A new injection treatment could be a game-changer for people with asthma and COPD

A new injection treatment could be a game-changer for people with asthma and COPD

An injection for some asthma and COPD attacks is more effective than current treatment with steroid tablets and reduces the need for further treatment by 30%.

The results published today inThe Lancet Respiratory Medicinecould be a “game-changer” for millions of people with asthma and COPD around the world, scientists say.

Asthma attacks and COPD flare-ups (also called exacerbations) can be fatal. Four people with asthma and 85 people with COPD tragically die every day in the UK. Both conditions are also very common, with someone in the UK having an asthma attack every 10 seconds. Asthma and COPD cost the NHS £5.9 billion a year.

The type of symptom flare that the injection treats is called an “eosinophilic exacerbation” and includes symptoms such as wheezing, coughing, and chest tightness due to inflammation caused by high levels of eosinophils (a type of white blood cell). Eosinophilic exacerbations account for up to 30% of COPD flares and almost 50% of asthma attacks. As the disease progresses, they may occur more frequently and, in some cases, lead to irreversible lung damage.

The treatment of this type of asthma at the time of exacerbation has changed little for over fifty years, with steroid medications representing the main drug treatment. Steroids such as prednisolone can reduce inflammation in the lungs, but have serious side effects such as diabetes and osteoporosis. Additionally, many patients “fail” treatment and require repeated courses of steroids, rehospitalization, or die within 90 days.

Results from the Phase 2 ABRA clinical trial, led by scientists at King's College London and sponsored by the University of Oxford, show that an already available drug can be reused in emergency situations to reduce the need for further treatment and hospitalization. The multi-centre study was carried out at Oxford University Hospitals NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust.

Benralizamab is a monoclonal antibody that targets certain white blood cells called eosinophils to reduce lung inflammation. It is currently used to treat severe asthma. The ABRA study found that a single dose may be more effective when injected at the time of exacerbation compared to steroid tablets.

Study researchers randomized people at high risk of an asthma or COPD attack into three groups: one received a benralizumab injection and dummy tablets, one received standard treatment (prednisolone 30 mg daily for five days) and a dummy injection, and the third group received both benralizumab injections and standard of care. Since it was a double-blind, placebo-controlled, double-dummy study with an active comparator, neither the study participants nor the study researchers knew which study arm or which treatment they were receiving.

After 28 days, respiratory symptoms of cough, wheezing, shortness of breath and sputum were found to be improved with benralizumab. After ninety days, there were four times fewer people in the benralizumab group who failed treatment compared to standard treatment with prednisolone.

Benralizumab injection treatment took longer to fail, meaning fewer episodes required to see a doctor or go to hospital. There was also an improvement in the quality of life for people with asthma and COPD.

This could be crucial for people with asthma and COPD. The treatment of asthma and COPD exacerbations has not changed in fifty years, even though they together cause 3.8 million deaths worldwide annually.

Benralizumab is a safe and effective medication that is already used to treat severe asthma. We used the drug in a different way - at the time of an exacerbation - to show that it is more effective than steroid tablets, which are currently the only treatment available. The major advance of the ABRA study is the finding that targeted therapy works for asthma and COPD attacks. Instead of giving everyone the same treatment, we found it was much better to target the highest risk patients with very targeted treatment and the right level of inflammation rather than just guessing what treatment they needed.”

Mona Bafadhel, lead investigator on the trial, professor at King’s College London

The benralizumab injection was administered by healthcare professionals in the study, but may be safe to administer at home, in the GP practice or in the emergency room. Benralizumab was found to be safe in the study and was similar to many previous studies in terms of safety.

Professor Mona Bafadhel said: “We hope these key studies will transform the way asthma and COPD exacerbations are treated in the future and ultimately improve the health of over one billion people living with asthma and COPD worldwide.”

Sanjay Ramakrishnan, Clinical Senior Lecturer at the University of Western Australia, who was lead author of the ABRA study and began work at the University of Oxford, said: "Our study shows great potential for the treatment of asthma and COPD. COPD is that." It is the third leading cause of death worldwide, but treatment of the disease is stuck in the 20th century. We must provide these patients with life-saving options before their time runs out.

“The ABRA study was only possible through collaboration between the NHS and universities and shows how this close relationship can innovate healthcare and improve people’s lives.”

Geoffrey Pointing, 77, from Banbury, who took part in the study, said: "Honestly, when you're having a flare-up it's very difficult to tell anyone how you're feeling - you can barely breathe. All that takes away and gives." They want to lead a normal life again, but I don't have any side effects from the injections like I used to with the steroid tablets. I never slept well the first night of taking steroids, but on the first day of the study I was able to sleep the first night and carry on with my life without any problems. I would like to add that I am just grateful that I participated and that everyone was involved in the ABRA study trying to give me a better life.

Dr. Samantha Walker, director of research and innovation at Asthma + Lung UK, said: "It's great news for people with lung disease that a potential alternative to steroid tablets has been found to treat asthma attacks and chronic obstructive pulmonary disease (COPD)." But it's shocking that this is the first new treatment for people suffering from asthma and COPD attacks, showing how research into lung health is severely underfunded.

"Someone dies from lung disease every four minutes in the UK. Thousands more live with the fear of not being able to breathe every day. With your help, we are fighting for more life-changing and life-saving research to transform the future." for anyone living with breathing problems. Together, we ensure that families everywhere never face lung disease without the best treatment and care.

"Our vision is a world in which everyone has healthy lungs. Only with your help can we get there."

This research was conducted with support from AstraZeneca UK Limited.

The paper, titled “Monoclonal antibodies are better than standard treatment for some types of asthma attacks and COPD flare-ups, results from phase II clinical trials show,” was published in The Lancet Respiratory Medicine.

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