Fluticasone Furoate/Vilanterol: A Review of Its Use in Chronic Obstructive Pulmonary Disease

Fluticasone furoate/vilanterol (Relvar (R), Breo (R), Revinty (R)) is a fixed combination of a corticosteroid and a long-acting beta(2)-adrenergic agonist (LABA) for once-daily use via a dry powder inhaler (Ellipta (R)). Fluticasone furoate/vilanterol 100/25 mu g is approved for the treatment of chronic obstructive pulmonary disease (COPD) in several countries. This article reviews the clinical use of the combination in COPD and summarises pharmacological properties. Fluticasone furoate has enhanced affinity for the glucocorticoid receptor compared with other clinically used inhaled corticosteroids (ICS) and longer lung retention than fluticasone propionate. Vilanterol is highly selective for beta(2)-adrenoreceptors and provides a rapid and prolonged duration of action. In phase 3 trials in patients with moderate to very severe COPD, overall, once-daily fluticasone furoate/vilanterol 100/25 mu g improved pulmonary function more than placebo and fluticasone furoate alone and improved exacerbation rates more than vilanterol alone. With regard to pulmonary function, once-daily fluticasone furoate/vilanterol 100/25 mu g was more effective than twice-daily fluticasone propionate/salmeterol 250/50 mu g and similarly effective as twice-daily fluticasone propionate/salmeterol 500/50 mu g. In 12-month trials, fluticasone furoate/vilanterol was generally well tolerated, and in 12- and 24-week trials, the incidence of adverse events was similar overall to that associated with the individual components or fluticasone propionate/salmeterol. However, as with the long-term use of all ICS agents, 12-month data indicate an increase in the risk of pneumonia with fluticasone furoate/vilanterol. In conclusion, fluticasone furoate/vilanterol is an effective and generally well tolerated additional LABA/ICS agent for the treatment of COPD with the added convenience of once-daily administration, which may improve treatment adherence in some patients.