What is Trelegy?
Trelegy is a once-daily triple therapy inhaler containing fluticasone furoate (an inhaled corticosteroid), umeclidinium bromide (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist) used for maintenance treatment of moderate to severe chronic obstructive pulmonary disease (COPD) in patients not adequately treated by dual therapy. 1
Components and Mechanism of Action
- Trelegy combines three different classes of medications in a single dry powder inhaler device called Ellipta 1:
- Fluticasone furoate: An inhaled corticosteroid (ICS) that reduces airway inflammation
- Umeclidinium bromide: A long-acting muscarinic antagonist (LAMA) that blocks acetylcholine receptors, preventing bronchoconstriction
- Vilanterol trifenatate: A long-acting beta2-agonist (LABA) that relaxes airway smooth muscle
Clinical Indications
- Indicated for maintenance treatment in adults with moderate to severe COPD who are not adequately controlled on a combination of ICS and LABA 1, 2
- Particularly beneficial for COPD patients who remain symptomatic and/or experience frequent exacerbations despite dual therapy 2
- Used in patients classified as GOLD Group B or D (according to 2011 GOLD classification) 2
Clinical Benefits
- Improves pulmonary function (measured by FEV1) compared to dual therapies 2
- Reduces the rate of moderate to severe COPD exacerbations compared to dual therapies 2
- Improves quality of life and symptom control in COPD patients 2
- The once-daily dosing regimen may improve treatment adherence compared to multiple-inhaler regimens 2, 3
Role in COPD Management
- Triple therapy with ICS/LABA/LAMA is recommended for selected patients with severe COPD when symptoms are not adequately controlled by dual LABA/LAMA therapy and exacerbations are frequent 4
- The 2023 Canadian Thoracic Society guidelines suggest single inhaler triple therapy (SITT) for patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with dual therapy 5
- SITT is also recommended for patients at high risk of COPD exacerbations due to its potential to reduce mortality in individuals with moderate-severe disease 5
Clinical Evidence
The IMPACT study demonstrated that triple therapy with umeclidinium/fluticasone furoate/vilanterol was superior to dual therapies in 2:
- Reducing the rate of moderate-severe exacerbations
- Improving trough FEV1
- Enhancing quality of life
Studies show that adding umeclidinium to fluticasone furoate/vilanterol improves lung function, symptoms, and quality of life compared to ICS/LABA combinations alone 2
Safety Profile
- Generally well-tolerated in clinical trials 2
- No excess cardiovascular effects or pneumonia were observed in major studies, though comorbidities were frequent in the study populations 2
- As with all inhaled medications, proper inhaler technique is critical for efficacy 6
Practical Considerations
- Delivered via the Ellipta dry powder inhaler device, which is designed for ease of use 6
- Once-daily administration simplifies treatment regimen, potentially improving adherence compared to multiple separate inhalers 3
- The INTREPID study is evaluating the real-world effectiveness of Trelegy compared to multiple-inhaler triple therapy in routine clinical practice 6