From the Guidelines
Adding Arnuity to Trelegy is not typically recommended because Trelegy already contains fluticasone furoate, and doubling the dose could increase the risk of corticosteroid-related side effects without providing additional therapeutic benefit. Arnuity (fluticasone furoate) is an inhaled corticosteroid (ICS) that helps reduce inflammation in the airways 1. According to the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report, triple inhaled therapy of ICS/LAMA/LABA, such as Trelegy, improves lung function, symptoms, and health status, and reduces exacerbations compared to ICS/LABA or LAMA monotherapy 1.
The benefits of adding an ICS to LABA plus LAMA are still being studied, and one RCT failed to demonstrate any benefit of adding an ICS to LABA plus LAMA on exacerbations 1. However, the report suggests that regular treatment with ICSs increases the risk of pneumonia, especially in those with severe disease 1.
In patients with chronic bronchitis, severe to very severe COPD, and a history of exacerbations, a PDE4 inhibitor, such as roflumilast, improves lung function and reduces moderate and severe exacerbations 1. But in the context of Trelegy, which already contains an ICS, adding Arnuity would not provide additional benefits and could increase the risk of side effects. If a patient's respiratory symptoms are not adequately controlled on Trelegy, a healthcare provider might consider adjusting the medication regimen in other ways, such as ensuring proper inhaler technique, addressing adherence issues, or considering alternative treatment options rather than adding another corticosteroid 1.
Some key points to consider when managing COPD include:
- Triple inhaled therapy of ICS/LAMA/LABA improves lung function, symptoms, and health status, and reduces exacerbations 1
- Regular treatment with ICSs increases the risk of pneumonia, especially in those with severe disease 1
- PDE4 inhibitors, such as roflumilast, improve lung function and reduce moderate and severe exacerbations in patients with chronic bronchitis, severe to very severe COPD, and a history of exacerbations 1
- Oral glucocorticoids have no role in the chronic daily treatment of COPD due to a lack of benefit and a high rate of systemic complications 1.
Any changes to medication should always be discussed with and supervised by a healthcare provider.
From the FDA Drug Label
Fluticasone furoate is a synthetic trifluorinated corticosteroid with anti-inflammatory activity The precise mechanism through which fluticasone furoate affects COPD and asthma symptoms is not known. Inflammation is an important component in the pathogenesis of COPD and asthma. Corticosteroids have been shown to have a wide range of actions on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) involved in inflammation.
The type of drug is fluticasone furoate, an inhalation corticosteroid (ICS). Adding Arnuity (fluticasone furoate) to Trelegy may benefit the patient by providing anti-inflammatory effects. However, the provided label does not directly address the benefits of adding Arnuity to Trelegy. Therefore, no conclusion can be drawn about the specific benefits of this combination 2.
From the Research
Drug Type and Benefits
- Arnuity is not mentioned in the provided studies, however, the studies discuss the benefits of adding an inhaled corticosteroid (ICS) to a long-acting beta2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA) in patients with chronic obstructive pulmonary disease (COPD) 3, 4, 5.
- The combination of fluticasone furoate (ICS), umeclidinium (LAMA), and vilanterol (LABA) in a single inhaler, known as Trelegy, has been shown to be effective in improving lung function, reducing symptoms, and decreasing the rate of exacerbations in patients with COPD 4, 5, 6.
- The addition of an ICS to a LABA and LAMA has been shown to reduce the risk of all-cause mortality in patients with COPD, as demonstrated in the IMPACT trial 7.
Mechanism of Action
- The exact mechanism of action of Arnunity is not mentioned in the provided studies, however, the combination of ICS, LABA, and LAMA in Trelegy works by: