What is Trelegy (fluticasone furoate, umeclidinium, and vilanterol)?

What is Trelegy?

Trelegy Ellipta is a once-daily, single-inhaler triple therapy containing fluticasone furoate (an inhaled corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist) delivered via the Ellipta dry powder inhaler device. 1, 2

Medication Components

Trelegy combines three distinct drug classes in one inhaler:

• Fluticasone furoate (ICS): An inhaled corticosteroid that reduces airway inflammation 2
• Umeclidinium bromide (LAMA): A long-acting muscarinic antagonist that provides bronchodilation by blocking acetylcholine receptors 2
• Vilanterol trifenatate (LABA): A long-acting beta2-agonist that relaxes airway smooth muscle 2

Clinical Indications

Trelegy is indicated for maintenance treatment of adults with moderate to severe COPD who are not adequately controlled on dual therapy (ICS/LABA combination). 2

Specific guideline-supported indications include:

• Patients with persistent moderate to severe dyspnea despite dual therapy 1, 3
• Patients at high risk of COPD exacerbations (≥2 exacerbations per year or ≥1 hospitalization requiring admission) 1, 4
• Patients in GOLD categories C and D with severe airflow obstruction (FEV₁ <50% predicted) and frequent exacerbations 4

Dosing and Administration

• Once-daily dosing via the Ellipta inhaler device 1
• This represents a significant advantage over many dual therapy regimens that require twice-daily administration 1

Evidence for Mortality Benefit

Single inhaler triple therapy like Trelegy may reduce mortality in individuals with moderate-severe COPD compared to dual therapy options. 1, 3 This mortality benefit is supported by multiple international respiratory societies including the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Canadian Thoracic Society, American Thoracic Society, and European Respiratory Society 1

Important Safety Considerations

The pneumonia risk is higher with ICS-containing regimens, with a number needed to harm of 33 patients treated for one year. 4 Patients on Trelegy face a 4% increased risk of pneumonia compared to non-ICS regimens 4

Critical Prescribing Pitfall

Never prescribe Trelegy concurrently with another ICS-containing medication (such as Pulmicort), as this represents irrational polypharmacy and doubles ICS exposure without guideline support. 4 When transitioning patients from dual ICS/LABA therapy to Trelegy, discontinue the previous ICS-containing regimen 4

When Trelegy May Be Insufficient

If patients continue experiencing exacerbations despite Trelegy:

• For chronic bronchitis phenotype with FEV₁ <50% predicted: add roflumilast rather than additional ICS 4
• Evaluate for pulmonary rehabilitation, oxygen therapy, or treatment of comorbidities rather than medication duplication 4