Trelegy Ellipta: Is There Any Downside To Taking All Three Medications Together?

Is There Any Downside to Taking Trelegy Ellipta?

Dear Dr. Mahler:

I read your recent post and have heard of Ellipta, though now Trelegy may be one step newer…
Is there any downside to taking all these helpers at once?
I was thinking, although it is more to do in a day, that keeping them separate might be a good thing.  More effect from each on their own?
Maybe not!
Thanks.

Katherine from Greensboro, NC

Dear Katherine:

Thanks for commenting on my recent post about a new 3-in-1 approved inhaler by the Food and Drug Administration (FDA) for those with COPD on September 18.

Please note that this single inhaler contains three different medications for treatment of those with COPD. These medications are already combined together and are available. These are Anoro Ellipta (different bronchodilators – vilanterol and umeclidinium) and Breo Ellipta (a bronchodilator – vilanterol – and an inhaled corticosteroid – fluticasone). So, the pharmaceutical company, GlaxoSmithKline, combined all three medications together in a dry powder inhaler called Trelegy Ellipta. They performed various studies (called randomized clinical trials) as required by the Food and Drug Administration. The company then submitted the results to the FDA for review and consideration of approval.

Although it may seem confusing, the different Ellipta inhalers along with numerous other inhalers developed by other pharmaceutical companies provide many options for health care providers to hopefully make it easier for you to breathe with activities and to reduce the chances of having a flare-up (called exacerbation). These treatment strategies are provided by the a group of experts in COPD called the GOLD committee.

You asked about a downside to taking all three medications together. Please note that current recommendations for the use of inhaled corticosteroids in treating those with COPD is for those individuals who have had 2 flare-ups (exacerbations) in the past one year OR one flare-up that was “bad enough” to require hospitalization. The reason for this recommendation is that inhaled corticosteroids can have side effects. The most concerning is an increased risk of pneumonia. Other possible side effects include a yeast infection in the throat, bruising of the skin, and thinning of the bones (called osteoporosis).

As with all medications, your health care provider should consider the likely benefits of the medications along with possible side effects. Some people call this “weighing the balance.”

A scale to weigh the benefits and risks of Trelegy Ellipta

A scale represents weighing the benefits and risks of a medication

 

I hope that this information is helpful. I encourage you to discuss the available inhalers with your health care professional.

Best wishes,

Donald A. Mahler, M.D.

Updated COPD Management Recommendations by GOLD

COPD Management Recommendations by GOLD Committee

On  World COPD Day (November 16, 2016) updated recommendations for management of those with COPD were released. The group of experts from throughout the world who made the recommendations is called the GOLD committee. GOLD stands for Global Initiative for Chronic Obstructive Lung Disease.

Bartolome Celli, M.D., of Brigham and Women's Hospital

Bartolome Celli, M.D., of Brigham and Women’s Hospital

Pulmonary physicians from the United States on the Board of Directors of GOLD include: Bartolome Celli, M.D., of Brigham and Women’s Hospital in Boston and Gerald Criner, M.D., of Louis Katz School of Medicine in Philadelphia.

Dr. Criner is on the Board of Directors which makes COPD management recommendations

Gerald Criner, M.D., Chair and Professor, Thoracic Medicine and Surgery

 

 

The COPD management recommendations can be found on the website: http://goldcopd.org. The major goals of treatment are to reduce symptoms (shortness of breath) and to reduce the risk of sudden worsening (called an exacerbation).

The following statements summarize the recommendations for personalized treatment of those with stable COPD.

  1. Long-acting bronchodilators (last 12 – 24 hours) are preferred over short-acting drugs (last 4 – 6 hours) for those with occasional shortness of breath.
  2. Either one or two long-acting bronchodilators may be used as initial treatment.  Increase to two bronchodilators is recommended if improvement is not achieved with one drug. The three approved dual bronchodilators available for prescription in the US are shown below.
    Anoro Ellipta enables patients to breathe easier with two bronchodilators

    Anoro Ellipta dry powder inhaler

    Stiolto Respimat delivers a fine mist.

    Stiolto Respimat delivers a fine mist.

     

    Bevespi contains two different bronchodilators in a single device

    Bevespi is a pressurized metered-dose inhaler

  3. For those who have a history of sudden worsening of COPD (exacerbation), use of an inhaled corticosteroid may be considered in addition to a long-acting beta-agonist bronchodilator (Advair, Symbicort, and Breo).
  4. For severe hereditary alpha-1 antitrypsin deficiency, replacement therapy (also called augmentation therapy) should be considered.
  5. Medicines to suppress coughing (called antitussives) are not recommended.
  6. If breathing difficulty is severe and disabling, low dose narcotics (opioids like morphine) may be considered.

These COPD management recommendations are based on the results of published clinical trials.