What inhalers are similar to Ellipta (fluticasone furoate and vilanterol) for a patient with asthma or chronic obstructive pulmonary disease (COPD)?

Inhalers Similar to Ellipta (Fluticasone Furoate/Vilanterol)

For patients requiring an alternative to Ellipta, the most directly comparable options are other ICS/LABA combinations delivered via different devices, with Advair Diskus (fluticasone propionate/salmeterol) being the most established alternative, though requiring twice-daily dosing instead of once-daily. 1

Device-Specific Alternatives

Once-Daily ICS/LABA Options

• Fluticasone furoate/vilanterol pMDI (pressurized metered-dose inhaler): This delivers the same medication combination as Ellipta but through a pMDI device rather than the dry powder Ellipta device, offering an alternative for patients with low inspiratory flow who cannot generate adequate flow through dry powder inhalers 2
• The pMDI formulation has demonstrated non-inferiority to twice-daily formoterol/fluticasone propionate in persistent asthma 2

Twice-Daily ICS/LABA Alternatives

• Fluticasone propionate/salmeterol (Advair Diskus): This is the most directly studied comparator to Ellipta, showing comparable efficacy in lung function, quality of life, and symptom scores over 24 weeks 1
• Formoterol fumarate/fluticasone propionate pMDI: Requires twice-daily dosing but provides similar efficacy outcomes 2

LABA/LAMA Dual Bronchodilator Options (Without ICS)

For patients where ICS risks outweigh benefits—such as those with recurrent pneumonia, primarily obstructive symptoms without inflammatory exacerbation phenotype, or ICS-related adverse effects—LABA/LAMA combinations are superior alternatives. 3

Specific LABA/LAMA Combinations

• Umeclidinium/vilanterol (Anoro Ellipta): Uses the same Ellipta device and contains the same LABA (vilanterol) as the ICS/LABA Ellipta, but substitutes a LAMA (umeclidinium) for the ICS component 3
• Glycopyrronium/indacaterol: Once-daily LABA/LAMA combination that has demonstrated superiority over glycopyrrolate monotherapy in reducing exacerbations 4
• Tiotropium/olodaterol: Once-daily combination mentioned as a novel therapy in development 4
• Umeclidinium/vilanterol: FDA-approved once-daily combination bronchodilator 4

Triple Therapy Options (ICS/LABA/LAMA)

For patients with persistent moderate-to-severe dyspnea despite dual therapy or those at high risk of COPD exacerbations, escalation to single-inhaler triple therapy is recommended and may reduce mortality compared to dual therapy. 3

• Fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta): Uses the same Ellipta device with once-daily dosing, adding a LAMA to the ICS/LABA combination 3
• Adding a LAMA to ICS/LABA reduces severe exacerbations and improves symptoms in moderate-to-severe COPD 4

Key Considerations for Device Selection

Ellipta Device Characteristics

• The Ellipta is a blister strip dry powder inhaler with medium resistance and consistent dose delivery across varying inspiratory flow rates 5
• Over 90% of patients rate the Ellipta as "easy to use" with correct technique demonstrated initially and maintained at 4 weeks 1
• Requires adequate inspiratory flow to generate the dry powder aerosol 5

When to Choose Alternatives

• Low inspiratory flow: Consider pMDI formulations rather than dry powder inhalers 2
• Device preference: Some patients prefer the feel or feedback of different inhaler types 1
• Dosing schedule: Twice-daily options may be preferred by patients who want medication effects distributed throughout the day, though once-daily dosing generally improves adherence 2

Clinical Equivalence Considerations

Comparing ICS/LABA Combinations

• LAMAs have demonstrated superiority over LABAs collectively in reducing COPD exacerbations, though specific LABAs may perform differently in subgroups 4
• The ICS/LABA combination is equivalent to LAMA monotherapy for exacerbation prevention, though several outcomes (health status, mortality) may favor ICS/LABA, with limited confidence due to small event numbers 4
• Common adverse effects (thrush, dysphonia) occur at similar frequencies across ICS/LABA combinations 1

Pneumonia Risk with ICS

• ICS/LABA combinations carry increased pneumonia risk, though this may vary by specific ICS formulation 4
• This risk consideration makes LABA/LAMA combinations preferable for patients with recurrent pneumonia 3

Practical Algorithm for Selection

1. Assess inspiratory flow capability: If inadequate for dry powder inhaler → choose pMDI formulation 2
2. Evaluate ICS appropriateness: If pneumonia history, no eosinophilia, or ICS adverse effects → choose LABA/LAMA (e.g., umeclidinium/vilanterol) instead of ICS/LABA 3
3. Determine disease severity: If persistent symptoms on dual therapy or high exacerbation risk → escalate to triple therapy (Trelegy Ellipta) 3
4. Consider adherence factors: Once-daily options improve adherence; if same medication needed but different device → consider fluticasone furoate/vilanterol pMDI 2, 1