Triple Therapy versus Dual Therapy in COPD (IMPACT)

Triple inhaler therapy (ICS/LABA/LAMA) was increasingly used in COPD but lacked large RCT evidence. IMPACT compared single-inhaler triple therapy vs. dual therapies.

Multicenter RCT (n=10,355) comparing fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs. FF/VI (ICS/LABA) or UMEC/VI (LAMA/LABA) over 52 weeks in symptomatic COPD with ≥1 exacerbation in prior year.

Triple therapy reduced moderate/severe exacerbations by 25% vs LAMA/LABA and 15% vs ICS/LABA. Triple therapy also reduced all-cause mortality vs LAMA/LABA (p=0.003). Higher pneumonia rate with ICS-containing arms.

Single-inhaler triple therapy (ICS/LABA/LAMA) reduces exacerbations and may reduce mortality in high-risk COPD patients. GOLD 2024 recommends triple therapy for Group E (high symptoms + high exacerbation risk). Blood eosinophil count guides ICS use (≥300 = benefit).

Enriched for exacerbation-prone patients — may not apply to all COPD. ICS-associated pneumonia risk persists.