Langham S, Lewis J, Pooley N, et al. - Researchers analyzed data from relevant randomised controlled trials published from inception to December 2018, to compare single-inhaler triple therapy in terms of efficacy and safety as a treatment option in chronic obstructive pulmonary disease, to ultimately evaluate the magnitude of benefit and to define patients with the best risk-benefit profile for treatment. In order to evaluate the strength of the evidence base, they assessed and compared study designs and population features. The annual rate of moderate and severe exacerbations was taken as the primary outcome. A decrease in the annual rate of moderate or severe exacerbations was revealed in relation to treatment with triple therapy, in the range of 15–52% vs long-acting muscarinic antagonist (LAMA)/long-acting β₂ agonist (LABA), 15–35% vs LABA/inhaled corticosteroids and 20% vs LAMA. Patients showing higher eosinophil counts or historical frequency of exacerbations as well as ex-smokers seemed to experience a greater absolute benefit. The triple therapy arm, in the largest study, exhibited a significantly higher incidence of pneumonia. They found that study designs and populations showed crucial differences, which influence the interpretation of the outcomes and is suggestive of significant heterogeneity in cross-trial comparisons. Based on the findings, experts recommended taking patient phenotype, magnitude of benefit and increased risk of adverse events into account when deciding on prescribing triple therapy.