August 5, 2016

expert reaction to trial of drug for treatment of asthma symptoms

Inflammation of airways is often found in asthmatic patients and a group of researchers publishing in the Lancet Respiratory Medicine journal have reported that a drug taken as a pill alongside standard inhaler treatment was associated with reduce asthmatic inflammation, increase lung function and improved asthma control in a group of people with severe asthma.

Prof. Carl Heneghan, Director of the Evidence-Based Medicine Centre, University of Oxford, said:

“This is an interesting finding based on a plausible mechanism of action for this new drug to treat asthma.

“The manufacturer led trial was well done and the findings are important. However, this is early stage research, asthma is a long term condition, with debilitating exacerbations.

“Whilst this trial looks at the surrogate measure of eosinophils counts it has not provided an answer for its effects on exacerbations – the important clinical outcomes. Furthermore, the small number of patients from a single centre needs replicating in much larger, longer trials.

“Therefore, tempering headlines with maybe, possibly or perhaps would be more appropriate at this current stage in the research of this novel treatment for asthma patients.”

Prof. Hans Michael Haitchi, Associate Professor in Respiratory Medicine, University of Southampton, and NHS Honorary Consultant Physician, said:

“The asthma study in the journal Lancet Respiratory Medicine by our colleagues from the University of Leicester and the Swiss drug company Novartis uses a new asthma pill, Fevipiprant, that treats the inflammation of asthma. The study not only shows improvement of inflammation but also asthma symptoms when patients were treated for 12 weeks. These results are very exciting and promising.

“This pill could become a new and very much needed treatment option for some of our patients with a more severe form of asthma that does not respond to anti-inflammatory inhaled steroids.

“Further studies are needed to confirm the safety of this new drug and also to find out if asthma attacks can be reduced or prevented in this particular patient group when more patients are treated with this new pill in multiple research centres over a much longer period.”

Prof. Stephen Durham, Professor of Allergy and Respiratory Medicine, Imperial College London, and Honorary Consultant physician, Royal Brompton Hospital, said:

“The mainstay of treatment for severe asthma in those who fail to respond adequately to maximal inhaler therapy and other currently available anti-asthma drugs is the use of corticosteroid tablets. Steroid tablets are associated with many side effects that include weight gain, high blood pressure, diabetes and osteoporosis.

“Professor Chris Brightling’s group in Leicester provide compelling evidence that a novel tablet treatment, Fevipiprant taken twice daily and on top of usual medication, has the ability to reduce asthmatic inflammation, increase lung function and improve asthma control in this severe group.

“The data strongly support further studies to see whether Fevipiprant may also reduce the frequency of asthma attacks, avoid steroid side effects and reduce NHS costs in the management of these severely ill patients.”

Dr Samantha Walker, Director of Research and Policy at Asthma UK, said:

“This research shows massive promise and should be greeted with cautious optimism.

“In general, the possibility of one day taking a pill instead of using an inhaler will be a very welcome one among the 5.4 million people in the UK with asthma, particularly as this study focused on people who develop the condition in later life, some of whom we know can struggle with the dexterity required to use an inhaler.

“More research is needed and we’re a long way off seeing a pill for asthma being made available over the pharmacy counter, but it’s an exciting development and one which, in the long term, could offer a real alternative to current treatments.”

‘Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial’ by Sherif Gonem et al. published in the Lancet Respiratory Medicine on Friday 5 August 2016. 

Declared interests

Prof. Carl Heneghan: “None declared.”

Prof. Stephen Durham: “None for asthma. I have received consultancy fees from Glaxo Smith Kline and Boehringer Ingelheim for work unrelated to asthma and from manufacturers of allergy vaccines for hay fever from Merck, Anergis, Biomay and Biotech Tools and Circassia.”

No others received.