Recommended Trelegy Ellipta Dose for Severe COPD
The recommended dose of Trelegy Ellipta for severe COPD with an FEV1/FVC ratio of 0.36 is one inhalation of 100/62.5/25 μg (fluticasone furoate/umeclidinium/vilanterol) once daily. 1
Dosing Rationale
Trelegy Ellipta is available in only one strength: 100/62.5/25 μg delivered once daily via the ELLIPTA dry powder inhaler. 1 This single-dose formulation simplifies prescribing and eliminates dose titration decisions.
Your patient's FEV1/FVC ratio of 0.36 confirms severe airflow obstruction (well below the diagnostic threshold of 0.70), meeting criteria for COPD requiring triple therapy. 2
Clinical Context for Triple Therapy
Triple therapy with Trelegy Ellipta is specifically indicated for moderate to severe COPD patients not adequately controlled on ICS/LABA combination therapy. 1 The IMPACT trial, which demonstrated mortality benefit, enrolled patients with symptomatic COPD and history of exacerbations—the population most likely to benefit. 3
The combination of all three drug classes (ICS/LAMA/LABA) in a single inhaler improves lung function, reduces exacerbations, and enhances quality of life compared to dual therapy. 4 In the IMPACT study, FF/UMEC/VI reduced all-cause mortality risk by 28% versus UMEC/VI alone (HR 0.72,95% CI 0.53-0.99). 3
Administration Details
Administer one inhalation once daily in the morning using the ELLIPTA device. 5 The once-daily dosing schedule may improve adherence compared to multiple-inhaler regimens or more frequent dosing. 4
The single-inhaler triple therapy (FF/UMEC/VI) demonstrated non-inferiority to using two separate inhalers (FF/VI plus UMEC) with comparable efficacy and safety profiles. 5
Important Clinical Considerations
Current GOLD guidelines base treatment decisions on symptom burden and exacerbation history rather than spirometric severity alone. 2 While your patient has severe obstruction by FEV1/FVC ratio, assess their symptom severity using validated tools (CAT or mMRC) and exacerbation frequency to confirm appropriateness of triple therapy.
Triple therapy is reserved for patients with frequent exacerbations (≥2 moderate or ≥1 severe exacerbation requiring hospitalization in the past year) or those remaining symptomatic despite dual bronchodilator therapy. 6, 4
Monitor for ICS-related adverse effects including pneumonia risk, though the IMPACT trial showed acceptable safety without excess cardiovascular events. 4, 3
Ensure proper inhaler technique at each visit, as device misuse is a common cause of treatment failure. 2
No Dose Adjustment Required
- There is no dose titration or adjustment for Trelegy Ellipta—the single available strength is used for all appropriate patients regardless of COPD severity. 1 This differs from some other COPD medications that require dose escalation.