First new asthma attack treatment in 50 years could be 'game-changing'

The first new treatment for asthma attacks in decades could prove "game-changing" for patients, researchers say.

Four people with asthma and 85 with chronic obstructive pulmonary disease (COPD), a progressive condition with symptoms similar to asthma, die every day and someone has an asthma attack every 10 seconds in the UK. About one in 10 children in the UAE are believed to have asthma.

Eosinophilic exacerbations – caused by high concentrations of a type of white blood cells called eosinophils – account for about 30 per cent of flare-ups in COPD and almost half of asthma attacks. They can become more frequent as the disease progresses, leading to irreversible lung damage in some cases.

Treatment for eosinophilic exacerbations has barely changed in 50 years. They are usually treated by steroids, which can reduce inflammation in the lungs, but have severe side effects such as diabetes and osteoporosis and do not always work.

The new drug, benralizumab, a monoclonal antibody, targets eosinophils to reduce lung inflammation and is more effective than steroids, reducing the need for further treatment by 30 per cent. A single dose is more effective when injected at the point of exacerbation compared to a short course of steroid tablets, the study found.

Lead investigator of the trial Prof Mona Bafadhel from King’s College London told The National the treatment was game-changing and could be available to asthmatics within five years.

"This is the first new treatment for asthma and COPD attacks in 50 years," she said. "The treatment really did improve people's symptoms within 28 days and also reduced the number of times they had treatment failures by a factor of four-fold. So it was quite a big reduction. We estimate in the UK it would be suitable for two million attacks every year, just in one country."

Researchers randomised people at high risk of an asthma or COPD attack into three groups: one receiving benralizumab injection and dummy tablets; one receiving prednisolone steroids for five days and dummy injection; and the third group receiving both benralizumab injection and prednisolone steroids for five days.

Neither investigators nor the people involved in the study, which was conducted at Oxford University Hospitals NHS Foundation Trust, and Guy’s and St Thomas’ NHS Foundation Trust, knew what treatment they received.

After 28 days, respiratory symptoms of cough, wheeze, breathlessness and sputum were found to be better with benralizumab. And after 90 days, there were four times fewer people in the benralizumab group that "failed treatment" compared to standard care with prednisolone.

Patients had to have high eosinophils for the injection to be given, said Prof Bafadhel. To determine that, researchers tested their blood at the time of the attack. "You can get a full blood count reading within 20 minutes and in other places you can actually do a pinprick blood test. The future is not that far away from being able to do that," she said.

Patients who received the benralizumab injection had fewer episodes that required a doctor appointment or hospital visit. There was also an improvement in quality of life for people with asthma and COPD.

The under-the-skin injection, which does not need to go directly into a vein, was administered by healthcare professionals in the study but can be potentially given safely at home, in a GP practice or in an emergency department.

Dr Sanjay Ramakrishnan, clinical senior lecturer at the University of Western Australia, who is the first author of the trial and started the work while at the University of Oxford, said the drug shows "massive promise" for asthma and COPD treatment. "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," he said.

Dr Samantha Walker, director of research and innovation at Asthma + Lung UK, said the findings were promising for patients. "But 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," she said.

The paper was published in The Lancet Respiratory Medicine.