TOPLINE

The addition of a long-acting muscarinic antagonist (LAMA) to inhaled corticosteroid (ICS)/long-acting beta-2 agonist (LABA) dual inhaler therapy was associated with higher odds of reaching clinical remission in patients with moderate-to-severe asthma that remained uncontrolled on the dual regimen alone.

METHODOLOGY

• Researchers conducted post hoc analyses of two phase 3 randomized controlled trials (TRIMARAN and TRIGGER), each lasting 52 weeks. The trials compared fixed-dose triple inhaler therapy, consisting of beclometasone dipropionate (BDP), formoterol fumarate (FF), and glycopyrronium (G), against dual therapy (BDP/FF) in adults whose asthma of moderate-to-severe intensity remained uncontrolled despite ICS and LABA therapy.
• The analysis included 1149 adults from TRIMARAN and 1142 from TRIGGER. They were randomly assigned to either continue BDP/FF or switch to BDP/FF/G, all dosed at two inhalations twice daily. 
• The criteria for clinical remission required patients to remain free of oral corticosteroids and severe exacerbations throughout the study, achieve adequate asthma control by scoring < 1.5 on the Asthma Control Questionnaire (ACQ-5) at weeks 26, 40, and 52, and maintain or improve their lung function by the end of the study.

TAKEAWAY

• Across both trials, the odds of achieving clinical remission at week 52 were 44% higher with triple therapy than with dual therapy (P < .001).
• In TRIGGER, clinical remission was achieved by 29.6% of patients receiving triple therapy compared with 20.0% receiving dual therapy (P < .001); in TRIMARAN, remission rates were 29.4% with triple therapy and 25.4% with dual therapy, a difference that was not statistically significant.
• Patients with less severe disease at baseline, measured by fewer past exacerbations, better symptom control, and more reversible airflow limitation, were more likely to reach remission than those with more severe disease.

IN PRACTICE

"These data demonstrate that clinical remission can be achieved in patients with asthma that is uncontrolled by ICS/LABA through the optimisation (i.e. adherence and improved inhaler technique) of the inhaled therapy, and that the proportion achieving clinical remission can be increased by the addition of a LAMA in the form of BDP/FF/G. This supports the recommendation to optimise inhaled asthma treatment prior to escalating to biologic therapies," the authors wrote.

SOURCE

The study was led by Giorgio Walter Canonica, MD, of Humanitas University in Milan, Italy. It was published online on September 12, 2026, in ERJ Open Research.

LIMITATIONS

The study had a limited follow-up period of 52 weeks, and a meaningful evaluation of clinical remission would ideally require multiple years of data. Neither of the trials collected information on key biomarkers systematically. The findings were derived from post hoc analyses and could benefit from further confirmation using real-world data.

DISCLOSURES

The study was supported by Chiesi Farmaceutici, and several authors reported being employees of this company. Some authors reported receiving research grants, consulting fees, advisory board fees, and speaker honoraria from multiple pharmaceutical companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.