Study demonstrates new treatment for severe asthma

Researchers from McMaster University and the Firestone Institute for Respiratory Health at St. Joseph's Healthcare Hamilton, together with colleagues at other partnering institutions, have developed a new method to treat severe asthma. In a study of over 200 participants with severe asthma, the new treatment was shown to have improved asthma symptoms and lung function, while reducing the need for corticosteroids by up to 70%.

According to Statistics Canada, 8% of Canadians aged 12 or older - approximately 2.4 million people - have been diagnosed with asthma. Of that, approximately 25% are considered to be severe cases of asthma.

Current treatments for severe asthma often include high doses of corticosteroids, such as prednisone, to control exacerbations. Reducing the need for corticosteroids with alternative treatments is preferable, since these medications are associated with serious side effects from prolonged use - including multi-organ toxicities and immunosuppression.

Dr. Parameswaran Nair, staff respirologist at St. Joseph's Healthcare Hamilton and professor of medicine at McMaster University, along with a team of researchers found that an antibody called dupilumab is effective in treating severe asthma in place of high doses of prednisone. The results were published in the New England Journal of Medicine, one of the world's most influential medical publications.

Researchers sought participants who had been using oral corticosteroids (prednisone) to treat severe asthma for at least six months prior to the study. In addition to their standard regimen of corticosteroids, patients received either dupilumab or a placebo during the 24 week trial. The corticosteroid dose was gradually reduced during weeks four to 20, and maintained at a low level for the final four weeks.

"The ability of dupilumab to increase lung function as markedly as it did in this study, even in the face of [corticosteroid] withdrawal, indicates that it appears to be inhibiting key drivers of lung inflammation," the researchers noted.

Dupilumab works to treat asthma by blocking two specific proteins (called interleukin-4 and interleukin-13) that are associated with inflammation of the airways.

This technique was based on Dr. Nair's previous work published in the New England Journal of Medicine in 2009 and in 2017. Those studies found that blocking another protein, interleukin-5, allowed patients with high eosinophil levels in their blood and airways to reduce their corticosteroid dose. Eosinophils are a type of white blood cell involved with the production of interleukins. High eosinophil levels are directly linked to an increased risk of severe asthma.

Unlike the previous studies, dupilumab was shown to be effective regardless of patients' eosinophil levels. Despite the reduced prednisone dose, patients in this study not only experienced a decrease in asthma exacerbations, but their lung function also improved significantly.

"Ultimately, our goal is to find new treatment pathways that allow us to circumvent the use of corticosteroids," said Dr. Nair. "Since dupilumab showed a significant improvement on asthma control regardless of eosinophil levels, we may be able to use this treatment for a wider range of patients than we previously thought possible. This might be due to the broad effects on inflammation in asthma of the two proteins that we were able to block with dupilumab. The treatment was not associated with any serious side effects."

Dr. Nair and his team presented the details of their study at the American Thoracic Society's international conference in San Diego this past week. There, researchers and clinicians from around the world gathered to discuss respiratory illnesses and the latest breakthroughs in treatment.

"This work highlights the clinical and research excellence in pulmonary diseases that exists at St Joseph's and the Firestone Institute," explained Dr. Jack Gauldie, vice president (research) at St. Joseph's Healthcare Hamilton and a professor emeritus of McMaster University.

"Dr. Nair is one of the world's best clinicians in the field of severe asthma and his studies on modification of immune regulation, targeting two important immune factors, bring an immense impact directly from the lab to the patient in managing this difficult and dangerous form of asthma. We are immensely proud of these advances in pulmonary medicine."

Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, Zhu H, Hamilton JD, Swanson BN, Khan A, Chao J, Staudinger H, Pirozzi G, Antoni C, Amin N, Ruddy M, Akinlade B, Graham NMH, Stahl N, Yancopoulos GD, Teper A.
Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma.
N Engl J Med. 2018 May 21. doi: 10.1056/NEJMoa1804093.

Most Popular Now

Most popular vitamin and mineral supplements provi…

The most commonly consumed vitamin and mineral supplements provide no consistent health benefit or harm, suggests a new study led by researchers at St. Michael's Hospital...

AstraZeneca heads to 2018 ASCO Annual Meeting with…

AstraZeneca and MedImmune, its global biologics research and development arm, head to the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, US...

Tiny particles could help fight brain cancer

Glioblastoma multiforme, a type of brain tumor, is one of the most difficult-to-treat cancers. Only a handful of drugs are approved to treat glioblastoma, and the median ...

New approach to immunotherapy leads to complete re…

A novel approach to immunotherapy developed by researchers at the National Cancer Institute (NCI) has led to the complete regression of breast cancer in a patient who was...

Spiolto® Respimat® enables greater physical activi…

Boehringer Ingelheim announced data which add to the growing body of evidence that show Spiolto® (tiotropium/olodaterol) Respimat® enables greater physical activity in pa...

Amgen Foundation and Harvard team up to offer free…

The Amgen Foundation and Harvard University today announced plans to launch a free online science education platform uniquely designed to level the playing field for aspi...

The Pfizer Foundation announces $5 million in gran…

The Pfizer Foundation announced a new $5 million grant commitment to initiatives in low- and middle-income countries that provide family planning access and education for...

Study finds antioxidant-enriched vitamin reduces r…

Researchers at Children's Hospital Colorado (Children's Colorado) and the University of Colorado School of Medicine have found that taking a specially formulated antioxid...

New drugs could also be deployed against lung and …

A new anti-cancer drug may be effective against a wider range of cancers than previously thought. Using a mouse model and samples taken from cancer patients, a team from ...

What would help or hinder patient participation in…

As clinical trials gear up with the aim of attaining the first FDA-approved treatments for mitochondrial disease, a new study reports for the first time what patients and...

Pfizer to expand venture investing with $600 milli…

Pfizer Inc. (NYSE:PFE) today announced it plans to invest $600 million in biotechnology and other emerging growth companies through Pfizer Ventures, the company’s venture...

Update on Phase III clinical trials of lanabecesta…

AstraZeneca and Eli Lilly and Company (Lilly) are discontinuing the global Phase III clinical trials of lanabecestat, an oral beta secretase cleaving enzyme (BACE) inhibi...