From the Guidelines
Trelegy is recommended as a once-daily maintenance treatment for patients with COPD who are not adequately controlled on dual therapy, as it has been shown to improve lung function, symptoms, and health status, and reduce exacerbations 1. The medication combines three active ingredients: fluticasone furoate (an inhaled corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Some key points to consider when prescribing Trelegy include:
- The standard dosage is one inhalation daily of Trelegy Ellipta 100/62.5/25 mcg.
- Patients should use it at the same time each day, and rinse their mouth with water afterward without swallowing to reduce the risk of oral thrush.
- This triple therapy works by reducing inflammation in the airways (fluticasone), relaxing airway muscles (umeclidinium), and opening airways (vilanterol), which together improve breathing and reduce COPD exacerbations.
- Trelegy is not intended for rescue therapy during acute bronchospasm episodes.
- Common side effects include headache, back pain, dysphonia, and upper respiratory tract infections.
- Patients with a history of severe milk protein allergy should avoid this medication due to lactose content in the formulation. It's also important to note that the use of triple inhaled therapy, such as Trelegy, has been shown to be effective in improving lung function, symptoms, and health status, and reducing exacerbations in patients with COPD, especially those with a history of exacerbations 1.
Some of the benefits of Trelegy include:
- Improved lung function and health status
- Reduced exacerbations
- Convenient once-daily dosing
- Combination of three active ingredients to address multiple aspects of COPD pathophysiology However, it's also important to consider the potential risks and side effects, such as:
- Increased risk of pneumonia, especially in patients with severe disease
- Common side effects like headache, back pain, and upper respiratory tract infections
- Potential for oral thrush and other local side effects Overall, Trelegy is a valuable treatment option for patients with COPD who are not adequately controlled on dual therapy, and its benefits and risks should be carefully considered on an individual basis 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE 1.1 Maintenance Treatment of Chronic Obstructive Pulmonary Disease Trelegy (fluticasone furoate, umeclidinium, vilanterol) is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).
The recommended use of Trelegy for chronic obstructive pulmonary disease (COPD) treatment is for the maintenance treatment of patients with COPD.
- Trelegy is not indicated for the relief of acute bronchospasm.
- The medication should be used as part of a comprehensive treatment plan, including lifestyle modifications and other therapies as needed. 2
From the Research
Recommended Use of Trelegy for COPD Treatment
The recommended use of Trelegy (fluticasone furoate, umeclidinium, vilanterol) for chronic obstructive pulmonary disease (COPD) treatment is as a maintenance treatment for adults with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid (ICS) and a long-acting beta2 agonist (LABA) 3.
Key Components and Mechanism
Trelegy Ellipta is a dry powder inhaler containing fluticasone furoate (ICS), vilanterol trifenatate (LABA), and umeclidinium bromide (long-acting muscarinic antagonist [LAMA]) 3. This combination provides a comprehensive approach to managing COPD symptoms by addressing inflammation, bronchodilation, and muscarinic receptor antagonism.
Clinical Evidence
Studies have shown that triple therapy with Trelegy can positively impact dyspnea and global health status, significantly decrease COPD exacerbations, and improve airflow limitation and lung hyperinflation in patients with frequent exacerbations 4. The use of ICS in combination with LABA or LABA/LAMA is associated with a reduced risk of exacerbations, although it also carries an increased risk of pneumonia 5, 6.
Treatment Considerations
When considering the use of Trelegy, it's essential to weigh the benefits against the potential risks, particularly the increased risk of pneumonia associated with ICS treatment 6. The choice of ICS may also impact the effectiveness and safety profile, with some studies suggesting a better effect-safety profile with budesonide compared to fluticasone propionate 6.
Economic Evaluation
A recent study compared the clinical and economic outcomes of Trelegy versus tiotropium/olodaterol therapy in maintenance treatment-naive patients with COPD, finding no significant difference in the risk of COPD exacerbation or pneumonia but higher pharmacy costs associated with Trelegy 7. This suggests that the choice of initial maintenance therapy should be guided by treatment recommendations for LAMA+LABA as the first line, considering the cost-effectiveness and risk-benefit profile of available treatments.
Key Points for Consideration
- Trelegy is indicated for adults with moderate to severe COPD not adequately controlled by an ICS and LABA combination.
- The treatment combines an ICS, LABA, and LAMA to address multiple pathways in COPD management.
- Clinical benefits include reduced exacerbations and improved lung function, but with an increased risk of pneumonia.
- Economic considerations and the choice of ICS can influence the treatment decision.