Single-inhaler triple therapy utilizing the once-daily combination of fluticasone furoate, umeclidinium and vilanterol in the management of COPD: the current evidence base and future prospects

Abstract

Maintenance pharmacological treatment for stable chronic obstructive pulmonary disease (COPD) is based on inhaled drugs, including long-acting muscarinic receptor antagonists (LAMA), long-acting β₂-adrenoceptor agonists (LABA) and inhaled corticosteroids (ICS). Inhaled pharmacological treatment can improve patients' daily symptoms and reduce decline of pulmonary function and acute exacerbation rate. Treatment with all three inhaled drug classes is reserved for selected, more severe, patients with COPD when symptoms are not sufficiently controlled by dual LABA/LAMA therapy and exacerbations are frequent. This review focuses on the role of single-inhaler triple therapy with once-daily fluticasone furoate/umeclidinium/vilanterol fixed-dose combination, which is in phase III clinical development for maintenance treatment of severe-to-very severe COPD. In this review, we summarize evidence providing the rationale for its use in COPD and discuss the gaps to be filled in this pharmacotherapeutic area.

Keywords: COPD; fluticasone; pharmacotherapy; single-inhaler; triple therapy; umeclidinium; vilanterol.

Figure 1.

Signal transduction pathways following activation of muscarinic M₃ receptors by acetylcholine. Ach, acetylcholine; DAG, diacylglicerol; (G)_q, GTP-binding protein; IP3, inositol-1,4,5-triphosphate; LAMA, long-acting muscarinic receptors antagonist; PKC, protein kinase C; PLC, phospholipase C.

Figure 2.

Signal transduction pathways following activation of β₂ adrenergic receptors by LABA. AC, adenylyl cyclase; cAMP, cyclic adenosine monophosphate; (G)s, stimulatory GTP-binding protein; LABA, long-acting β2-adrenoceptor agonist; MLCK, myosin light chain kinase; PKA, protein kinase A.