Trelegy for COPD: Recommended Use and Dosage
Trelegy Ellipta (fluticasone furoate 100 mcg/umeclidinium 62.5 mcg/vilanterol 25 mcg) should be administered as one inhalation once daily for maintenance treatment of moderate to severe COPD in patients not adequately controlled on dual therapy with an ICS/LABA. 1
Specific Indications for Trelegy
Patient Selection Criteria:
- Adults with moderate to severe COPD who remain symptomatic or experience exacerbations despite treatment with ICS/LABA combination therapy 1, 2
- Patients with FEV1 <50% predicted and ≥2 exacerbations per year, or those with severe airflow obstruction and frequent exacerbations despite optimal bronchodilator therapy 3
- The triple therapy approach (ICS/LABA/LAMA) is specifically reserved for patients with characteristics of chronic bronchitis and a history of exacerbations who are not sufficiently controlled by dual LABA/LAMA therapy 4
Dosing Specifications
Standard Dosage:
- One inhalation of Trelegy Ellipta 100/62.5/25 mcg once daily by oral inhalation 1
- Must be used at the same time every day 1
- Do not use more than once every 24 hours 1
Administration Technique:
- After inhalation, patients must rinse their mouth with water without swallowing to reduce the risk of oropharyngeal candidiasis 1
- Avoid beta-blocking agents (including eyedrop formulations) in patients using this medication 5
Clinical Evidence Supporting Use
Exacerbation Reduction: Real-world evidence demonstrates that patients previously treated with ICS/LABA who switched to Trelegy experienced significantly fewer exacerbations (53.49% vs 62.59% of patients experiencing any exacerbation; p<0.001) and lower COPD-related healthcare resource utilization during the 12 months following initiation 6. This effect was particularly pronounced in patients with ≥1 exacerbation at baseline 6.
Lung Function Improvements: Trelegy provides sustained improvements in lung function, with the median time to onset (defined as 100-mL increase in FEV1) occurring approximately 15 minutes after beginning treatment 1.
Rescue Medication Protocol
If shortness of breath occurs between doses, patients should use an inhaled short-acting beta2-agonist (e.g., albuterol) for immediate relief 1. Trelegy is NOT indicated for relief of acute bronchospasm 1.
Important Safety Considerations
Contraindications and Precautions:
- Increased risk of pneumonia with ICS-containing regimens should be considered, particularly in patients with FEV1 <50% predicted 3
- Monitor for oropharyngeal candidiasis 1
- Avoid in patients taking beta-blockers 5
When Trelegy May Not Be Appropriate
For patients without a history of frequent exacerbations (≥2 per year) or those with FEV1 ≥50% predicted who are well-controlled on dual bronchodilator therapy (LABA/LAMA), triple therapy may not provide additional benefit and dual bronchodilator therapy should be optimized first 3.