From the Research
Trelegy should be used with caution in patients with GERD due to potential worsening of reflux symptoms, and its use should be carefully considered based on the individual patient's risk-benefit profile. The most recent and highest quality study, published in 2025 1, compared the effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) and budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FORM) in patients with chronic obstructive pulmonary disease (COPD), but did not specifically address the issue of GERD. However, based on the known components of Trelegy, which includes fluticasone, umeclidinium, and vilanterol, it is possible that the inhaled corticosteroid component can potentially relax the lower esophageal sphincter, worsening reflux symptoms, and the anticholinergic component (umeclidinium) can slow gastric emptying, potentially exacerbating GERD.
Some key points to consider when using Trelegy in patients with GERD include:
- Taking Trelegy at least 2 hours before lying down and always with a full glass of water while standing or sitting upright to minimize the risk of reflux
- Proactively managing GERD with medications like proton pump inhibitors (such as omeprazole 20mg daily) or H2 blockers (such as famotidine 20mg twice daily) while using Trelegy
- Monitoring for worsening GERD symptoms and consulting a healthcare provider about alternative respiratory medications with fewer GERD-related side effects or adjustments to the GERD management plan if necessary
It is essential to weigh the benefits of Trelegy in managing COPD or asthma against the potential risks of worsening GERD symptoms and to make an informed decision based on the individual patient's needs and medical history. The 2025 study 1 provides valuable insights into the effectiveness of FF/UMEC/VI in reducing COPD exacerbations and mortality, but the decision to use Trelegy in patients with GERD should be made on a case-by-case basis, taking into account the potential risks and benefits.