A recent clinical trial offers hope for individuals living with asthma and chronic obstructive pulmonary disease (COPD). The study suggests that benralizumab, an antibody drug, could significantly reduce and even prevent certain types of asthma and COPD exacerbations, potentially outperforming the current standard treatment of steroids.
This double-blinded, randomized, controlled phase II trial, conducted by researchers in the UK, Australia, and Sweden, evaluated benralizumab’s efficacy in treating specific asthma and COPD flare-ups. Participants at high risk for these exacerbations were randomly assigned to receive either steroids (the standard treatment), benralizumab alone (a single injection), or a combination of benralizumab and steroids. The results indicated that individuals treated with benralizumab were considerably less likely to require additional treatment or hospitalization. This breakthrough could position benralizumab, which is already approved for other uses, as the first new drug in 50 years specifically designed to treat these potentially life-threatening attacks.
Benralizumab: Targeting Eosinophils
Benralizumab, developed by AstraZeneca, is a monoclonal antibody that targets and reduces eosinophils, a type of white blood cell. While eosinophils play a crucial role in fighting bacterial and parasitic infections, they can also contribute to allergy and asthma symptoms. Elevated eosinophil levels are a key factor in certain types of asthma, COPD, and other respiratory illnesses. The FDA initially approved benralizumab in 2017 as an add-on therapy for severe eosinophilic asthma. However, ongoing research is exploring its potential for broader application in treating eosinophil-driven asthma and COPD exacerbations.
Addressing the Challenge of Flare-Ups
Individuals with asthma or COPD can experience acute exacerbations, characterized by worsening symptoms such as wheezing, coughing, and difficulty breathing. These flare-ups can lead to permanent lung damage and increase the risk of severe illness if not effectively managed. Steroids are the current frontline treatment for these episodes, but they are often insufficient, leading to further treatment or hospitalization (treatment failure). Steroids also carry potential side effects, including weight gain and an increased risk of chronic conditions like type 2 diabetes. Because eosinophils are believed to be involved in approximately one-third of COPD exacerbations and nearly half of asthma attacks, benralizumab presents a promising alternative for managing these episodes.
Clinical Trial Results and Future Directions
The study involved 158 asthma and COPD patients who had recently experienced a flare-up. They were divided into three groups: prednisolone (a steroid), benralizumab, and a combination of both. Over 28 days, the benralizumab group reported significantly improved symptoms and a higher quality of life compared to the prednisolone-only group. Furthermore, over 90 days, the benralizumab group demonstrated a lower rate of treatment failure (45% compared to 74% in the steroid group), with a longer time to treatment failure, resulting in fewer doctor and hospital visits. These findings were published in The Lancet Respiratory Medicine.
While promising, these phase II results require confirmation through larger-scale studies to definitively establish benralizumab’s effectiveness in managing these challenging cases. However, if confirmed, benralizumab could represent a substantial improvement for individuals living with these chronic conditions. Given its existing approvals for other indications, including recent approvals for young children with severe asthma and eosinophilic granulomatosis with polyangiitis, the timeline for approval for this new indication could be expedited.
A Potential Game-Changer
This research offers hope for a significant advancement in the treatment of asthma and COPD exacerbations, which have remained largely unchanged for decades despite contributing to millions of deaths worldwide annually. While further research is necessary, the potential of benralizumab to improve the lives of those affected by these chronic respiratory illnesses is significant.
