Key Points

Both Trelegy and Anoro have been shown to be effective for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults. However, Trelegy contains an extra medicine, the inhaled corticosteroid known as fluticasone as part of a triple therapy for COPD. Trelegy has been shown in clinical studies to offer an advantage over Anoro to patients with worsening COPD symptoms.

These medicines are used once daily to help breathing symptoms and reduce the number of flare-ups in patients with COPD. COPD is a chronic lung disease that includes chronic bronchitis, emphysema, or both.

In COPD studies, patients taking Trelegy had improved lung function when compared to patients taking Anoro. Triple therapy in one inhaler may also offer improved treatment and convenience in patients with COPD flare-ups.

Trelegy is also approved for the maintenance treatment of asthma in adults, but Anoro is not approved for this indication.

Which medicines are in Trelegy and Anoro?

Trelegy Ellipta contains three long-acting medications:

• fluticasone, an inhaled corticosteroid that lowers inflammation and swelling in the lung airways
• vilanterol, a long-acting beta-agonist (LABA), that works by relaxing muscles in the airways to improve breathing.
• umeclidinium, an anticholinergic drug, which also helps to relax the airways.

Anoro Ellipta is only for use in people with COPD and is not FDA-approved to treat asthma.

• Anoro Ellipta inhalation powder contains umeclidinium and vilanterol, 2 of the same 3 medications found in Trelegy. These drugs work by relaxing muscles in the airways to improve breathing.

You should use either Trelegy or Anoro, but not both. Neither drug is used to control sudden breathing problems. You should use a rescue inhaler, such as albuterol (ProAir, Proventil HFA, Ventolin HFA) or levalbuterol (Xopenex), for sudden symptoms. If you do not have a rescue inhaler, speak with your doctor.

Some patients may need to move up to triple therapy for long-term control of their breathing symptoms or flare-ups due to COPD.

How does Trelegy compare to Anoro in studies?

It can be helpful to look at comparative studies to see how well different medicines work. In studies of patients with worsening COPD symptoms, patients taking Trelegy had improved lung function when compared to patients taking Anoro.

Trelegy Ellipta and Anoro Ellipta were compared in a 52-week study evaluating over 10,000 patients being treated for COPD. Patients participating in the study had moderate to severe COPD and a history of flare-ups in the past year.

In this clinical trial, called the IMPACT study, the main endpoint researchers were looking for was the yearly rate of moderate or severe exacerbations (flare-ups) during treatment.

• The results showed that Trelegy was more effective for reducing flare-ups and improving lung function compared to the two medicines in Anoro. Trelegy reduced flare-ups by 25% compared to Anoro over one-year, a significant effect.
• Triple therapy with Trelegy also resulted in a 34% lower rate of hospitalization due to COPD than with Anoro.
• The results also showed that patients who took Trelegy Ellipta could breathe out significantly more air in one second compared to those who took Anoro Ellipta, which is known as the forced expiratory volume in one second (FEV1). This improved lung function was sustained over the one year period.
• Based on a survey, Trelegy also improved patient’s health-related quality of life when compared to Anoro, which included items such as daily symptoms, daily activities and perceived well-being.

Are side effects similar between Trelegy and Anoro?

Trelegy contains fluticasone, vilanterol and umeclidinium, while Anoro contains only umeclidinium and vilanterol. Because Trelegy contains an extra medicine (fluticasone, an inhaled corticosteroid), some side effects may differ between the two drugs. In general, these medications are effective and well-tolerated in most patients who use them; however, your effects may vary.

Examples of the most common effects seen with the use of Trelegy include:

• upper respiratory tract infection
• runny nose and sore throat
• pneumonia (lung infection)
• taste disturbance
• bronchitis
• constipation
• thrush (fungal infection) in your mouth and throat (to help prevent rinse your mouth with water without swallowing)
• painful and frequent urination (signs of a urinary tract infection)
• headache
• nausea, vomiting, and diarrhea
• back pain
• mouth and throat pain
• joint pain
• cough
• flu
• hoarse voice
• sinus swelling

Examples of the most common effects seen with the use of Anoro include:

• sore throat
• sinus infection
• lower respiratory infection
• common cold symptoms
• constipation
• diarrhea
• pain in your arms or legs
• muscle spasms
• neck pain
• chest pain

You are unlikely to develop thrush as a side effect of Anoro as it does not contain the corticosteroid fluticasone. Inhaled corticosteroids are associated with this side effect.

These are not all of the common or serious side effects that can occur with Trelegy Ellipta or Anoro Ellipta. See their individual package inserts to review more side effects (in detail), or ask your doctor or pharmacist for an explanation.

Related questions

• What are some alternatives for Trelegy Ellipta?
• Can asthma inhalers cause a sore throat?
• What is the difference between Breztri vs Trelegy?

Can I use Trelegy or Anoro for sudden breathing problems?

No. Neither drug is a rescue medicine for bronchospasm attacks and sudden breathing problems. Use only your fast-acting inhalation medicine (for example, albuterol or levalbuterol) for sudden symptoms.

If you do not have a fast-acting inhaler, call your doctor for a prescription. Seek emergency medical treatment or call 911 if your breathing problems get worse quickly.

Do not take Trelegy or Anoro with other medicines that contain a long-acting beta2-adrenergic agonist (LABA) or an anticholinergic for any reason. If you are not sure if your medicines contain these drugs, ask your doctor or pharmacist.

Which costs more - Trelegy or Anoro?

The cost of medications can vary based on your insurance type, coverage, copays, pharmacy, discounts, and location.

• The cash price for a one-month supply of Anoro Ellipta (one inhaler), which contains 2 medicines, is around $450, using an online coupon.
• The cash price for a one month supply of Trelegy Ellipta (one inhaler), which contains 3 medicines, is around $600, using an online coupon.
• No generic alternatives are available for either Trelegy or Anoro at this time.

These are expensive medications. If your insurance does not cover the cost of these medications, you may be able to receive help for your prescription costs from GlaxoSmithKline (GSK), the manufacturer of these medicines.

In addition, online coupons and discount cards are available that may lower your price if you are paying cash.

If you are still having trouble with the cost of this medicine, contact your doctor to determine if there are comparable but more affordable options available to treat your COPD.

Bottom Line

• Trelegy Ellipta and Anoro Ellipta are oral inhalers for the long-term treatment of COPD. They are not used for sudden breathing problems. Do not use both of these medicines; use one or the other as prescribed by your doctor.
• Trelegy is also approved for maintenance treatment of asthma, but Anoro is not.
• Common side effects that occur with both Trelegy and Anoro include respiratory tract infections, constipation and sore throat. Other side effects may occur.
• Neither Trelegy nor Anoro are available as a lower-cost generic at this time. These medications are expensive but may be covered by your insurance.
• GlaxoSmithKline (GSK) is the manufacturer of both of these drugs and may be able to help you with the cost of your medicine if you are eligible.

This is not all the information you need to know about Trelegy Ellipta or Anoro Ellipta for safe and effective use. Review the full product information and discuss this information with your doctor or other health care provider.

References

• Lipson 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(18):1671-1680. Accessed Sept. 18, 2020 at doi:10.1056/NEJMoa1713901
• Trelegy Ellipta [Prescribing Information]. GlaxoSmithKline. Research Triangle Park, NC. Accessed Sept. 18, 2020 at https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Trelegy/pdf/TRELEGY-ELLIPTA-PI-PIL-IFU.PDF
• Anoro Ellipta [Prescribing Information]. GlaxoSmithKline. Research Triangle Park, NC. Accessed Sept. 18, 2020 at https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Anoro_Ellipta/pdf/ANORO-ELLIPTA-PI-PIL-IFU.PDF
• Trelegy Ellipta. Efficacy. Accessed Sept. 18, 2020 at https://gskpro.com/en-us/products/trelegy/efficacy

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