First new asthma treatment in 50 years offers hope for millions

A breakthrough clinical trial has revealed that an injection given during asthma and COPD (chronic obstructive pulmonary disease) flare-ups is significantly more effective than the traditional treatment of steroid tablets. 

According to findings published in The Lancet Respiratory Medicine, the injection reduces the need for further treatment by 30%, offering a potential “game-changing” solution for millions worldwide.

Asthma and COPD flare-ups, known as exacerbations, can be life-threatening. In the UK alone, four people with asthma and 85 with COPD tragically lose their lives each day. 

These conditions are not only deadly but also widespread, with someone in the UK experiencing an asthma attack every 10 seconds. Combined, asthma and COPD cost the NHS £5.9 billion annually.

Targeted approach to asthma treatment 

The injection specifically targets “eosinophilic exacerbations,” which account for up to 30% of COPD flare-ups and nearly 50% of asthma attacks. 

These exacerbations result from inflammation caused by elevated levels of eosinophils, a type of white blood cell, leading to symptoms such as wheezing, coughing, and chest tightness.

Historically, the standard treatment for such flare-ups has been steroids like prednisolone, which reduce lung inflammation. However, these drugs come with significant side effects, including an increased risk of diabetes and osteoporosis. 

Furthermore, many patients do not respond adequately to steroids, leading to repeated hospitalizations or, in severe cases, death within 90 days of treatment.

Testing the new asthma treatment 

The ABRA trial, led by researchers from King’s College London, tested the efficacy of a monoclonal antibody called benralizumab, already approved for managing severe asthma. 

The drug targets eosinophils, reducing lung inflammation. For the trial, the drug was repurposed as a one-time injection administered during exacerbations.

The multi-center trial, conducted at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust, randomized participants into three groups.

One group received the benralizumab injection with placebo tablets, while another received standard steroid treatment (prednisolone) with a placebo injection. The third group received both the injection and standard care.

As a double-blind, placebo-controlled study, neither the participants nor the researchers knew which treatment was being administered.

Game-changing treatment for people with asthma 

The results were striking. After 28 days, participants in the benralizumab group showed significant improvements in respiratory symptoms such as coughing, wheezing, and breathlessness compared to those receiving steroids. 

By the 90-day mark, treatment failure rates were four times lower in the benralizumab group than in the steroid group.

Not only did the injection reduce the need for doctor visits or hospitalizations, but it also improved patients’ overall quality of life.

“This could be a game-changer for people with asthma and COPD,” said Professor Mona Bafadhel, lead investigator of the trial. 

“Treatment for asthma and COPD exacerbations has not changed in 50 years despite causing 3.8 million deaths worldwide a year combined. The big advance in the ABRA study is the finding that targeted therapy works in asthma and COPD attacks.”

A safe and versatile treatment

The study demonstrated that benralizumab is safe, with no significant side effects compared to past studies of the drug.

While healthcare professionals administered the injections during the trial, the drug could potentially be delivered at home, in GP practices, or in emergency departments in the future.

Professor Bafadhel emphasized the importance of personalized treatment: “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.”

Addressing a critical need in lung health

The findings underscore a critical gap in research and treatment for lung conditions. Dr. Samantha Walker, Director of Research and Innovation at Asthma + Lung UK, celebrated the breakthrough but highlighted the long delay in innovation. 

“It’s appalling that this is the first new treatment for those suffering from asthma and COPD attacks in 50 years, indicating how desperately underfunded lung health research is.”

“Every four minutes in the UK, someone dies from a lung condition. Thousands more live with the terror of struggling to breathe every day,” she added.

The future of asthma treatment

The ABRA trial’s success highlights the importance of collaboration between universities and healthcare systems. 

“The ABRA trial was only possible with collaboration between the NHS and universities and shows how this close relationship can innovate health care and improve people’s lives,” said lead author Sanjay Ramakrishnan, a clinical research fellow at the University of Western Australia and the University of Oxford.

As researchers continue to explore benralizumab’s potential, the hope is that it will transform how asthma and COPD exacerbations are managed globally. 

“We hope these pivotal studies will change how asthma and COPD exacerbations are treated for the future, ultimately improving the health for over a billion people living with asthma and COPD across the world,” Bafadhel concluded.

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