From the Guidelines
Trelegy (fluticasone furoate, umeclidinium, and vilanterol) is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD) who are not adequately controlled on a combination of inhaled corticosteroid and long-acting beta-agonist therapy or a combination of long-acting beta-agonist and long-acting muscarinic antagonist. The criteria for its use prioritize patients with severe COPD who have a history of exacerbations, as it has been shown to improve lung function and reduce exacerbations more effectively than monocomponents 1.
Key Considerations
- The standard dosage is one inhalation once daily, preferably at the same time each day.
- Patients should not use Trelegy for acute bronchospasm or status asthmaticus, as it is not a rescue medication.
- Clinicians should ensure patients don't have hypersensitivity to any of the components and should use caution in patients with certain conditions like cardiovascular disorders, glaucoma, urinary retention, or those at risk for pneumonia.
Mechanism of Action
The triple therapy in Trelegy works by:
- Reducing inflammation in the airways through fluticasone furoate, an inhaled corticosteroid.
- Relaxing airway muscles through umeclidinium, a long-acting muscarinic antagonist.
- Preventing bronchoconstriction through vilanterol, a long-acting beta-agonist, providing comprehensive management of COPD.
Patient Selection
Patients eligible for Trelegy should have:
- A diagnosis of COPD with a history of exacerbations.
- Inadequate control on current medications, such as a combination of inhaled corticosteroid and long-acting beta-agonist or a combination of long-acting beta-agonist and long-acting muscarinic antagonist.
- No known hypersensitivity to the components of Trelegy.
- Caution should be exercised in patients with certain comorbidities, as mentioned earlier.
From the FDA Drug Label
The population demographics across all treatments were: mean age of 65 years, 77% white, 66% male, and an average smoking history of 46. 6 pack-years, with 35% identified as current smokers. At trial entry, the most common COPD medications were ICS + anticholinergic + LABA (34%), ICS + LABA (26%), anticholinergic + LABA (8%), and anticholinergic (7%). The mean postbronchodilator percent predicted FEV1 was 46% (standard deviation: 15%), the mean postbronchodilator FEV1/FVC ratio was 0.47 (standard deviation: 0. 12), and the mean percent reversibility was 10% (range: -59% to 125%).
The criteria for the use of Trelegy (fluticasone furoate, umeclidinium, and vilanterol) include:
- COPD patients with a history of 1 or more moderate or severe exacerbations in the prior 12 months
- Age: mean age of 65 years
- Smoking history: average smoking history of 46.6 pack-years
- Lung function: mean postbronchodilator percent predicted FEV1 of 46%, mean postbronchodilator FEV1/FVC ratio of 0.47, and mean percent reversibility of 10% 2
From the Research
Criteria for the Use of Trelegy
The criteria for the use of Trelegy (fluticasone furoate, umeclidinium, and vilanterol) include:
- Maintenance treatment for adults with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an inhaled corticosteroid (ICS) and a long-acting beta2 agonist (LABA) 3
- Patients with severe-to-very severe COPD who have frequent exacerbations and are not sufficiently controlled by dual LABA/LAMA therapy 4
- Patients who are not adequately controlled with dual ICS/LABA or LAMA/LABA therapy 5
Patient Considerations
When considering the use of Trelegy, patient factors such as:
- Adherence to treatment, with a single administration a day through a dry powder inhalator device showing good adherence 6
- Preference for a single inhaler triple therapy, which can increase adherence and efficacy of treatment 6, 7
- Presence of comorbidities, which was frequent in studies of Trelegy 7
Clinical Evidence
The use of Trelegy is supported by clinical evidence showing: