What is the recommended dose of Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) for chronic obstructive pulmonary disease?

Trelegy Ellipta Dosing for COPD

The recommended dose of Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) for chronic obstructive pulmonary disease is 100/62.5/25 μg (delivering 92/22/55 μg) administered as one inhalation once daily. 1, 2

Standard Dosing Regimen

• One inhalation once daily in the morning is the established dosing schedule for Trelegy Ellipta in COPD patients 2
• The single-inhaler formulation delivers fluticasone furoate 100 μg, umeclidinium 62.5 μg, and vilanterol 25 μg per actuation 1, 2
• This once-daily dosing provides 24-hour coverage for maintenance treatment 1

Patient Selection Criteria

Trelegy Ellipta is specifically indicated for patients who meet the following criteria:

• Moderate to severe COPD who are not adequately controlled on dual therapy with an inhaled corticosteroid plus long-acting beta-agonist 1
• Patients with severe COPD experiencing repeated exacerbations despite optimal dual bronchodilator therapy 3
• Adults aged 40 years or older with documented COPD and history of at least one moderate or severe exacerbation in the previous 12 months 2

Clinical Efficacy at Standard Dose

The 100/62.5/25 μg once-daily dose has demonstrated:

• Significant improvements in trough FEV1 ranging from 111-128 mL compared to dual therapy 2, 4
• Reduction in moderate-to-severe exacerbations with 24-27% of patients experiencing exacerbations over 24 weeks compared to higher rates with dual therapy 2, 5
• Clinically meaningful improvements in CAT scores with reductions of 2.6 units at 12 months in real-world settings 6
• Improved health status with approximately 50% of patients achieving responder status on quality of life measures 2

Administration Considerations

• Delivered via the ELLIPTA dry powder inhaler device, which requires proper technique verification 7
• Up to 76% of COPD patients make critical errors with inhaler use, making technique assessment essential before escalating therapy 7
• The single-inhaler formulation is non-inferior to using two separate inhalers (FF/VI plus UMEC) for the same medication components 2

Common Pitfalls to Avoid

• Do not prescribe higher doses than the standard 100/62.5/25 μg formulation, as this is the only licensed strength for COPD 1
• Verify the diagnosis of COPD and rule out other conditions before initiating triple therapy 7
• Assess current inhaler technique before assuming treatment failure, as poor technique is extremely common 7
• Monitor for pneumonia risk, particularly in patients with additional risk factors, though incidence remains low (0-1%) across studies 4

Safety Profile

• Adverse event rates of 30-48% are comparable to dual therapy regimens 2, 4
• Cardiovascular events of special interest occur in less than 1-3% of patients 4
• Pneumonia incidence remains low at 0-1% in clinical trials 4
• No new safety signals have emerged in real-world effectiveness studies 6

When Triple Therapy May Be Insufficient

If patients remain symptomatic on Trelegy at the standard dose:

• Evaluate for home nebulizer therapy with high-dose bronchodilators after formal respiratory physician assessment 7
• Consider adding theophyllines with careful monitoring for side effects in severe disease 7
• Ensure optimal management of exacerbations with increased bronchodilators, oral corticosteroids (30 mg daily for one week), and antibiotics when indicated 7
• Implement non-pharmacological approaches including pulmonary rehabilitation, nutritional support if malnourished, and vaccination 7