Trelegy Equivalent of Breztri 160-4.8-9
The equivalent dose of Trelegy (fluticasone furoate/umeclidinium/vilanterol) to Breztri (budesonide/glycopyrrolate/formoterol) 160-4.8-9 mcg is Trelegy 100/62.5/25 mcg.
Medication Component Comparison
Both medications are triple therapy combinations for COPD/asthma management, containing:
Inhaled Corticosteroid (ICS)
- Breztri: Budesonide 160 mcg
- Trelegy: Fluticasone furoate 100 mcg (standard strength) or 200 mcg (high strength)
Long-Acting Muscarinic Antagonist (LAMA)
- Breztri: Glycopyrrolate 4.8 mcg
- Trelegy: Umeclidinium 62.5 mcg
Long-Acting Beta-Agonist (LABA)
- Breztri: Formoterol 9 mcg
- Trelegy: Vilanterol 25 mcg
Rationale for Equivalence
The Trelegy 100/62.5/25 mcg formulation is considered equivalent to Breztri 160-4.8-9 mcg based on:
Corticosteroid potency: Fluticasone furoate 100 mcg has approximately equivalent anti-inflammatory potency to budesonide 160 mcg, though they have different molecular structures 1, 2
Clinical efficacy: Both medications demonstrate similar efficacy profiles in improving lung function, reducing exacerbations, and improving quality of life in COPD patients 3, 4
Delivery characteristics: Both are delivered via dry powder inhalers with similar fine particle fractions and lung deposition patterns 2
Clinical Considerations
Dosing frequency: Trelegy is administered once daily while Breztri is typically administered twice daily, which may impact adherence 1
Device differences: Trelegy uses the ELLIPTA inhaler device while Breztri uses the Aerosphere inhaler device, which may require different inhalation techniques
Real-world effectiveness: Recent comparative effectiveness research suggests that FF/UMEC/VI (Trelegy) may be associated with a 12% lower rate of moderate-severe COPD exacerbations compared to BUD/GLY/FORM (Breztri) 5
Potential Advantages of Trelegy
- Once-daily dosing may improve adherence compared to twice-daily Breztri
- The ELLIPTA device has been shown to deliver consistent dosing across a wide range of inspiratory flow rates (30-90 L/min), making it suitable for patients with varying severity of airflow limitation 2
- Recent real-world data suggests a potential mortality benefit with FF/UMEC/VI compared to BUD/GLY/FORM (11% lower risk of all-cause mortality at 12 months) 5
Cautions and Monitoring
Monitor for common side effects including:
- Local effects: Oral thrush, dysphonia, cough
- Systemic effects: Potential adrenal suppression with long-term use
- LAMA-specific effects: Dry mouth, urinary retention
- LABA-specific effects: Tachycardia, tremor, hypokalemia
Consider bone health monitoring for patients on long-term therapy due to potential effects on bone density with inhaled corticosteroids
In conclusion, when switching from Breztri 160-4.8-9 mcg to Trelegy, the 100/62.5/25 mcg strength is the appropriate equivalent dose for most patients.