NAPLEX® Review Question of the Week: Making SMART Decisions
A physician calls you to discuss a 23-year-old patient with uncontrolled asthma who is currently only on as needed albuterol. The physician tells you how they read about the benefits of SMART therapy, and they want to start their patient on an inhaled corticosteroid and a long acting beta agonist. Which of the following products would you recommend to the physician that would meet these drug class requirement criteria?
A. Arnuity Ellipta
B. Trelegy Ellipta
C. Incruse Ellipta
D. Breo Ellipta
Answer with rationale
Although it is tricky, it is essential to master the brand and generic names for each inhaler product in order to appropriately counsel your patients and to succeed on the NAPLEX. In addition, a number of misfills have occurred with products with similar names, especially those that all use the Ellipta device.
There is increasing evidence pointing to the convenience of use and effectiveness of having a single inhaler for relieving symptoms and maintaining open airways in patients with asthma. Both SMART and MART therapy are essentially the same, in which they both refer to a single inhaler approach to relieve and maintain asthma symptoms. The Global Initiative for Asthma and the National Asthma Education and Prevention Program both recommend the use of SMART therapy in patients with moderate to severe asthma. The inhaler must contain an inhaled corticosteroid (ICS) and a long acting beta-2 agonist (LABA) in order to reduce inflammation and open up the patients’ airways. As of right now, Symbicort and Dulera are recommended for SMART therapy use by national guidelines. Some challenges that may arise as SMART therapy use becomes more and more accepted is having insurance companies adjust their formularies to cover more than one inhaler at one time. Hence while certain products that fulfill SMART criteria are not 1st line per guidelines, they may be the only product offered on a formulary.
Answer A is incorrect. Arnuity Ellipta contains only fluticasone furoate, a corticosteroid.
Answer B is incorrect. Trelegy Ellipta contains fluticasone furoate, a corticosteroid, umeclidinium, a long acting muscarinic antagonist, and vilanterol, a LABA. Therefore it contains one additional therapy than what was requested by the physician for management.
Answer C is incorrect. Incruse Ellipta contains only umeclidinium, a long acting muscarinic antagonist.
Answer D is correct. Breo Ellipta contains fluticasone furoate (inhaled corticosteroid) and vilanterol (LABA). This is the only answer choice Ellipta product that contains both an inhaled corticosteroid and a LABA.
Brand/Generic: Anoro Ellipta (fluticasone furoate), Breo Ellipta (fluticasone furoate + vilanterol), Dulera (mometasone furoate + formoterol fumarate), Incruse Ellipta (umeclidinium), Symbicort (budesonide + formoterol fumarate), Trelegy Ellipta (fluticasone furoate + umeclidinium + vilanterol)
NAPLEX Content Domains Covered:
2.A.1 Drug names and therapeutic classes
Dr. Christopher M. Bland is the Albert W. Jowdy Professor in Pharmacy Care at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has nearly 25 years of academic and clinical experience both in the inpatient and community patient care settings. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy and has been named Teacher of the Year at the University of Georgia College of Pharmacy. He is co-author of the book "InteGREAT: A Guidebook for Creating Great Healthcare Teams."
He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with nearly 100 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as upcoming 5th edition, as well as the Editor-In-Chief for the Question of the Week. He has provided hundreds of hours in live, interactive NAPLEX reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.
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