Yes, Breo Ellipta Plus Incruse Ellipta Constitutes Triple Therapy
When Breo Ellipta (fluticasone furoate/vilanterol, an ICS/LABA combination) is used together with Incruse Ellipta (umeclidinium, a LAMA), this constitutes triple therapy containing all three major drug classes: inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and long-acting muscarinic antagonist (LAMA). 1
Understanding the Components
Breo Ellipta contains:
Incruse Ellipta contains:
- Umeclidinium (LAMA) 2
When combined, these provide LAMA/LABA/ICS triple therapy, which is the same drug class combination found in single-inhaler triple therapy products. 1
Clinical Implications and Guideline Recommendations
The 2023 Canadian Thoracic Society guidelines strongly recommend LAMA/LABA/ICS triple combination therapy for symptomatic individuals with COPD at high risk of future exacerbations (≥2 moderate exacerbations or ≥1 severe exacerbation in the past year), moderate to high symptom burden (CAT ≥10, mMRC ≥2), and FEV1 <80% predicted. 1 This recommendation is based on evidence showing reduced mortality, improved lung function, better symptom control, and fewer exacerbations compared to dual therapy. 1
Triple therapy improves lung function, symptoms, and health status compared to ICS/LABA or LAMA monotherapy, and significantly reduces exacerbations. 1, 3
Important Practical Consideration
While your current regimen (Breo + Incruse) provides triple therapy, the 2023 Canadian Thoracic Society guidelines preferentially recommend single-inhaler triple therapy (SITT) over multiple inhalers, though they acknowledge some patients prefer separate devices. 1 Single-inhaler formulations may improve adherence compared to multiple inhalers. 3
The equivalent single-inhaler product containing the same medications (fluticasone furoate/umeclidinium/vilanterol) is available and has demonstrated efficacy in reducing exacerbations and improving outcomes in patients with moderate to severe COPD. 4, 2, 5
Safety Monitoring
Patients on ICS-containing triple therapy require monitoring for pneumonia risk, particularly if they are current smokers, age ≥55 years, have prior exacerbations/pneumonia history, BMI <25 kg/m², or severe airflow limitation. 1, 3 The incidence of pneumonia is slightly higher with ICS-containing regimens (number needed to harm of 33), but the benefit-risk ratio favors triple therapy in appropriate patients (number needed to treat of 4 to prevent one moderate-to-severe exacerbation). 3