A recent trial indicates that an injection administered during certain asthma and COPD attacks is more effective than the existing approach of using steroid tablets, leading to a 30% reduction in subsequent treatment needs.
An injection given during some asthma and COPD attacks is more effective than the current treatment of steroid tablets, reducing the need for further treatment by 30%.
Findings published today in The Lancet Respiratory Medicine could significantly impact millions of individuals suffering from asthma and COPD globally, according to researchers.
Asthma attacks and flare-ups of COPD can be life-threatening. In the UK, four individuals with asthma and 85 with COPD lose their lives daily due to these conditions. Asthma is particularly prevalent, with someone experiencing an attack every 10 seconds. The economic burden of asthma and COPD on the NHS amounts to £5.9 billion annually.
The type of flare-up treated by this injection is known as ‘eosinophilic exacerbations,’ characterized by symptoms like wheezing, coughing, and chest tightness due to inflammation from elevated eosinophils (a subtype of white blood cells). Eosinophilic exacerbations account for 30% of COPD flare-ups and nearly 50% of asthma attacks. As the diseases worsen, these symptoms can become more frequent, leading to potential irreversible lung damage.
Treatment options for this specific type of asthma exacerbation have remained largely unchanged for over fifty years, primarily relying on steroid medications. While steroids such as prednisolone can decrease lung inflammation, they also come with serious side effects, including diabetes and osteoporosis. Many patients struggle with treatment failures, often requiring repeated steroid courses, readmissions to hospitals, or facing mortality within 90 days.
Results from the phase two clinical trial named the ABRA study, conducted by researchers from King’s College London and supported by the University of Oxford, show promising outcomes with a drug that is readily available. This drug could be repurposed in urgent care settings to reduce the necessity for further treatments and hospital admissions. The multi-center trial took place at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust.
Benralizumab is a monoclonal antibody that targets specific white blood cells responsible for lung inflammation. Currently, it is utilized in managing severe asthma. The findings from the ABRA trial indicate that a single injection can be more effective than steroid tablets when administered at the onset of an asthma exacerbation.
The study randomly assigned participants at high risk for asthma or COPD attacks into three groups: one received the benralizumab injection along with dummy tablets, another group received the standard treatment (prednisolone 30mg daily for five days) along with a placebo injection, and the third group received both the benralizumab injection and standard care. In this double-blind, double-dummy trial, neither the participants nor the researchers were aware of which treatment was administered.
After 28 days, respiratory symptoms such as cough, wheezing, breathlessness, and sputum production showed improvement in the group receiving benralizumab. After 90 days, the number of participants in the benralizumab group who experienced treatment failure was four times lower compared to those receiving prednisolone.
Furthermore, treatment involving the benralizumab injection took longer to result in treatment failure, which led to fewer visits to doctors or hospitals. Participants also reported an enhancement in their quality of life.
Professor Mona Bafadhel, the lead investigator from King’s College London, remarked, “This could revolutionize care for individuals with asthma and COPD. Treatment approaches for exacerbations of these conditions haven’t changed in fifty years, resulting in 3.8 million deaths worldwide annually.”
“Benralizumab is a proven, safe, and effective medication for severe asthma management. We utilized this drug in a novel manner—at the time of exacerbation—and discovered that it surpasses steroid tablets, which are currently the sole available treatment option. The main innovation of the ABRA study is that targeted therapies can be effective for asthma and COPD exacerbations. Instead of administering a universal treatment, we found that focusing on the highest-risk patients with precise treatment based on their inflammation levels yields far superior results than merely guessing what they might need.”
In the trial, healthcare professionals administered the benralizumab injection, but it could also be safely administered at home, within GP practices, or in emergency departments. The study confirmed that benralizumab was safe, with a safety profile similar to that of numerous previous studies.
Professor Bafadhel expressed hopes that these crucial studies will transform the treatment landscape for asthma and COPD exacerbations, ultimately enhancing the health of over a billion individuals struggling with these conditions worldwide.
Dr. Sanjay Ramakrishnan of the University of Western Australia, who spearheaded the ABRA trial while at the University of Oxford, commented: “Our research holds immense promise for asthma and COPD management. COPD ranks as the third leading cause of death globally, yet treatment options remain stuck in the past. We need to offer life-saving alternatives for patients before it’s too late.”
“The collaboration between the NHS and universities made the ABRA trial feasible, demonstrating how this partnership can foster healthcare innovations and improve lives.”
Geoffrey Pointing, 77, from Banbury, who participated in the study, shared, “When experiencing a flare-up, it’s tough to communicate how you feel—you can hardly breathe. Anything that alleviates that and restores a sense of normalcy is invaluable. After receiving the injections, my experience was fantastic. I didn’t suffer side effects like I previously did with steroid tablets. Normally, with steroids, I’d struggle to sleep on the first night, but that first night in the study, I slept well and was able to resume my life without issues. I’m just thankful to have been a part of it, and I appreciate everyone involved in the ABRA study for striving to improve my quality of life.”
Dr. Samantha Walker, Director of Research and Innovation at Asthma + Lung UK, stated: “This is fantastic news for individuals with lung conditions as it presents a potential alternative to steroid tablets for treating asthma attacks and COPD exacerbations. However, it’s disheartening that this is the first new treatment in 50 years for these patients, highlighting the significant underfunding of lung health research.”
“Every four minutes in the UK, someone dies from a lung condition. Thousands more live daily in fear of struggling for breath. With your support, we are advocating for more transformative, life-saving research to improve the future for everyone with respiratory challenges. Together, we will ensure that families do not face lung health issues without access to the best treatments and care.”
“Our goal is a world where everyone enjoys healthy lungs. Achieving that requires your assistance.”
This research received support from AstraZeneca UK Limited.
