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Trelegy Ellipta vs. Breo for COPD

Written by Andrew Le, MD

UpdatedMay 29, 2024

Chronic obstructive pulmonary disease (COPD) is a serious lung condition that can significantly impact quality of life. Finding the right treatment to manage symptoms is crucial.

Two popular choices for long-term COPD maintenance therapy are Trelegy Ellipta and Breo Ellipta, which have similarities but also some important differences.

Comparing these two inhalation drug regimens is key for understanding which might best serve an individual patient’s needs in consultation with their healthcare provider.

In this article, you will learn an in-depth review of the mechanism of action, administration, effectiveness, side effect profiles, and costs of Trelegy Ellipta versus Breo Ellipta for controlling COPD.

🔑 Key Takeaways

  • Trelegy Ellipta contains three active ingredients (fluticasone, vilanterol, and umeclidinium), while Breo Ellipta contains two (fluticasone and vilanterol). The additional anticholinergic in Trelegy aims to provide more robust symptom management.
  • Both are taken as an oral inhalation once daily, with the maximum dose being one inhalation per 24 hours. Proper use and storage of the inhaler device are essential.
  • In a large clinical trial, Trelegy Ellipta showed a 15% greater reduction in COPD flare-ups and better lung function over one year than Breo Ellipta. It also improved the quality of life versus Breo.
  • Trelegy Ellipta demonstrated a superior improvement in lung function for asthma patients versus Breo Ellipta in another major trial. However, responses can vary individually.
  • Both drugs have potentially serious side effects like breathing problems, infections, vision changes, and hormonal issues. Trelegy also lists tremors and nervousness. The common side effects differ somewhat.
  • Trelegy Ellipta costs around $323 for 28 doses, while Breo Ellipta costs around $170 for 28 doses. However, Breo's generic is more expensive. Discounts can reduce costs.
  • Our prescription savings service, Cuverd®, searches smarter than other options to find the best pricing on medications like these COPD treatments.

1. Mechanism of Action

Trelegy Ellipta and Breo Ellipta have similarities in containing the corticosteroid fluticasone and the Long-Acting Beta-Agonist (LABA) vilanterol, but Trelegy adds the Long-Acting Muscarinic Antagonist (LAMA) umeclidinium for more comprehensive symptom relief. We'll compare how these medications work to open airways.

Trelegy Ellipta

Trelegy Ellipta takes a comprehensive approach by incorporating three active ingredients—fluticasone, vilanterol, and umeclidinium. As a corticosteroid, Fluticasone addresses inflammation and swelling in the lung airways. Vilanterol, the LABA component, relaxes airway muscles, promoting their expansion.

Adding umeclidinium, an anticholinergic bronchodilator (LAMA), further enhances Trelegy's mechanism. Umeclidinium works to block the tightening of muscles around the airways, helping to maintain their openness. This triad of medications aims to provide a more robust and multifaceted approach to managing COPD symptoms, potentially reducing the need for multiple inhalers.

Breo Ellipta

Breo Ellipta operates through a combination of two active ingredients—fluticasone and vilanterol. Fluticasone, an inhaled corticosteroid, is pivotal in mitigating inflammation and reducing swelling within the lung airways. This anti-inflammatory action is crucial for managing the symptoms associated with COPD, such as difficulty breathing and chest tightness.

Vilanterol, a LABA, complements the corticosteroid by relaxing the muscles around the airways. This muscle relaxation facilitates the dilation of airways, improving the overall breathing capacity of individuals suffering from COPD.

💡 Did You Know?

Asthma and COPD are both lung diseases that obstruct breathing, but asthma is usually triggered by allergens or exercise, causing swollen, narrowed airways and excess mucus, while COPD involves chronic inflammation and damage to airways caused by irritants like cigarette smoke.

2. Dosage and Administration

Both Trelegy and Breo are inhaled powder medications taken once daily, but there are some differences in their indications and instructions for use.

Trelegy Ellipta

Trelegy Ellipta is a combination inhalation powder indicated for the long-term maintenance treatment of COPD and the prevention and control of asthma symptoms in adults.

The recommended dosage for Trelegy Ellipta in adults with COPD is one inhalation (fluticasone/umeclidinium/vilanterol 100 mcg-62.5 mcg-25 mcg) orally once a day. The maximum dose is one inhalation every 24 hours. Using the medication daily and not more than once in 24 hours is essential.

Patients are advised to follow all dosing instructions provided with the inhaler device, rinse the mouth with water (not swallowed) after use to prevent yeast infection, and store the inhaler device at room temperature, away from moisture, heat, and light.

Breo Ellipta

Breo Ellipta is also an inhalation powder prescribed for maintenance treatment of asthma or COPD.

For adults with COPD, Breo Ellipta is recommended for long-term treatment, while in people with asthma, it is used until symptoms are well-controlled with other medicines. The dosage involves using Breo Ellipta inhalation powder once daily and not more than once in 24 hours.

Like Trelegy Ellipta, users are advised to rinse their mouths with water after each use to prevent thrush. Preloaded with measured doses, the inhaler device should be stored at room temperature, away from moisture, heat, and light.


The choice between the Trelegy Ellipta and Breo Ellipta would depend on the specific respiratory condition and the patient's medical history, including any allergies or contraindications to the components of each medication. Patients must adhere to their prescribed dosage and consult their healthcare providers for any concerns or adjustments in treatment.

3. Efficacy

Both drugs have demonstrated effectiveness in controlled clinical studies, but Trelegy Ellipta offers a unique advantage in its role as a single inhaler triple therapy, containing an anticholinergic bronchodilator (umeclidinium) along with the two medications found in Breo Ellipta.

Trelegy's convenience factor is noteworthy, as it simplifies the treatment regimen by consolidating three medications into one inhaler. This can enhance patient adherence and ease the management of the disease, especially for those who may find using multiple inhalers challenging.

In a comprehensive study involving over 10,000 COPD patients, known as the IMPACT study, Trelegy Ellipta demonstrated superior effectiveness compared to Breo Ellipta. The study's primary endpoint was the annual rate of moderate to severe exacerbations (flare-ups) in COPD patients. Trelegy exhibited a 15% reduction in flare-ups over one year compared to Breo, which signifies a significant clinical benefit. Moreover, Trelegy users experienced improved lung function, as indicated by a sustained increase in forced expiratory volume in one second (FEV1) throughout the year.

The study also delved into the impact on health-related quality of life, revealing that patients using Trelegy reported better outcomes in daily symptoms, daily activities, and perceived well-being than those on Breo. This holistic improvement in quality of life is a crucial consideration when evaluating the overall effectiveness of a COPD treatment.

The CAPTAIN study involving over 2,400 patients with asthma further demonstrated Trelegy Ellipta's superior efficacy compared to Breo. The improvement in lung function, measured by the change in trough FEV1 at 24 weeks of treatment, was substantial with both strengths of Trelegy (100/62.5/25 mcg and 200/62.5/25 mcg) when compared to Breo. Trelegy significantly improved FEV1 over 24 weeks, reinforcing its efficacy in asthma management.


It's crucial to emphasize that individual responses may vary, and the choice between Trelegy and Breo should be made in consultation with a healthcare professional who can assess the patient's specific symptoms, medical history, and overall health. Personalized treatment plans are essential to ensure optimal outcomes for individuals with COPD or asthma, taking into account the unique characteristics of each patient's condition.

4. Side Effects

Both medications have potentially serious respiratory, vision, hormonal, and other side effects. We'll compare those along with the more common side effects.

Trelegy Ellipta

Serious side effects:

  • Tremors, nervousness, chest pain, fast or pounding heartbeats
  • Sores or white patches in the mouth and throat, pain when swallowing
  • Wheezing, choking, or other breathing problems after use
  • Painful or difficult urination
  • Blurred vision, tunnel vision, eye pain, or seeing halos around lights
  • Signs of lung infection: Fever, chills, cough with mucus, feeling short of breath
  • High blood sugar: Increased thirst, increased urination, dry mouth, fruity breath odor
  • Low potassium level: Leg cramps, constipation, irregular heartbeats, fluttering in the chest, numbness or tingling, muscle weakness, or limp feeling
  • Signs of a hormonal disorder: Worsening tiredness or muscle weakness, feeling light-headed, nausea, vomiting

Common side effects:

  • Cold or flu symptoms like a runny or stuffy nose, sore throat, cough, chest tightness
  • Lung infection
  • Nausea, vomiting, constipation, diarrhea
  • Joint pain
  • Mouth sores, hoarse voice
  • Headache, back pain
  • Mouth pain, changes in taste

Breo Ellipta

Serious side effects:

  • Wheezing, choking, or other breathing problems after use
  • Chest pain, fast or pounding heartbeats, pounding in the neck or ears
  • Sores or white patches in the mouth and throat, pain when swallowing
  • Fever, chills, cough with yellow or green mucus
  • Blurred vision, tunnel vision, eye pain, or seeing halos around lights
  • High blood sugar: Increased thirst, increased urination, dry mouth, fruity breath odor
  • Low potassium level: Leg cramps, constipation, irregular heartbeats, fluttering in the chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling
  • Signs of a hormonal disorder: Worsening tiredness or muscle weakness, feeling light-headed, nausea, vomiting

Common side effects:

  • Headache, back pain, joint pain
  • Fever, flu symptoms
  • Increased blood pressure
  • Runny or stuffy nose, sore throat, cough, or a hoarse voice

5. Cost

While Breo Ellipta has a lower upfront cost, Trelegy's savings programs can narrow the price difference. We'll overview the costs and available discounts for both.

Trelegy Ellipta

Trelegy Ellipta, with its inhalation powder (100 mcg-62.5 mcg-25 mcg/inh), comes with a price tag of approximately $323 for a 28-powder dose supply. This cost is for cash-paying customers and may not apply to insurance plans.

The price can be further reduced through discounts, such as the Discount Card, co-pay coupons, or patient assistance programs. Several options are available to eligible patients, including a co-pay coupon for commercially insured individuals, a Medicare Part D Extra Help Subsidy, and various patient assistance programs offered by organizations like the Patient Access Network Foundation (PAN) and GSK.

Breo Ellipta

On the Breo Ellipta side, the inhalation powder (100 mcg-25 mcg/inh) costs around $170 for a 28-powder dose supply. Breo Ellipta also has a generic version available, with prices starting from $381.44 for 60 powder doses. While Breo Ellipta seems to have a lower initial cost than Trelegy Ellipta, it's essential to note that the generic version is priced higher, which could impact the overall cost-effectiveness.

Also, Breo Ellipta offers discounts through the Discount Card, allowing customers to save up to 80% or more off the retail price. Patient assistance programs, such as those provided by the Patient Access Network Foundation (PAN) and GSK, are also available for eligible individuals.

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Wrap Up

Trelegy Ellipta and Breo Ellipta have demonstrated efficacy as maintenance treatments for COPD, but Trelegy stands out for containing an additional active ingredient that enables it to open airways even further.

In a major clinical trial, Trelegy reduced flare-ups more than Breo over one year and improved lung function and quality of life. However, Breo does have a lower cost.

Ultimately, working with one's doctor to weigh the pros and cons of these two options based on medical history and needs is imperative.

FAQs on Trelegy Ellipta and Breo Ellipta

Do Trelegy Ellipta and Breo Ellipta contain steroids?

Yes, both contain fluticasone furoate, which is a corticosteroid. Trelegy contains a lower dose of the steroid component than Breo.

Are there any contraindications or special warnings for Trelegy Ellipta and Breo Ellipta?

Trelegy has warnings related to glaucoma risk and urinary retention due to its anticholinergic component. Both have risks if patients have untreated infections or are exposed to chickenpox or measles.

Which patients might be better suited for Trelegy Ellipta and Breo Ellipta?

Trelegy may be preferred for patients with more severe COPD. Breo may be suitable for those concerned about anticholinergic side effects or with contraindications for that class.