New findings from researchers in the UK could be ‘game-changing’ for millions of people around the world living with asthma and COPD.
The type of symptom flare-up the injection treats are called ‘eosinophilic exacerbations’ and 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% of COPD flare-ups and almost 50% of asthma flare-ups. They can become more frequent as the disease progresses, leading to irreversible lung damage in some cases.
Treatment at the point of an exacerbation for this type of asthma has minimally changed for over fifty 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 sadly pass away within 90 days.
Results from the phase two clinical trial ABRA study, published in The Lancet Respiratory Medicine, have highlighted that a drug already available can be re-purposed in emergency settings to reduce the need for further treatment and hospitalisations.
Benralizamab is a monoclonal antibody which targets specific white blood cells, called eosinophils, to reduce lung inflammation. It is currently used for the treatment of severe asthma. The ABRA trial – led by researchers at King’s College London and sponsored by the University of Oxford – found that a single dose can be more effective when injected at the point of exacerbation compared to steroid tablets.
The study investigators randomised people at high risk of an asthma or COPD flare-up 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.
As a double-blind, double-dummy, active-comparator placebo-controlled trial, neither the people in the study, nor the study investigators knew which study arm or treatment they were given.
After 28 days, respiratory symptoms of cough, wheeze, breathlessness and sputum were found to be better with Benralizumab. After ninety 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.
Lead investigator of the trial, Professor Mona Bafadhel from King’s Centre for Lung Health, said 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,” Professor Bafadhel said.
“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.”
The Benralizumab injection was administered by healthcare professionals in the study but the researchers state that it could be potentially administered in the GP practice or in the Emergency Department.
Dr Sanjay Ramakrishnan, Respiratory Physician and Researcher, and the latest member of Respiratory Care WA’s Clinical Advisory Group, is the first author of the ABRA trial and worked on the trail during his time at the University of Oxford.
“COPD 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,” Dr Ramakrishnan said.
“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.”
Geoffrey Pointing (77), who took part in the study, said when you are having a flare-up it can be difficult to tell people how you feel.
“You can hardly breathe. Anything that takes that away and gives you back a normal life is what you want. But on the injections, it’s fantastic. I didn’t get any side effects like I used to with the steroid tablets. I used to never sleep well the first night of taking steroids, but the first day on the study, I could sleep that first night, and I was able to carry on with my life without problems. I want to add that I’m just grateful I took part and that the everyone involved in the ABRA study are trying to give me a better life.”
Respiratory Care WA welcomes the UK researchers’ findings and how it will inform further research and treatments to support people living with respiratory conditions.
We are here to support West Australians impacted by asthma and COPD with free best-practice community based respiratory services including diagnostic Lung Function Testing and respiratory education.
You can access the full journal article here: https://shorturl.at/dGGn7
