News from the FDA/CDC

FDA: More COPD patients can use triple therapy


 

The Food and Drug Administration has approved a new indication for the chronic obstructive pulmonary disease (COPD) therapy fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta), which allows physicians to prescribe the drug to a broader class of COPD patients, according to a statement from two pharmaceutical companies.

A notepad that says, "Diagnosis COPD" copyright designer491/Thinkstock
This triple-therapy inhaler was approved for use as a long-term, once-daily maintenance treatment in some COPD patients back in September 2017. Those were defined as COPD patients who were already using the corticosteroid and long-acting beta2-agonist drug combination fluticasone furoate/vilanterol (Breo Ellipta) but required additional bronchodilation or those who were already using the same drugs contained in Trelegy Ellipta by taking both of the following two therapies: Breo Ellipta and the long-acting muscarinic antagonist umeclidinium (Incruse Ellipta). Physicians can now use fluticasone Trelegy Ellipta to treat all COPD patients who have airflow limitation or have experienced an acute worsening of respiratory symptoms, according to the statement that GlaxoSmithKline and Innoviva released on April 24. In this new population of COPD patients who are now approved to use Trelegy Ellipta, the drug will continue to serve as a long-term once-daily maintenance therapy.

“Following the initial approval of Trelegy Ellipta in September, we have analysed the data from the IMPACT study and identified additional benefits that this important medicine offers patients with [COPD],” said Hal Barron, MD, chief scientific officer and president of research and development at GlaxoSmithKline, in the statement. “We are pleased that the robust data from the IMPACT study has enabled the expanded indication announced today and the FDA action has been taken so swiftly.”

The results of the IMPACT trial, which was the first study to compare a single-inhaler triple therapy with two dual therapies, were published on April 18 (N Engl J Med 2018. doi: 10.1056/NEJMoa1713901).

This study randomized patients to 52 weeks of either triple inhaled therapy involving a once-daily combination of 100 mcg fluticasone furoate, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol; or dual inhaled therapy involving either 100 mcg fluticasone furoate plus 25 mcg of vilanterol, or 62.5 mcg of umeclidinium plus 25 mcg of vilanterol.


After 1 year, the rate of moderate to severe COPD exacerbations in the triple-therapy group was 0.91 per year, compared with 1.07 in the fluticasone furoate–vilanterol group and 1.21 in the vilanterol-umeclidinium group. This translated to a 15% reduction with triple therapy compared with fluticasone furoate–vilanterol and a 25% reduction, compared with vilanterol-umeclidinium (P less than .001 for both).

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