Trelegy vs. Breo: How does their use and cost compare?

Trelegy Ellipta and Breo Ellipta are both orally inhaled maintenance (long-term) medications for treatment of either asthma or COPD (including chronic bronchitis, emphysema).

Trelegy Ellipta contains three long-acting medications: fluticasone, an inhaled corticosteroid, vilanterol, a long-acting beta-agonist (LABA), and umeclidinium, an anticholinergic drug. Breo Ellipta contains only two of these medications: fluticasone and vilanterol. You should use either Trelegy or Breo, but not both.

These medicines are used once daily to help with breathing symptoms and reduce the number of flare-ups by lowering lung inflammation and relaxing the airways. They are not used to control sudden breathing problems.

Trelegy Ellipta is an orally inhaled medicine approved by the FDA as a maintenance treatment for asthma and chronic obstructive pulmonary disease (COPD) in adults. Trelegy Ellipta is inhaled once per day and contains 3 medications:

• fluticasone, a corticosteroid, lowers inflammation and swelling in the lung airways
• vilanterol, a long-acting beta-agonist (LABA) that relaxes the airway muscles to help open airways
• umeclidinium, an anticholinergic drug, helps to block muscle tightening around your airways to improve breathing.

Breo Ellipta is also an orally inhaled medicine used once-daily for the treatment of asthma in adults and children 5 years of age and older. It's also used for long-term treatment of COPD in adults. Breo Ellipta only contains two medicines (these are also found in Trelegy):

• the corticosteroid fluticasone
• the long-acting beta-agonist (LABA) vilanterol

Breo Ellipta does not contain the anticholinergic bronchodilator umeclidinium, which is found in Trelegy.

Do I use Trelegy and Ellipta together?

Do not use both Breo Ellipta and Trelegy Ellipta to treat your asthma or COPD. Only use one drug or the other as prescribed by your doctor. Follow your doctor’s instructions exactly.

Do not use other medicines that contain a long-acting beta-agonist (LABA) or an anticholinergic for any reason. Ask your health care provider or pharmacist if any of your other medicines contain LABA or anticholinergic medicines.

Neither of these drugs should be used as a fast-acting (rescue) inhaler for the relief of sudden breathing problems.

To learn more, see:

• Trelegy Ellipta dosing (in more detail)
• Breo Ellipta dosing (in more detail)

After inhalation of either Trelegy or Breo, you should rinse your mouth with water (without swallowing) to lower the risk of developing oral thrush, a type of fungal infection.

A short-acting (rescue) inhaler, like albuterol should be used for immediate relief of breathing symptoms if needed.

Which is better - Trelegy or Breo ?

Both drugs have been shown to be effective for the treatment of asthma or COPD in controlled clinical studies. However, some patients may need to move up to triple therapy for long-term control of their breathing symptoms or flare-ups. In the past, this often involved the use of two separate inhalers.

Patients who are not adequately controlled by using the two medicines found in Breo Ellipta may find that Trelegy Ellipta offers an advantage as it also contains umeclidinium, an anticholinergic bronchodilator, all in one inhaler. This means you may only need one inhaler instead of two, which may be more convenient.

Trelegy was the first FDA-approved, single inhaler, triple therapy for once-daily maintenance treatment of both asthma and COPD in the U.S.

Trelegy and Breo studies

COPD
Trelegy Ellipta and Breo Ellipta were both compared in a study evaluating over 10,000 patients being treated for COPD. In this study, called the IMPACT study, the main endpoint researchers were looking at was the annual rate of moderate to severe exacerbations ("flare-ups") in patients with COPD.

• The results showed that Trelegy was more effective for reducing flare-ups and improving lung function compared to the two medicines in Breo. Trelegy reduced flare-ups by 15% compared to Breo over one-year, a significant effect.
• The results also showed that patients who took Trelegy Ellipta could breathe out significantly more air in one second compared to those who took Breo 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 these patient’s health-related quality of life when compared to Breo, which included items such as daily symptoms, daily activities and perceived well-being.

Asthma
In the CAPTAIN study in over 2,400 patients with asthma, Trelegy Ellipta led to an improvement in lung function when compared to Breo using two different strengths of Trelegy: 100/62.5/25 mcg and 200/ 62.5/25 mcg.

• Improvement in lung function was measured by the change from baseline in trough forced expiratory volume over one second (FEV1) at 24 weeks of treatment.
• Compared to Breo (fluticasone furoate / vilanterol) 100/25 mcg, Trelegy Ellipta 100/62.5/25 mcg once daily demonstrated a 110 mL significant improvement in FEV1 over a 24 week period.
• When Trelegy Ellipta 200/62.5/25 mcg once daily, triple therapy was compared to Breo 200/25 mcg dual therapy, a significant improvement of 92 mL in trough FEV1 was seen for Trelegy.

Your results can vary as each person’s condition is unique. Your doctor can evaluate your symptoms and determine which treatment may be the best option for you.

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 Breo 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 (brand examples: ProAir or Ventolin) or levalbuterol (brand name: Xopenex) 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 Breo with other medicines that contain a long-acting beta2-adrenergic agonist (LABA) or an anticholinergic for any reason. If you are not sure, check with your pharmacist.

Are side effects similar between Trelegy and Breo?

Trelegy contains fluticasone, vilanterol and umeclidinium, while Breo contains only fluticasone and vilanterol. Because Trelegy contains an extra medicine, some side effects may differ between the two drugs.

Examples of similar side effects seen with the use of Trelegy Ellipta or Breo Ellipta include:

• upper respiratory tract infection
• pneumonia
• flu
• bronchitis
• thrush fungal infections (oral candidiasis)
• headache
• back or joint pain
• swelling of the sinuses
• runny nose, sore throat, cough
• mouth and/or throat pain
• hoarse voice

Additional common side effects you may experience with Trelegy that were not reported with Breo include:

• taste disturbance
• constipation
• diarrhea
• upset stomach or infection
• urinary tract infection

Additional common side effects you may experience with Breo that were not reported with Trelegy include:

• increased blood pressure
• fever

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

How do Trelegy and Breo come from the pharmacy?

Both Trelegy Ellipta and Breo Ellipta come as dry powder oral inhalers that you use once a day. You breathe the medicine into your lungs. Your doctor, nurse or pharmacist can show you how to use your inhaler. Do not use both of these medicines to treat your asthma or COPD.

These inhalers come with foil strips that contain the medicine. You place the foil strips into the inhaler before you breathe in the medicine.

• For Trelegy, one strip contains fluticasone furoate (100 or 200 mcg per blister), and the other strip contains a blend of umeclidinium and vilanterol (62.5 and 25 mcg per blister, respectively). A blister from each strip is used to create 1 dose.
• For Breo, one strip contains fluticasone furoate (50, 100 or 200 mcg per blister), and the other strip contains vilanterol (25 mcg per blister). A blister from each strip is used to create 1 dose.

Which costs more - Trelegy or Breo?

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

No generic alternatives are available for Trelegy, but a generic option for Breo is available at this time.

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

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

Related:

• Trelegy Ellipta: Price Guide, Coupons and Manufacturer Assistance
• Breo Ellipta: Price Guide, Coupons and Manufacturer Assistance

If you are still having trouble with the cost of this medicine, contact your doctor to determine if there are other, more affordable options available to treat your asthma or COPD. It's important you do not go untreated.

Bottom Line

Trelegy Ellipta and Breo Ellipta are oral inhalers for the long-term treatment of asthma or 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.

Common side effects that occur with both Trelegy and Breo include respiratory tract infections, oral thrush, headache and sore throat. Other common and serious side effects may occur.

Breo Ellipta is available as a generic option, but Trelegy is only available as a brand name product as of March 2024. These medications are expensive but may be covered by your insurance. The manufacturer of both of these drugs, GlaxoSmithKline (GSK), may be able to help you with the costs.

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