Trelegy vs Anoro for COPD Management
Trelegy (fluticasone furoate/umeclidinium/vilanterol) is superior to Anoro (umeclidinium/vilanterol) for patients with COPD who have moderate to severe symptoms and/or a history of exacerbations, as it provides better exacerbation prevention, improved lung function, and reduced mortality. 1
Key Differences Between Medications
Composition
Trelegy: Triple therapy containing:
- Fluticasone furoate (inhaled corticosteroid/ICS)
- Umeclidinium (long-acting muscarinic antagonist/LAMA)
- Vilanterol (long-acting beta2-agonist/LABA)
Anoro: Dual therapy containing:
- Umeclidinium (LAMA)
- Vilanterol (LABA)
The fundamental difference is the addition of the inhaled corticosteroid (fluticasone furoate) in Trelegy.
Clinical Benefits Comparison
Exacerbation Prevention
- Trelegy demonstrates superior efficacy in reducing the rate of moderate-severe COPD exacerbations compared to Anoro 2, 3
- This is particularly important as exacerbations are associated with increased risk of myocardial infarction and stroke 1
Lung Function
- Both medications improve lung function, but Trelegy provides greater improvements in trough FEV1 compared to Anoro 2
- The 2023 Canadian Thoracic Society guidelines support that single-inhaler triple therapy provides better lung function outcomes than LAMA/LABA combinations in patients with persistent symptoms 1
Mortality Benefit
- Recent evidence shows Trelegy reduces all-cause mortality compared to Anoro (HR 0.72,95% CI 0.53-0.99) 3
- This mortality benefit is significant and represents a key advantage of triple therapy over dual therapy 1
Patient Selection Algorithm
Use Anoro (LAMA/LABA) when:
- Patient has confirmed COPD with moderate symptoms
- No history of frequent exacerbations (less than 2 per year)
- No evidence of eosinophilic inflammation
- Patient is at low risk for COPD-related mortality
Use Trelegy (ICS/LAMA/LABA) when:
- Patient has moderate to severe COPD symptoms despite dual therapy
- History of exacerbations (≥2 per year)
- Blood eosinophil count ≥300 cells/μL
- Patient is at high risk of COPD-related mortality 1
Real-World Outcomes
A recent real-world study showed that patients switching from ICS/LABA therapy to Trelegy experienced:
- Significantly fewer exacerbations (53.49% vs 62.59%, p<0.001)
- Reduced COPD-related healthcare resource utilization 4
Administration and Adherence
- Both medications are administered once daily via the Ellipta dry powder inhaler
- The once-daily dosing with a simple device may increase adherence and treatment efficacy 5
- Anoro delivers 62.5 mcg umeclidinium and 25 mcg vilanterol per actuation 6
Common Pitfalls and Caveats
Safety Considerations
- Neither medication should be used for acute bronchospasm or asthma 6
- Monitor for:
- Cardiovascular effects (especially in patients with pre-existing cardiovascular disease)
- Worsening of narrow-angle glaucoma
- Urinary retention, particularly in patients with prostatic hyperplasia
- Potential for pneumonia with ICS component in Trelegy
Drug Interactions
- Use caution when combining with:
- Strong CYP3A4 inhibitors (e.g., ketoconazole)
- Monoamine oxidase inhibitors
- Beta-blockers
- Other anticholinergic medications 6
Conclusion
When deciding between Trelegy and Anoro, the evidence strongly supports using Trelegy for patients with moderate to severe COPD who have persistent symptoms and/or history of exacerbations due to its superior effects on exacerbation prevention, lung function improvement, and mortality reduction. For patients with less severe disease and no history of frequent exacerbations, Anoro may be sufficient as initial therapy.