An injection given during some asthma and COPD attacks is more effective than current treatment with steroid tablets, reducing the need for further treatment by 30%.
The findings, published today in Lancet Respiratory Medicinecould be a “game changer” for millions of people with asthma and COPD around the world, scientists say.
Asthma attacks and COPD flares (also called exacerbations) can be fatal. Four people with asthma and 85 people with COPD will tragically die every day in the UK. Both conditions are also very common: in the UK someone has 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 “eosinophilic exacerbations” and involves symptoms such as wheezing, coughing, and chest tightness due to inflammation resulting from high amounts of eosinophils (a type of white blood cell). Eosinophilic exacerbations account for up to 30% of COPD flares and almost 50% of asthma attacks. They can become more frequent as the disease progresses, in some cases causing irreversible lung damage.
Treatment at the time of an exacerbation of this type of asthma has hardly changed for more than fifty years, with steroids being the mainstay of medication. Steroids like prednisolone can reduce inflammation in the lungs, but they 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 two clinical trial of the ABRA study, led by scientists at King’s College London and sponsored by the University of Oxford, show that an already available drug can be repurposed in emergency settings to reduce the need for additional treatments and hospitalizations. The multicentre trial was conducted at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust.
Benralizamab is a monoclonal antibody that targets specific white blood cells, called eosinophils, to reduce lung inflammation. It is currently used for the treatment of severe asthma. The ABRA trial has found that a single dose may be more effective when injected at the time of exacerbation compared to steroid tablets.
Study researchers randomly assigned people at high risk for an asthma or COPD attack into three groups: one that received an injection of benralizumab and dummy tablets, another that received standard care (prednisolone 30 mg daily for five days ) and a dummy injection and the third group that received both benralizumab injections. and standard of care. As a double-blind, double-dummy, active-comparator, placebo-controlled trial, neither the people in the study nor the study investigators knew which arm of the study or treatment they were given.
After 28 days, respiratory symptoms of cough, wheezing, shortness of breath, and sputum were found to improve with benralizumab. After ninety days, there were four times fewer people in the benralizumab group who failed treatment compared to standard treatment with prednisolone.
Treatment with benralizumab injection took longer to fail, meaning fewer episodes of seeing a doctor or going to the hospital. There was also an improvement in the quality of life of people with asthma and COPD.
Lead researcher on the trial, Professor Mona Bafadhel from King’s College London, said: “This could be a game-changer for people with asthma and COPD. Treatment for asthma and COPD exacerbations has not changed in fifty years despite causing 3.8 million deaths annually worldwide.
“Benralizumab is a safe and effective drug that is already used to control severe asthma. We have used the drug in a different way (at the time of an exacerbation) to show that it is more effective than steroid tablets, which is the only treatment currently. The big breakthrough 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 that targeting the highest-risk patients with a very specific treatment, with the right level of inflammation, was much more important. “Better than guessing what treatment they receive.”
Benralizumab injection was administered by healthcare professionals in the study, but can potentially be administered safely at home, in the GP’s office, or in the emergency department. Benralizumab was safe in the study and similar in safety to many previous studies.
Professor Mona Bafadhel said: “We hope these pivotal studies will change the way asthma and COPD exacerbations are treated in the future and ultimately improve the health of more than a billion people living with asthma and COPD around the world.
Dr Sanjay Ramakrishnan, senior clinical lecturer at the University of Western Australia, first author of the ABRA trial and who began the work while at the University of Oxford, said: “Our study shows great promise for the treatment of asthma and COPD. COPD is the third leading cause of death worldwide, but treatment for this condition is stuck in the 20th century. We need to give these patients life-saving options before their time runs out.
“The ABRA trial was only possible thanks to 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 have an attack, it’s very difficult to tell someone how you feel – you can barely breathe. Anything that takes that away from you and gives you back a normal life, that’s what you want. But with the injections, it’s fantastic. I didn’t have any side effects like I used to with steroid tablets. I never slept well the first night of taking steroids, I was able to sleep that one. first night and I was able to continue with my life without problems. I want to add that I am grateful to have participated and that everyone involved in the ABRA study is trying to give me a better life.”
Dr Samantha Walker, Research and Innovation Director at Asthma + Lung UK, said: “It is great news for people with lung diseases that a potential alternative to taking steroid tablets to treat asthma attacks has been found. and chronic obstructive pulmonary disease (COPD). pulmonary.
“Every four minutes in the UK, someone dies from a lung disease. Thousands more live in terror of struggling to breathe every day. With your help, we fight for more life-changing and life-saving research to transform the future. For all people living with respiratory problems. Together, we will ensure that families around the world never face a lung condition without the best treatment and care.
“Our vision is a world where everyone has healthy lungs. We can only achieve this with your help.”
This research was carried out with the support of AstraZeneca UK Limited.