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Seventy-seven-year-old Geoffrey Pointing, from Banbury, UK, can finally breathe easy, thanks to an injection that relieved his Chronic Obstructive Pulmonary Disease (COPD), when airways in the lungs stiffen up and become clogged with mucus. “When you’re having a flare-up, it’s very difficult to tell anybody how you feel — you can hardly breathe…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,” says Pointing who participated in a study that tested the efficacy of the asthma drug Benralizumab in relieving patients like him.
COPD flare-ups (also called exacerbations) can be deadly. But an injection of Benralizumab given during such a bout is more effective than the current treatment with steroid tablets, reducing the need for further treatment by 30 per cent, according to the study published in The Lancet Respiratory Medicine. The phase two clinical trial, called Acute Exacerbations Treated with Benralizumab (ABRA) study, was led by scientists from King’s College London and sponsored by the University of Oxford. Steroids have been in use for about 50 years.
The study assumes significance considering the rising complaints of COPD and asthma from polluted cities across India or as a side effect of viral or bacterial upper respiratory infections. It could also be due to poorly-treated asthma and COPD in the past. Such flare-ups are common during severe pollution, of the kind seen in north India.
What is Benralizumab and why is it effective?
It is a monoclonal antibody which targets specific white blood cells, called eosinophils, to reduce lung inflammation. Already effective in treating severe asthma, the study shows it can be re-purposed in emergency settings to reduce the need for further treatment and hospitalisation in cases of COPD.
First study author Dr Sanjay Ramakrishnan, from the University of Western Australia and University of Oxford, says, “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.”
Steroids such as prednisolone can reduce inflammation in the lungs but have severe side-effects such as diabetes and osteoporosis. Furthermore, many patients need repeated courses of steroids, re-hospitalisation or die within 90 days. “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,” said researchers.
These flare-ups make up 30 per cent of COPD and almost 50 per cent of asthma attacks and can become more frequent as the disease progresses, leading to irreversible lung damage in some cases.
What’s the challenge with drug use in India?
The main challenge with the new injection given subcutaneously is that it costs Rs 1.48 lakh for a 30 mg dose. Dr Sundeep Salvi , a member of the Global Initiative for Asthma(GINA) scientific committee, says a phase III trial will be required to establish its efficacy and usefulness. “This huge cost can be afforded by very few people in India,” adds Dr Salvi. .
