New treatment for serious asthma attacks 'game-changer'

A new way of treating serious asthma and chronic obstructive pulmonary disease (COPD) attacks could be a "game-changer" and is the first leap in treatment for 50 years, researchers say.

Offering patients an injection is more effective than the current care of steroid tablets and cuts the need for further treatment by 30%, according to a study.

The study involved 158 patients, who were monitored for three months after a flare-up.

The drug, Benralizumab, is not ready for widespread use and experts say a much larger trial is needed to be certain of any benefit.

That larger trial, which is due to start next year and last two years, will establish the cost-effectiveness of the drug.

Benralizumab is a monoclonal antibody that targets specific white blood cells, called eosinophils, to reduce lung inflammation.

It is currently used as a repeat treatment for severe asthma at a low dose, but a new clinical trial has found that a higher single dose can be very effective if injected at the time of a flare-up.

The findings, published in the Lancet Respiratory Medicine, included 158 people who needed medical attention in hospital for their asthma or COPD attack (COPD is a group of lung conditions that cause breathing difficulties).

Patients were given a quick blood test to see what type of attack they were having, with those suffering an "eosinophilic exacerbation" involving eosinophils (a type of white blood cell) being suitable for treatment.

Around 50% of asthma attacks are eosinophilic exacerbations, as are 30% of COPD ones, according to the scientists.

The clinical trial, led by King's College London and carried out at Oxford University Hospitals NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, saw patients randomly split into three groups.

One group received the benralizumab injection and dummy tablets, another received standard care (prednisolone steroids 30mg daily for five days) and a dummy injection, and the third group received both the benralizumab injection and steroids.

After 28 days, respiratory symptoms of cough, wheeze, breathlessness and sputum were found to be better in people on benralizumab.

And after 90 days, there were four times fewer people in the benralizumab group who failed treatment compared with those receiving steroids.

Treatment with the benralizumab injection also took longer to fail, meaning fewer visits to a GP or hospital for patients, researchers said.

Furthermore, people also reported a better quality of life on the new regime.

Scientists at King's said steroids can have severe side-effects such as increasing the risk of diabetes and osteoporosis, meaning switching to benralizumab could provide huge benefits.

Lead investigator Professor Mona Bafadhel, from King's, said: "This could be a game-changer for people with asthma and COPD.

"Treatment for asthma and COPD exacerbations have not changed in 50 years, despite causing 3.8 million deaths worldwide a year combined.

"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."

Researchers said benralizumab could also potentially be administered safely at home or in a GP practice, as well as in hospitals.

First author Dr Sanjay Ramakrishnan, clinical senior lecturer at the University of Western Australia, said the study "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," he said.

"We need to provide these patients with life-saving options before their time runs out."

Dr Samantha Walker, director of research and innovation at Asthma and Lung UK, welcomed the findings but said: "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."

AstraZeneca provided the drug for the study and funded the research, but had no input into trial design, delivery, analysis or interpretation.

The Medical Director at the Asthma Society of Ireland said the new drug offers genuine hope to sufferers who want to experience less harm and side effects from the traditional steroid treatments.

"The side effects are very real," Prof Marcus Butler said.

"Apart from the fact that a lot of people will notice weight gain when they're staying on steroids long term, which is a very visible side effect.

"Skin gets thinner, paper like, they can also end up with osteoporosis and life limiting fractures later in life. They can get vision loss from cataracts and promote diabetes developing.

"It's a litany of side effects, which we see virtually in none of these sorts of side effects with these alternative injection."

Speaking to RTÉ's Today with Claire Byrne, Prof Butler said the new treatment is currently a phase two study and needs to be confirmed on a larger scale.

He said it targets eosinophil inflammations and will only be useful for patients experiencing these flare ups.

Both of these disease group populations occupy emergency departments around the world with flare ups, he added.

He said it would cost "many thousands of euro a year" to normally have a patient on this drug.

However, the difference is that this study proposes to give a higher dosage on the day a patient is sick to see if that can lessen flare ups over the next three months.

Additional reporting Fergal Bowers