A new development in respiratory medicine has emerged with a drug for asthma and chronic obstructive pulmonary disease (COPD), advancing treatment options after 50 years. According to a study published in The Lancet, the drug Benralizumab demonstrated a 30% reduction in need for hospitalisations among patients, showing an improvement in disease management.
Researchers from the University of Oxford and King’s College London have described the findings, published in The Lancet Respiratory Medicine, as potentially transformative for millions of people living with asthma and COPD worldwide. The study received support from the NIHR Oxford Biomedical Research Centre (BRC).
The Study
Researchers proposed that a single injection of benralizumab, a humanized monoclonal antibody targeting the interleukin-5 receptor-alpha, alone or combined with predisolone, could improve clinical outcomes more effectively than predisolone alone, which is the current standard treatment.
The phase two ABRA trial, led by King’s College London and sponsored by the University of Oxford, explored repurposing an existing drug, benralizumab, to reduce asthma and COPD exacerbations, hospitalizations, and additional treatments. Conducted at Oxford University Hospitals and Guy’s and St Thomas’ NHS Foundation Trust, the double-blind, placebo-controlled study involved three patient groups:
- Benralizumab with placebo tablets,
- Standard care (prednisolone 30 mg for 5 days) with placebo injection,
- Benralizumab with standard care.
After 28 days, the benralizumab group showed better improvement in symptoms (cough, wheeze, breathlessness) than the standard care group. At 90 days, treatment failures in the benralizumab group were four times fewer, with fewer doctor visits and hospitalizations. Participants also reported improved quality of life with benralizumab, highlighting its potential for managing asthma and COPD exacerbations effectively.
Research in Context :
Exacerbations of chronic obstructive pulmonary disease (COPD) have been shown to involve distinct biological clusters, or endotypes, with eosinophilic inflammation being a common feature in both asthma and COPD exacerbations. Current treatments for these exacerbations rely on systemic glucocorticoids, as recommended by international guidelines for managing acute exacerbations of asthma and COPD. Respiratory conditions are the leading reason for prescribing systemic glucocorticoids worldwide, despite their well-documented harmful effects.
Randomized controlled trials conducted in primary and secondary hospital settings have highlighted the usefulness of blood eosinophil counts in identifying patients who may not require systemic glucocorticoids. However, for patients with elevated blood eosinophil counts, who are at the highest risk for exacerbations, there are currently no alternatives to systemic glucocorticoids. (https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00299-6/fulltext)
Procedures
Patients were evaluated at urgent care or emergency departments during exacerbation and at 7, 14, 28, and 90 days post-randomization. Assessments included spirometry, fractional exhaled nitric oxide, symptom questionnaires, and safety labs (blood tests and pregnancy tests for women). Asthma and COPD patients completed disease-specific and general health scales, with higher scores indicating better or worse control depending on the metric. An unmasked investigator reviewed lab results for safety monitoring.
How It Works
The drug targets inflammation and airway constriction in asthma and COPD by blocking specific lung receptors, reducing mucus, and preventing airway remodeling. It provides rapid relief and long-term disease control, addressing limitations of current therapies.
Future Outlook
The success of this drug paves the way for further research into similar therapies that could offer even greater benefits. Researchers are optimistic about its potential to reshape the landscape of respiratory medicine.
