Beclomethasone, Glycopyrronium, and Formoterol (Trimbow)

Key Messages

• Canada’s Drug Agency (CDA-AMC) recommends that Trimbow be reimbursed by public drug plans for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, and to reduce exacerbations (flare-ups) of COPD in patients with a history of flare-ups, if certain conditions are met.
• The subcommittee of the Canadian Drug Expert Committee (CDEC) determined that Trimbow demonstrates acceptable clinical value versus multiple inhaler triple therapies and single inhaler triple therapies in patients with COPD whose condition is not adequately controlled with optimal dual inhaled therapy. This determination was enough for the subcommittee to recommend that Trimbow be reimbursed.
• Evidence from 2 clinical trials showed that outcomes in flare-ups, lung function, health-related quality of life (HRQoL), and adverse effects were similar between Trimbow and 2 multiple inhaler triple therapies (beclomethasone dipropionate–formoterol fumarate plus tiotropium [BDP-FOR + TIO] and fluticasone furoate–vilanterol plus tiotropium [FF-VI + TIO]) in patients with COPD whose condition is not adequately controlled with dual inhaled therapy.
• Evidence from an indirect treatment comparison suggested that outcomes in flare-ups and lung function were similar between Trimbow and 2 other single inhaler triple therapies (fluticasone furoate–umeclidinium–vilanterol [FF-UMEC-VI] and budesonide–glycopyrronium–formoterol fumarate [BUD-GLY-FOR]). The indirect treatment comparison did not assess HRQoL or general adverse effects.
• Trimbow should only be covered for patients with COPD whose condition is not adequately controlled with optimal dual inhaled therapy.
• Trimbow should only be reimbursed similarly to currently reimbursed single inhaler triple combination therapies for the same indication. The cost of Trimbow should not exceed that of the least costly single inhaler triple therapy reimbursed for COPD.