Can Wixela (fluticasone/salmeterol) be taken once daily for Chronic Obstructive Pulmonary Disease (COPD) and still be effective?

From the Guidelines

Wixela (fluticasone propionate/salmeterol) should not be taken only once a day for COPD, as its standard dosing is twice daily to maintain adequate medication coverage and effectiveness. The medication is specifically designed with a 12-hour duration of action, containing both an inhaled corticosteroid (fluticasone) to reduce inflammation and a long-acting beta-agonist (salmeterol) to relax airway muscles. Taking it only once daily would leave you without adequate medication coverage for approximately 12 hours each day, potentially leading to symptom breakthrough, increased exacerbations, and poorer disease control.

Key Considerations

• The standard dosing for COPD is typically one inhalation of Wixela Inhub 250/50 mcg twice daily, approximately 12 hours apart 1.
• Combination inhaled corticosteroid/long-acting β-agonist therapy, like Wixela, is recommended for patients with stable moderate, severe, and very severe COPD to prevent acute exacerbations of COPD, as it improves lung function, health-related quality of life, dyspnea, and reduces use of rescue medication 1.
• There are few data comparing triple therapy with double or single therapy, but available evidence suggests that combination therapy improves lung function and health-related quality of life, although it may increase the risk of adverse events like pneumonia 1.

Alternative Options

If you're finding it difficult to maintain a twice-daily regimen, it's essential to discuss this with your healthcare provider rather than reducing the frequency on your own. They might consider alternative medications with once-daily dosing that are specifically formulated for 24-hour coverage, such as certain other combination inhalers designed for once-daily use in COPD management.

Evidence-Based Decision

The recommendation to take Wixela twice daily is based on the highest quality evidence available, which emphasizes the importance of maintaining adequate medication coverage to prevent symptom breakthrough and exacerbations in COPD patients 1. While there are studies suggesting the effectiveness of once-daily formulations, these are typically for different medications specifically designed for 24-hour coverage, not for Wixela, which has a 12-hour duration of action.

From the FDA Drug Label

The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. The FDA-approved dosage for COPD is twice daily, and there is no indication that taking Wixela once a day would be effective for COPD treatment 2.

• The recommended dosage is 1 inhalation of Wixela Inhub 250/50 twice daily.
• There is no evidence to support the effectiveness of taking Wixela only once a day for COPD.
• Twice-daily administration is the approved regimen for COPD treatment 2.

From the Research

Wixela for COPD Treatment

• Wixela is a generic equivalent of Advair Diskus, a fixed-dose combination of fluticasone propionate/salmeterol powder for oral inhalation, used for patients with asthma or COPD 3.
• The efficacy of once-daily fluticasone furoate/vilanterol (FF/VI) has been compared to twice-daily fluticasone propionate/salmeterol (FP/SAL) in COPD patients, showing that FF/VI provides FEV1 improvement comparable to FP/SAL 4.
• A study comparing once-daily FF/VI with twice-daily FP/SAL in patients with asthma-COPD overlap syndrome found that FF/VI provided substantial improvement in lung functions, indicating its potential for regular treatment of ACOS 5.
• Another study demonstrated that umeclidinium/vilanterol (UMEC/VI) resulted in statistically significant, clinically meaningful improvements in lung function versus FP/SAL in patients with moderate-to-severe COPD and infrequent exacerbations 6.
• The IMPACT study showed that triple therapy with umeclidinium, fluticasone furoate, and vilanterol had a greater effect compared to dual therapies in reducing the rate of moderate-severe exacerbations, improving trough FEV1, and improving quality of life 7.

Administration and Efficacy

• Once-daily administration of FF/VI with a simple and effective device may increase adherence and efficacy of the treatment 7.
• The safety profiles of FF/VI and FP/SAL are similar, with pooled adverse events and serious adverse events being comparable between treatments 4.
• Wixela Inhub, a generic equivalent of Advair Diskus, has been shown to have comparable in vitro performance, improvements in forced expiratory volume in 1 s, and fluticasone propionate/salmeterol dose strengths to Advair Diskus 3.