New, effective treatment discovered for the most difficult asthma cases

Ask 31-year-old Vancouver resident Madeline Laberge about what triggers her asthma and she’ll say with a sigh: “Basically any living thing the world”. Exposure to cats, dogs, trees, flowers, grasses, pollens, dust – the list goes on – all make breathing more challenging for Laberge whose asthma is categorized as severe and uncontrolled.

Since being diagnosed with asthma at two-and-a-half years old, Laberge has tried multiple different combinations of medications, most of which have been corticosteroids taken regularly to calm the inflammation of her airways. 

However, two years ago while participating in the CALIMA clinical trial, which was an international study that tested the efficacy of an experimental AstraZeneca asthma drug called benralizumab, Laberge felt like her life changed.

“It was like I didn’t even have asthma,” says Laberge, a respiratory therapist, of her response to the novel medication. 

“I didn’t need to take a corticosteroid for a whole year, which is unheard of in my life – I’ve never gone that long without it! And I wasn’t hospitalized for that entire year.”

According to Vancouver Coastal Health Research Institute (VCHRI) clinician scientist and global principal investigator for CALIMA Dr. Mark FitzGerald, Laberge belongs to the four per cent of asthma sufferers in British Columbia who utilize more health care resources than the average asthma patient to treat and manage their symptoms.

“In the past we haven’t had very effective treatments for this group, but benralizumab is one of a new class of non-corticosteroid asthma drugs that target a type of white blood cell called eosinophils. It’s been found that when eosinophils levels increase in your blood and airways, you’re at increased risk of having asthma exacerbations,” explains Dr. FitzGerald, director of the VCHRI Centre for Heart and Lung Health and head of the Division of Respiratory Medicine at the University of British Columbia. “Benralizumab causes eosinophils to die.”

CALIMA involved 1,306 patients aged 12 to 75 with severe asthma. The aim of the trial was to measure the effect of the drug on the annual rate of exacerbations in a sub-group of 728 patients with high eosinophils counts that are associated with the most severe form of asthma. An additional study, SIRROCO, was also completed evaluating the same medication. The SIRROCO and CALIMA studies showed that the use of benralizumab resulted in a 28 to 52 per cent reduction in rates of exacerbation, compared to placebo and also resulted in improved lung function.

“Additional therapeutic options to control severe asthma are urgently needed and our findings support the use of benralizumab as an add-on therapy for the treatment of severe asthma with persistent eosinophilia,” says Dr. FitzGerald.

“The goal of our research was to achieve the results that Madeline experienced: a controller medication given every month or two that reduces exacerbations and the need for oral corticosteroids, and results in fewer hospitalizations.”

The drug is also a novel asthma treatment in that it’s administered via an injection given to patients every four to eight weeks rather than being taken orally.

Results from both the CALIMA and SIRROCO trials were recently published in the Lancet and are being presented on September 5th at the European Respiratory Society International Congress 2016 in London.