Once-daily triple therapy for COPD to be PBS listed

A once-daily, single inhaler triple therapy for  chronic obstructive pulmonary disease (COPD) is set to be listed on the PBS from 1 July.

The triple-therapy inhaler Trelegy Ellipta (fluticasone furoate, umeclidinium and vilanterol) is indicated for long-term maintenance treatment of adults with moderate to severe COPD.

COPD kills about 3 million people each year, making it the third most common cause of death worldwide behind heart disease and stroke. Globally there were an estimated 251 million cases of COPD in 2016, while in Australia over 1.45 million people have some form of COPD.¹

A randomised controlled trial of the triple therapy was undertaken in 10,355 patients with COPD over 52 weeks. The inhaled combination of a glucocorticoid (fluticasone furoate), a long-acting muscarinic antagonist-LAMA (umeclidinium), and a long-acting β2-agonist-LABA (vilanterol) was compared against dual therapy (either glucocorticoid–LABA or LAMA–LABA) to measure the annual rate of moderate or severe COPD exacerbations during treatment.²

The trial found:²

• a 25% reduction for Trelegy Ellipta compared with Anoro Ellipta (umeclidinium/vilanterol);
  0.91 vs 1.21 per year respectively; p<0.001
• a 15% reduction for Trelegy Ellipta compared with Breo Ellipta (fluticasone furoate/vilanterol);
  0.91 vs 1.07 per year respectively; p<0.001

According to Professor Philip Bardin, Director of Respiratory Medicine at Monash Health, improved access to Trelegy Ellipta through PBS listing could lead to reduced exacerbations for patients being treated for COPD.

‘Triple therapy in a single inhaler is an emerging option for COPD and we’re always looking at new ways to reduce exacerbations for our patients. New options with good evidence behind them are always going to be of interest for the future, so I certainly welcome increased access to Trelegy Ellipta,’ Professor Bardin said.

‘I would like to emphasise that the triple therapy should not be used indiscriminately. It is only indicated if combined LABA/LAMA therapy has not been successful to reduce exacerbations. Adding a glucocorticoid  as part of triple therapy will not improve symptoms and can be detrimental since it is linked to a higher incidence of pneumonia,’ he told Australian Pharmacist.

The editorial from the journal issue in which the trial was published discusses these concerns further.

Product Information: Trelegy Ellipta

References

¹Trounson A. Putting the brakes on lung disease. 2018. At: https://pursuit.unimelb.edu.au/articles/putting-the-brakes-on-lung-disease

²Lipson DA, Barnhart F, Brealey N, et al.  Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med  2018; 378:1671-1680