Doctors find using drug differently may be ‘gamechanger’ for asthma treatment

The results could be transformative for millions of people with asthma and COPD around the world. File photo 

Doctors are hailing a new way to treat serious asthma and chronic obstructive pulmonary disease (COPD) attacks that marks the first breakthrough for 50 years and could be a “gamechanger” for patients.

A trial found offering patients an injection was more effective than the current care of steroid tablets, and cuts the need for further treatment by 30%. The results, published in the Lancet Respiratory Medicine journal, could be transformative for millions of people with asthma and COPD around the world.

Benralizumab is a monoclonal antibody that targets specific white blood cells, called eosinophils, to reduce lung inflammation. It is used as a repeat treatment for severe asthma at a low dose, but the trial found a higher single dose could be very effective if injected at the time of a flare-up.

Lead investigator Professor Mona Bafadhel, of King’s College London, said: “This could be a gamechanger for people with asthma and COPD. Treatment for asthma and COPD exacerbations have not changed in 50 years, despite causing 3.8 million deaths worldwide a year, combined.

“Benralizumab is a safe and effective drug already used to manage severe asthma. We’ve used the drug in a different way — at the point of an exacerbation — to show that it’s more effective than steroid tablets, which is the only treatment currently available.” 

The drug trial

The trial involved 158 people who needed medical attention in A&E for their asthma or COPD attack.

Patients were given a quick blood test to see what type of attack they were having, with those suffering an “eosinophilic exacerbation” being suitable for treatment. About 50% of asthma attacks are eosinophilic exacerbations, as are 30% of COPD attacks, according to the scientists.

The trial, led by King’s and carried out at Oxford University hospitals NHS foundation trust and Guy’s and St Thomas’ NHS foundation trust, saw patients randomly split into three groups.

One group received the benralizumab injection and dummy tablets. Another group received standard care of prednisolone steroids, 30mg daily for five days, and a dummy injection. The third group received the benralizumab injection and steroids.

After 28 days, respiratory symptoms of coughing, wheezing, breathlessness and sputum were found to be better in those on benralizumab. After 90 days, there were four times fewer people in the benralizumab group who failed treatment compared with those receiving steroids.

Treatment with the benralizumab injection also took longer to fail, meaning fewer visits to a GP or hospital for patients, researchers said. Furthermore, people also reported a better quality of life on the new regime.

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Scientists said steroids could have severe side-effects such as increasing the risk of diabetes and osteoporosis, meaning switching to benralizumab could provide huge benefits.

Benralizumab could also potentially be administered safely at home or in a GP practice, as well as in in a hospital emergency department, they said. AstraZeneca provided the drug for the study and funded the research, but had no input into trial design, delivery, analysis or interpretation.

Side-effects

In Ireland also this drug has potential to be “a game-changing breakthrough”, the Asthma Society medical director said.

Professor Marcus Butler said it is especially interesting for patients who want to avoid the side-effects of traditional steroid treatments.

“It's a litany of side-effects — which we see virtually none of these sorts of side-effects with these alternative injections,” he said.

Those side-effects can include osteoporosis and life-limiting fractures later in life as well as weight-gain and having paper-thin skin, he said.

However this new treatment is only at Phase II study stage, and needs to be confirmed on a larger scale before being approved around the world, he told RTÉ's Today with Claire Byrne.

It offers “genuine hope”, he said, for asthma patients and those with a COPD-like flare-up for avoiding steroids and having a better outcome in the three months following the injection.