{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:03:27Z","timestamp":1784538207132,"version":"3.55.0"},"reference-count":47,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Fixed-dose triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) at high risk of exacerbations; however, direct comparative effectiveness data between available triple therapy regimens remain limited. We compared real-world clinical outcomes among adults with COPD receiving fluticasone furoate\/vilanterol\/umeclidinium (FF\/VI\/UMEC) or budesonide\/glycopyrrolate\/formoterol (BUD\/GLY\/FOR). Methods: We conducted a retrospective propensity score-matched cohort study using the TriNetX Research Network. Adults with a spirometrically confirmed diagnosis of COPD who received fluticasone furoate\/vilanterol\/umeclidinium (FF\/VI\/UMEC) or budesonide\/glycopyrrolate\/formoterol (BUD\/GLY\/FOR) between July 2020 and August 2024 were included in the analysis. A 365-day landmark period was applied to establish maintenance therapy, with outcome follow-up beginning 1 year after treatment initiation. Patients were followed for outcomes through August 2025, the date of database analysis. After 1:1 propensity score matching, treatment groups were compared for COPD exacerbations, acute respiratory failure (ARF), hospitalization, and all-cause mortality using RR and Cox proportional hazards analyses. Results: In matched cohorts, FF\/VI\/UMEC was associated with a significantly higher risk of COPD exacerbations (5.6% vs. 3.9%; RR 1.44; 95% CI 1.30\u20131.59; p &lt; 0.001) and ARF (2.5% vs. 1.9%; RR 1.28; 95% CI 1.11\u20131.46; p &lt; 0.001) compared with BUD\/GLY\/FOR. Time-to-event analyses demonstrated lower event-free probability for exacerbations (HR 1.35; (95% CI 1.21\u20131.50) and ARF (HR 1.15; (95% CI 1.00\u20131.32))). All-cause mortality was numerically higher in the FF\/VI\/UMEC cohort (5.2% vs. 4.7%; RR 1.09; 95% CI 1.00\u20131.19; p = 0.050); however, time-to-event analysis did not demonstrate a statistically significant difference. Hospitalization rates were similar between groups. Conclusions: In this large propensity score-matched real-world cohort study, patients receiving BUD\/GLY\/FOR experienced lower rates of COPD exacerbations and acute respiratory failure than those receiving FF\/VI\/UMEC. Because of the retrospective observational nature of the analysis, these findings should be considered hypothesis-generating and require confirmation in prospective comparative effectiveness studies.<\/jats:p>","DOI":"10.3390\/jcm15145650","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"5650","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Real-World Effectiveness of Fixed-Dose Triple Therapy Regimens in COPD: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2148-4441","authenticated-orcid":false,"given":"Rushi","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3874-1197","authenticated-orcid":false,"given":"Jacob","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4714-0493","authenticated-orcid":false,"given":"Namra","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Medicine, GMERS Medical College and Hospital, Valsad 396001, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-1588","authenticated-orcid":false,"given":"Abhi C.","family":"Lohana","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, WVU Camden Clark Medical Center, Parkersburg, WV 26101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fnu","family":"Versha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9796-2772","authenticated-orcid":false,"given":"Subhash","family":"Chander","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-0299","authenticated-orcid":false,"given":"Viral","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Iribarren","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"GBD 2021 Chronic Respiratory Disease Collaborators (2025). Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: An analysis for the Global Burden of Disease Study 2021. Respir. Res., 26, 2.","DOI":"10.1186\/s12931-024-03051-2"},{"key":"ref_2","unstructured":"World Health Organization (2026). Chronic Obstructive Pulmonary Disease (COPD) [Internet], World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ccm.2020.05.002","article-title":"Epidemiology of Chronic Obstructive Pulmonary Disease","volume":"41","author":"Ruvuna","year":"2020","journal-title":"Clin. Chest Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","article-title":"Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: A systematic review and modelling analysis","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/resp.14041","article-title":"Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact","volume":"26","author":"MacLeod","year":"2021","journal-title":"Respirology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ccm.2020.06.007","article-title":"Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations","volume":"41","author":"Ritchie","year":"2020","journal-title":"Clin. Chest Med."},{"key":"ref_7","first-page":"354","article-title":"Acute respiratory failure in chronic obstructive pulmonary disease","volume":"1","author":"Naughton","year":"2020","journal-title":"Oh\u2019s Intensive Care Man."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1146\/annurev-med-080919-112707","article-title":"Advances in Chronic Obstructive Pulmonary Disease","volume":"72","author":"Ferrera","year":"2021","journal-title":"Annu. Rev. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107956","DOI":"10.1016\/j.rmed.2025.107956","article-title":"Efficacy and safety of long-acting muscarinic antagonists in COPD: A meta-analysis and meta-regression with a focus on aging","volume":"238","author":"Calzetta","year":"2025","journal-title":"Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/00325481.2019.1702834","article-title":"Current evidence for COPD management with dual long-acting muscarinic antagonist\/long-acting \u03b22-agonist bronchodilators","volume":"132","author":"Skolnik","year":"2020","journal-title":"Postgrad. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1080\/17512433.2020.1787830","article-title":"The role of triple therapy in the management of COPD","volume":"13","author":"Calzetta","year":"2020","journal-title":"Expert Rev. Clin. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"00615-2022","DOI":"10.1183\/23120541.00615-2022","article-title":"Triple therapy in COPD: Understanding the data","volume":"9","author":"Suissa","year":"2023","journal-title":"ERJ Open Res."},{"key":"ref_13","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2025, December 24). Global Strategy for Prevention, Diagnosis and Management of COPD: 2025 Report. Available online: https:\/\/goldcopd.org\/2025-gold-report\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.chest.2023.08.014","article-title":"2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD","volume":"164","author":"Bourbeau","year":"2023","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.2147\/COPD.S424128","article-title":"Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus","volume":"18","author":"Miravitlles","year":"2023","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Li, Y., Li, J., Yang, H., and Zhang, Y. (2025). Effect of triple therapy on mortality and cardiovascular risk in patients with moderate to severe COPD: A meta-analysis of randomized controlled trials. BMC Pulm. Med., 25.","DOI":"10.1186\/s12890-025-03823-6"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"230084","DOI":"10.1183\/16000617.0084-2023","article-title":"How inhaled corticosteroids target inflammation in COPD","volume":"32","author":"Lea","year":"2023","journal-title":"Eur. Respir. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/s41533-023-00347-6","article-title":"Rational use of inhaled corticosteroids for the treatment of COPD","volume":"33","author":"Quint","year":"2023","journal-title":"npj Prim. Care Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102076","DOI":"10.1016\/j.pupt.2021.102076","article-title":"Which LABA\/LAMA should be chosen in COPD patients in real life?","volume":"71","author":"Sposato","year":"2021","journal-title":"Pulm. Pharmacol. Ther."},{"key":"ref_20","first-page":"1","article-title":"Comparative Effectiveness of Initial LAMA versus LABA in COPD: Real-World Cohort Study","volume":"18","author":"Suissa","year":"2021","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lai, C.-C., Chen, C.-H., Chen, K.-H., Wang, C.-Y., Huang, T.-M., Wang, Y.-H., and Wang, H.-C. (2022). The Impact of 52-Week Single Inhaler Device Triple Therapy versus Dual Therapy on the Mortality of COPD Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life, 12.","DOI":"10.3390\/life12020173"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s40265-021-01562-6","article-title":"Budesonide\/Glycopyrrolate\/Formoterol: A Review in COPD","volume":"81","author":"Heo","year":"2021","journal-title":"Drugs"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"ooad035","DOI":"10.1093\/jamiaopen\/ooad035","article-title":"A global federated real-world data and analytics platform for research","volume":"6","author":"Palchuk","year":"2023","journal-title":"JAMIA Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102171","DOI":"10.1016\/j.pupt.2022.102171","article-title":"Comparative clinical pharmacology of mometasone furoate, fluticasone propionate and fluticasone furoate","volume":"77","author":"Deans","year":"2022","journal-title":"Pulm. Pharmacol. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Keir, H.R., Contoli, M., and Chalmers, J.D. (2021). Inhaled Corticosteroids and the Lung Microbiome in COPD. Biomedicines, 9.","DOI":"10.3390\/biomedicines9101312"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1042\/CS20191202","article-title":"Effects of corticosteroids on COPD lung macrophage phenotype and function","volume":"134","author":"Higham","year":"2020","journal-title":"Clin. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"210075","DOI":"10.1183\/16000617.0075-2021","article-title":"Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD","volume":"30","author":"Miravitlles","year":"2021","journal-title":"Eur. Respir. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ccm.2020.05.006","article-title":"Inhaled corticosteroids in chronic obstructive pulmonary disease","volume":"41","author":"Mkorombindo","year":"2020","journal-title":"Clin. Chest Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kim, Y., Kim, S.H., Rhee, C.K., Lee, J.S., Lee, C.Y., Kim, D.K., Shin, K.-C., Jung, K.S., Yoo, K.H., and Park, Y.B. (2022). Air Trapping and the Risk of COPD Exacerbation: Analysis from Prospective KOCOSS Cohort. Front. Med., 9.","DOI":"10.3389\/fmed.2022.835069"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.arbres.2024.07.017","article-title":"Mucus Plugs as Precursors to Exacerbation and Lung Function Decline in COPD Patients","volume":"61","author":"Jin","year":"2024","journal-title":"Arch. De Bronconeumol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sposato, B., Ricci, A., Lacerenza, L.G., Petrucci, E., Cresti, A., Baratta, P., Perrella, A., Serafini, A., and Scalese, M. (2024). Triple Therapy in COPD in Real Life: Is It Better to Use Single or Multiple Inhalers?. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206191"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"17534666211066063","DOI":"10.1177\/17534666211066063","article-title":"Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution","volume":"16","author":"Braido","year":"2022","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.2147\/COPD.S513351","article-title":"Inhaled Triple Therapy with Extrafine Single Inhaler Versus Multiple Devices in Chronic Obstructive Pulmonary Disease (TRIPOLI): A Post-Authorization Retrospective Study","volume":"20","year":"2025","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1056\/NEJMoa1916046","article-title":"Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD","volume":"383","author":"Rabe","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.chest.2024.03.029","article-title":"POINT: Should Triple Inhaled Therapy Be Considered in All Patients With Group E COPD? Yes","volume":"166","author":"Adrish","year":"2024","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s12931-025-03356-w","article-title":"Toward precision medicine in COPD: Phenotypes, endotypes, biomarkers, and treatable traits","volume":"26","author":"Xie","year":"2025","journal-title":"Respir. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12931-021-01794-w","article-title":"Single-inhaler triple vs. single-inhaler dual therapy in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized control trials","volume":"22","author":"Long","year":"2021","journal-title":"Respir. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"106509","DOI":"10.1016\/j.rmed.2021.106509","article-title":"Benefits of budesonide\/glycopyrrolate\/formoterol fumarate (BGF) on symptoms and quality of life in patients with COPD in the ETHOS trial","volume":"185","author":"Martinez","year":"2021","journal-title":"Respir. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"220260","DOI":"10.1183\/20734735.0260-2022","article-title":"Impact of triple therapy on mortality in COPD","volume":"19","author":"Soumagne","year":"2023","journal-title":"Breathe"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Costa, V., Custodio, M.G., Gefen, E., and Fregni, F. (2025). The relevance of the real-world evidence in research, clinical, and regulatory decision making. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1512429"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1056\/NEJMoa1713901","article-title":"Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD","volume":"378","author":"Lipson","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4432","DOI":"10.1007\/s12325-025-03295-4","article-title":"Comparative Effectiveness of FF\/UMEC\/VI and BUD\/GLY\/FORM in Patients with COPD Stepping Up From Dual Therapy","volume":"42","author":"Wedzicha","year":"2025","journal-title":"Adv. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e080409","DOI":"10.1136\/bmj-2024-080409","article-title":"Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: New user cohort study","volume":"389","author":"Feldman","year":"2024","journal-title":"BMJ"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s12325-024-03088-1","article-title":"Comparative Effectiveness of Fluticasone Furoate\/Umeclidinium\/Vilanterol and Budesonide\/Glycopyrrolate\/Formoterol Fumarate among US Patients with Chronic Obstructive Pulmonary Disease","volume":"42","author":"Mannino","year":"2024","journal-title":"Adv. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.2147\/COPD.S139470","article-title":"Impact and prevention of severe exacerbations of COPD: A review of the evidence","volume":"12","author":"Halpin","year":"2017","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Prediletto, I., Giancotti, G., and Nava, S. (2023). COPD Exacerbation: Why It Is Important to Avoid ICU Admission. J. Clin. Med., 12.","DOI":"10.3390\/jcm12103369"},{"key":"ref_47","first-page":"121","article-title":"Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview","volume":"8","author":"Leviton","year":"2023","journal-title":"J. Healthc. Inform. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5650\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:13:23Z","timestamp":1784535203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":47,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145650"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145650","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]}}}