From the Guidelines
Converting from Trelegy Ellipta to Advair should be done under medical supervision, starting with Advair 250/50 twice daily, as this switch involves discontinuing a long-acting muscarinic antagonist component and changing from a triple to a dual therapy regimen. This conversion is complex due to the differences in active ingredients between Trelegy (fluticasone furoate, umeclidinium, and vilanterol) and Advair (fluticasone propionate and salmeterol) [ 1 ]. The decision to switch should consider the patient's current symptoms and disease severity, and the switch should occur without a gap in therapy to maintain continuous symptom control. It's crucial to monitor respiratory function closely after switching, as the removal of the umeclidinium component might affect symptom control [ 1 ]. The patient should be aware that Advair requires twice-daily dosing, unlike Trelegy's once-daily regimen, which may impact adherence.
Key considerations in this conversion include:
- The potential impact of discontinuing umeclidinium on symptom control and exacerbation risk [ 1 ]
- The difference in dosing regimens between Trelegy (once daily) and Advair (twice daily)
- The need for close monitoring of respiratory function post-switch
- Starting with Advair 250/50 twice daily as a common initial dose for patients with moderate to severe COPD or asthma [ 1 ]
It's essential to weigh the benefits and risks of this conversion, considering the patient's individual needs and medical history, and to adjust the treatment plan as necessary to optimize outcomes [ 1 ].
From the Research
Conversion from Trelegy Ellipta to Advair
There are no direct studies on converting from Trelegy Ellipta (fluticasone furoate, umeclidinium, vilanterol) to Advair (fluticasone propionate, salmeterol). However, some information can be gathered from studies comparing the components of these medications:
- The study 2 compared the lung function effects of fluticasone furoate/vilanterol (FF/VI) with those of fluticasone propionate/salmeterol (FP/SAL) in COPD patients, suggesting that once-daily FF/VI provides FEV(1) improvement comparable to twice-daily FP/SAL.
- Another study 3 reviewed the clinical use of fluticasone furoate/vilanterol in COPD, stating that once-daily fluticasone furoate/vilanterol 100/25 μg was more effective than twice-daily fluticasone propionate/salmeterol 250/50 μg and similarly effective as twice-daily fluticasone propionate/salmeterol 500/50 μg in terms of pulmonary function.
Key Considerations
When considering a conversion from Trelegy Ellipta to Advair, the following points should be taken into account:
- The difference in dosage forms: Trelegy Ellipta is a once-daily dry powder inhaler, while Advair is a twice-daily dry powder inhaler or metered-dose inhaler.
- The difference in corticosteroid components: fluticasone furoate in Trelegy Ellipta has enhanced affinity for the glucocorticoid receptor compared to fluticasone propionate in Advair 3.
- The presence of umeclidinium in Trelegy Ellipta, which is not present in Advair.
Potential Steps for Conversion
Based on the available information, potential steps for conversion could include:
- Consulting the studies 2 and 3 to understand the comparative efficacy of fluticasone furoate/vilanterol and fluticasone propionate/salmeterol in COPD patients.
- Considering the dosage and administration frequency of Advair, as it is a twice-daily medication.
- Monitoring the patient's response to the conversion and adjusting the treatment plan as needed.