Asthma attacks and chronic obstructive pulmonary disease flare-ups, also called exacerbations, can be deadly; every day in the UK four people with asthma and 85 people with chronic obstructive pulmonary disease will die. Asthma and chronic obstructive pulmonary disease costs the NHS £5.9 billion a year. The injection treats a type of flare-up called ‘eosinophilic exacerbations’, which involve 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 make up to 30 percent of chronic obstructive pulmonary disease flare-ups and almost 50 percent of asthma attacks. They can become more frequent as the disease progresses, leading to irreversible lung damage in some cases. There are two million of these exacerbations in the UK every year.
Treatment at the point of an exacerbation for this type of asthma has barely changed for over 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’ treatment and need repeated courses of steroids, re-hospitalisation or die within 90 days.
Results from the phase two ABRA clinical trial - conducted at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust - show that a drug that is already available can be repurposed in emergency settings to reduce the need for further treatment and hospitalisations.
Benralizumab is a monoclonal antibody which targets eosinophils to reduce lung inflammation. It is currently used for the treatment of severe asthma. The ABRA trial found that a single dose can be more effective when injected at the point of exacerbation compared to steroid tablets. 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.
Lead investigator Professor Mona Bafadhel, formerly a researcher at the Nuffield Department of Medicine and now at the King's Centre for Lung Health, said: ‘This could be a game-changer for people with asthma and chronic obstructive pulmonary disease. Treatment for asthma and chronic obstructive pulmonary disease exacerbations have not changed in 50 years. The big advance in the ABRA study is the finding that targeted therapy works in asthma and chronic obstructive pulmonary disease 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. We hope these pivotal studies will change how asthma and chronic obstructive pulmonary disease exacerbations are treated for the future, ultimately improving the health for over a billion people living with asthma and COPD across the world.’
The first author of the ABRA trial Dr Sanjay Ramakrishnan, who started the work while at NDM and is now Clinical Senior Lecturer at the University of Western Australia, said: ‘Our study shows massive promise for asthma and chronic obstructive pulmonary disease treatment. Chronic obstructive pulmonary disease is the third leading cause of death worldwide but treatment for the condition is stuck in the 20th century. We need to provide these patients with life-saving options before their time runs out. The ABRA trial was only possible with collaboration between the NHS and universities and shows how this close relationship can innovate healthcare and improve people’s lives.’
The full paper is available on the Lancet Respiratory Medicine website.