A new study published in The Lancet Respiratory Medicine offers a promising breakthrough for those grappling with asthma and chronic obstructive pulmonary disease (COPD).
Researchers have found that a single injection delivered during acute episodes could outshine traditional steroid tablets, leading to a remarkable 30% reduction in the necessity for additional treatment.
This development stands to reshape the lives of countless people affected by these chronic respiratory conditions around the world.
Impact of Asthma and COPD on Health and Economy
Asthma flare-ups and COPD exacerbations not only pose serious health risks but are also alarmingly common.
In the UK, they contribute to four asthma-related deaths and 85 COPD-related fatalities every day.
With an asthma incident occurring every 10 seconds, the financial strain of these conditions on the National Health Service (NHS) is estimated to be a staggering £5.9 billion yearly.
The injections focus on a specific type of exacerbation known as eosinophilic exacerbations.
Characterized by wheezing, coughing, and chest tightening, these episodes result from inflammation driven by elevated levels of eosinophils— a type of white blood cell.
Eosinophilic exacerbations are implicated in nearly 30% of COPD flare-ups and close to 50% of asthma attacks, with their frequency potentially increasing as the diseases progress, which could lead to irreversible lung damage.
For over half a century, treatments for acute asthma symptoms have remained largely stagnant, with corticosteroids like prednisolone serving as the primary therapy despite their significant side effects, which may include diabetes and osteoporosis.
Treatment failures are common, often resulting in recurrent steroid courses, hospitalizations, or even mortality within 90 days post-exacerbation.
The ABRA Study and Benralizumab
The ABRA study, a phase two clinical trial conducted by King’s College London in partnership with the University of Oxford, suggests that a well-known medication can be adapted for emergency use to decrease the likelihood of subsequent treatment or hospitalization.
This multicenter trial was carried out at various NHS trusts, including Oxford University Hospitals and Guy’s and St Thomas’.
The medication evaluated in this study, benralizumab, is a monoclonal antibody designed to lessen lung inflammation by targeting eosinophils.
While currently approved for treating severe asthma, the ABRA study revealed that a single benralizumab injection outperformed conventional steroid therapies in alleviating exacerbation symptoms.
Participants at heightened risk of asthma or COPD attacks were evenly divided into three groups: one received the benralizumab injection alongside placebo tablets, another received standard treatment—prednisolone 30mg for five days—alongside a placebo injection, while the third group received both benralizumab and standard treatment.
In this double-blind, placebo-controlled trial, neither researchers nor participants knew their assigned treatment.
After just 28 days, those treated with benralizumab reported marked improvements in respiratory symptoms, including reductions in coughing, wheezing, breathlessness, and sputum production.
Notably, at the 90-day follow-up, the treatment failure rate among participants in the benralizumab group was four times lower than that of those receiving standard care.
Future Implications and Need for Research
The benralizumab group experienced delays in treatment failure, resulting in fewer healthcare visits and notable enhancements in quality of life for those suffering from asthma and COPD.
Professor Mona Bafadhel, the lead investigator from King’s College London, articulated the potential of this development to fundamentally alter the landscape for people with asthma and COPD.
As conditions that currently contribute to approximately 3.8 million deaths globally each year, exacerbation treatments have seen little evolution in the past fifty years.
The advent of benralizumab could pave the way for more personalized treatments tailored to specific inflammation levels rather than a one-size-fits-all solution.
Currently administered by healthcare professionals during trials, the benralizumab injection may eventually be offered at home, in general practices, or emergency settings, thanks to its established safety profile.
Future studies like the ABRA trial could revolutionize management strategies for asthma and COPD exacerbations, potentially improving the lives of over a billion people worldwide living with these chronic conditions.
Dr. Sanjay Ramakrishnan, a Clinical Senior Lecturer at the University of Western Australia and first author of the ABRA trial, highlighted the urgent need for advancements in treatment options, particularly given that COPD is the third leading cause of death worldwide.
The ABRA trial serves as a prime example of how collaborative efforts between the NHS and academic institutions can foster healthcare innovations that enhance lives.
One study participant, Geoffrey Pointing, a 77-year-old from Banbury, shared his experience of participating in the trial.
He described how flare-ups make communication daunting and breathing laborious.
The injection not only alleviated his symptoms without the side effects associated with steroid tablets but also allowed him to reclaim a sense of normalcy in his life.
Dr. Samantha Walker, Director of Research and Innovation at Asthma + Lung UK, welcomed the findings as a potential alternative to steroid tablets for managing asthma attacks and COPD exacerbations.
However, she lamented that this innovation represents the first new treatment in 50 years, highlighting the critical need for increased funding in lung health research.
With someone succumbing to a lung condition in the UK every four minutes, she stresses the importance of ongoing transformative research to ensure that all people facing lung conditions have access to optimal treatment and care.
This essential research has garnered support from AstraZeneca UK Limited.
“`html
Study Details:
- Title: Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial
- Authors: Sanjay Ramakrishnan, Richard E K Russell, Hafiz R Mahmood, Karolina Krassowska, James Melhorn, Christine Mwasuku, Ian D Pavord, Laura Bermejo-Sanchez, Imran Howell, Mahdi Mahdi, Stefan Peterson, Thomas Bengtsson, Mona Bafadhel
- Journal: The Lancet Respiratory Medicine
- Publication Date: 2024
- DOI: 10.1016/S2213-2600(24)00299-6
“`