, Ballal S, McLaren J, Darken P, Aurivillius M, Reisner C, Dorinsky P (2020) Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. N Engl J Med 383: 35-48

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