What is the Trelegy (fluticasone furoate, umeclidinium, vilanterol) equivalent dose for a patient currently on Symbicort (budesonide, formoterol) 160-4.5?

Trelegy Equivalent to Symbicort 160-4.5

The equivalent dose of Trelegy (fluticasone furoate/umeclidinium/vilanterol) for a patient currently on Symbicort (budesonide/formoterol) 160-4.5 is Trelegy 100/62.5/25 mcg once daily.

Understanding the Medications

Symbicort 160-4.5

• Combination of budesonide (inhaled corticosteroid/ICS) 160 mcg and formoterol (long-acting beta-agonist/LABA) 4.5 mcg
• Typically dosed twice daily
• Used for asthma and COPD management

Trelegy

• Triple therapy containing:
  • Fluticasone furoate (ICS)
  • Umeclidinium (long-acting muscarinic antagonist/LAMA)
  • Vilanterol (LABA)
• Available in one strength: 100/62.5/25 mcg
• Administered once daily via ELLIPTA inhaler

Dose Equivalence Rationale

1. ICS Component:

   • Budesonide 160 mcg twice daily (320 mcg total daily dose)
   • Equivalent to fluticasone furoate 100 mcg once daily
   • According to guidelines, fluticasone furoate 100 mcg falls within the low-to-medium dose range for adults 1

2. LABA Component:

   • Formoterol 4.5 mcg twice daily in Symbicort
   • Equivalent to vilanterol 25 mcg once daily in Trelegy
   • Both provide 24-hour bronchodilation despite different dosing schedules

3. Added LAMA Component:

   • Umeclidinium 62.5 mcg is the standard dose in Trelegy
   • This represents an additional bronchodilator class not present in Symbicort

Clinical Evidence Supporting Equivalence

Research has demonstrated that single-inhaler triple therapy with FF/UMEC/VI is non-inferior to using multiple inhalers for similar medications 2. The standard dose of Trelegy (100/62.5/25 mcg) has been shown to provide effective symptom control and lung function improvement in patients previously on dual therapy 3.

Important Considerations When Switching

• Dosing frequency: Trelegy is administered once daily, while Symbicort is typically twice daily
• Inhaler technique: The ELLIPTA device used for Trelegy differs from the Turbuhaler used for Symbicort
• Added bronchodilation: The addition of umeclidinium (LAMA) may provide additional bronchodilation for patients with COPD
• Disease state: Trelegy is primarily indicated for COPD, while Symbicort is approved for both asthma and COPD

Monitoring After Switching

• Assess symptom control and lung function after 4-6 weeks
• Monitor for potential side effects including:
  • Local effects: oral candidiasis, pharyngitis
  • Systemic effects: potential adrenal suppression with long-term use
  • LAMA-specific effects: dry mouth, urinary retention

Potential Pitfalls

• Overtreatment: Triple therapy may represent overtreatment for some patients with mild or well-controlled asthma
• Inhaler technique: Ensure proper training on the ELLIPTA device when switching from Turbuhaler
• Loss of rescue option: If Symbicort was being used in a maintenance and reliever therapy approach, this option is lost with Trelegy

The transition from Symbicort 160-4.5 to Trelegy 100/62.5/25 mcg represents not just a change in medication but an escalation in therapy with the addition of a LAMA component. This should be considered in the context of the patient's specific disease state, control level, and treatment goals.