What is Trelegy and How Does it Work?
Trelegy Ellipta is a combination dry powder inhaler that delivers three different long-acting medications in a single dose. The synergistic action of these components addresses different aspects of lung disease pathology, providing a comprehensive approach to managing chronic respiratory conditions. The three active ingredients are:
- Fluticasone furoate: An inhaled corticosteroid (ICS) that works by reducing inflammation and swelling in the lungs and airways. For patients with asthma, this can decrease airway sensitivity to triggers, while for both asthma and COPD patients, it helps control inflammation.
- Umeclidinium: A long-acting muscarinic antagonist (LAMA), also known as an anticholinergic. It helps relax the muscles around the airways, widening them and making breathing easier.
- Vilanterol: A long-acting beta2-adrenergic agonist (LABA). This bronchodilator also works by relaxing the muscles that surround the airways to help them open up.
The effects of these medicines are long-lasting.
Conditions Treated by the TRELEGY Inhaler
Trelegy is a long-term, daily maintenance treatment and is approved for adults with specific respiratory conditions.
Chronic Obstructive Pulmonary Disease (COPD)
For adults with COPD, including chronic bronchitis and emphysema, Trelegy is used to improve breathing and reduce the number of flare-ups, also known as exacerbations. Clinical trials, such as the IMPACT study, have demonstrated that Trelegy can significantly reduce the annual rate of moderate to severe exacerbations compared to dual-therapy inhalers. By addressing inflammation and airway constriction simultaneously, it helps provide better symptom control for those at risk of exacerbations.
Asthma
Trelegy is also approved for the maintenance treatment of asthma in adults aged 18 and older. It is specifically for patients whose asthma is not adequately controlled with a combination of an inhaled corticosteroid and a long-acting beta2-agonist (ICS/LABA). The CAPTAIN study showed significant improvements in lung function for these patients with the addition of the third medication in Trelegy. This helps prevent and control asthma symptoms like wheezing over the long term.
TRELEGY vs. Other Respiratory Therapies
Trelegy is distinct from other respiratory medications due to its comprehensive triple-therapy formula in a single device. The following table highlights key differences compared to some dual-therapy options, using data from clinical studies.
| Feature | TRELEGY (Triple Therapy) | BREO (ICS/LABA Dual Therapy) | ANORO (LAMA/LABA Dual Therapy) |
|---|---|---|---|
| Active Ingredients | Fluticasone + Umeclidinium + Vilanterol | Fluticasone + Vilanterol | Umeclidinium + Vilanterol |
| Therapeutic Action | Anti-inflammatory + Dual Bronchodilator | Anti-inflammatory + Bronchodilator | Dual Bronchodilator |
| Effect on Exacerbations | Superior reduction in moderate to severe exacerbations in COPD | Less effective at reducing exacerbations compared to Trelegy | Less effective at reducing exacerbations compared to Trelegy |
| Lung Function | Superior improvement compared to both dual therapies | Less effective at improving lung function compared to Trelegy | Less effective at improving lung function compared to Trelegy |
| Risk of Pneumonia | Higher risk in some COPD patients compared to LAMA/LABA | May carry a risk of pneumonia | Less risk of pneumonia compared to Trelegy |
| Indicated For | COPD & Asthma (adults) | COPD & Asthma | COPD |
Important Safety Information and Side Effects
While Trelegy is an effective treatment, it's crucial to be aware of its potential side effects and safety considerations.
- Oral Thrush: The inhaled corticosteroid can cause a fungal infection in the mouth or throat. Patients should rinse their mouth with water and spit it out after each dose to reduce this risk.
- Pneumonia: Patients with COPD, in particular, may have an increased risk of developing pneumonia while using Trelegy. Symptoms include fever, chills, increased cough, or changes in mucus.
- Cardiovascular Effects: Some patients may experience increased blood pressure, a fast or irregular heartbeat, or chest pain. These effects warrant medical attention.
- Weakened Immune System: The corticosteroid component can suppress the immune system, making users more susceptible to infections.
- Adrenal Suppression: Long-term use can affect the adrenal glands' ability to produce hormones.
- Eye Problems: Prolonged use may lead to eye issues like glaucoma or cataracts. Regular eye exams are recommended.
- Urinary Retention: Some patients, especially those with prostate or bladder problems, may experience difficult or painful urination.
- Allergic Reactions: Severe allergic reactions, such as swelling of the face, tongue, or lips, can occur and require immediate medical attention.
- Paradoxical Bronchospasm: In rare cases, the inhaler can cause a sudden tightening of the airways. If this happens, discontinue use and seek immediate medical care.
Note: Trelegy contains lactose (milk protein) as an inactive ingredient, and should not be used by individuals with a severe milk protein allergy.
Proper Usage and Precautions
To ensure Trelegy is both safe and effective, patients should follow their doctor's instructions carefully. It is vital to remember that Trelegy is a maintenance inhaler and does not replace a fast-acting rescue inhaler for sudden breathing problems. If a dose is missed, take it as soon as you remember, but never take more than one dose as instructed by your healthcare provider.
Conclusion
Trelegy is a once-daily, single-inhaler triple therapy for adults with chronic obstructive pulmonary disease and specific types of asthma. Its combination of an inhaled corticosteroid and two bronchodilators effectively manages symptoms, improves lung function, and reduces flare-ups. However, its use requires careful consideration of potential side effects and adherence to proper administration techniques, including rinsing the mouth after each use. Patients should always have a rescue inhaler readily available for acute symptom relief.
