The first new treatment for asthma attacks in 50 years has been developed by researchers, in a move that is being hailed as ‘game-changing’ for patients.
An injection given during some asthma and chronic obstructive pulmonary disease (COPD) attacks is more effective than the current treatment of steroid tablets, reducing the need for further treatment by 30%, the study led by a team from King’s College London (KCL) has concluded.
The research, published in the journal The Lancet Respiratory Medicine, could be “game-changing” for millions of people with asthma and COPD around the world, the scientists have concluded.
Every day in the UK it is estimated as many four people with asthma and 85 people with COPD will die. Asthma and COPD costs the NHS £5.9bn a year.
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The injection treats ‘eosinophilic exacerbations’, which involves symptoms such as wheezing, coughing and chest tightness because of inflammation resulting from high amounts of eosinophils (a type of white blood cell).
Eosinophilic exacerbations make up to 30% of COPD flare-ups and almost 50% of asthma attacks, the KCL team said.
They can become more frequent as the disease progresses, leading to irreversible lung damage in some cases. There are two million attacks or exacerbations of this type in the UK per year.
Treatment at the point of an exacerbation for this type of asthma has barely changed for more than 50 years, with steroid drugs being the mainstay of medication.
Steroids such as prednisolone can reduce inflammation in the lungs but have severe side-effects such as diabetes and osteoporosis.
Furthermore, many patients fail to respond to treatment and need repeated courses of steroids, rehospitalisation or can even die within 90 days, the researchers pointed out.
Results from the phase two clinical ‘ABRA’ study, led by KCL and sponsored by the University of Oxford, showed the monoclonal antibody benralizamab, which is already available in hospitals, can be re-purposed in emergency settings to reduce the need for further treatment and hospitalisations.
The multi-centre trial was conducted at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust.
Benralizamab is currently used for the treatment of severe asthma. The ABRA trial has found a single dose can be more effective when injected at the point of exacerbation compared with steroid tablets.
The study investigators randomised people at high risk of an asthma or COPD attack into three groups, one receiving benralizumab injection and dummy tablets, one receiving standard of care (prednisolone 30mg daily for five days) and dummy injection and the third group receiving both benralizumab injection and standard of care.
After 28 days, respiratory symptoms of cough, wheeze, breathlessness and sputum were found to be better with benralizumab. After 90 days, there were four times fewer people in the benralizumab group that failed treatment compared to standard of care with prednisolone.
Treatment with the benralizumab injection took longer to fail, meaning fewer episodes 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 a game-changer for people with asthma and COPD. Treatment for asthma and COPD exacerbations have not changed in fifty years despite causing 3.8 million deaths worldwide a year combined,” said lead investigator Professor Mona Bafadhel, from King’s Centre for Lung Health.
“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 big advance in the ABRA study is the finding that targeted therapy works in asthma and COPD attacks. Instead of giving everyone the same treatment, we found targeting the highest risk patients with very targeted treatment, with the right level of inflammation was much better than guessing what treatment they needed,” Professor Bafadhel added.
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