The chronic lung disease asthma can result in more than inconvenient wheezing. Close to 10 percent of adults with asthma have a severe, life-threatening type, known as eosinophilic asthma. For these individuals, asthma is frequent, unpredictable, and hard to control. Severe asthma often requires the use of steroid drugs through an inhaler or in pill form. The most common treatment is a high-dose inhaled corticosteroid (ICS). Even with these drugs on board, asthma can have a heavy physical and emotional impact on quality of life.

A new study from Kings College London, hailed as a landmark study, has shown that once a patient starts a biologic drug, they can safely reduce or even eliminate the need for steroids, along with the side effects steroids often bring such as osteoporosis, bone fractures, diabetes, and cataracts. The study was conducted at 22 sites in the United Kingdom, France, Germany, and Italy. The results are published in the prestigious British medical journal The Lancet.

Eosinophils with a Purpose

Eosinophils are white blood cells that play an important role in the body’s immune system. They are meant to protect the lungs against foreign invaders such as viruses or bacteria, but in people with severe asthma, eosinophils attack normal tissues of the lung and cause inflammation. When a person’s immune system overreacts and attacks normal body tissues it is called an autoimmune response or disease.

Benralizumab (Fasenra) is a biologic drug (or man-made antibody) that latches on to eosinophils and reduces their numbers and effects. Biologic drugs are a new type of drug that can dial back the autoimmune response. These drugs are called biologics because they are made from living cells and tissues.

A Biologic Beats Steroids

For the study, patients with severe eosinophilic asthma were started on at least three doses of benralizumab, given as an injection every four to eight weeks. The research team used a five-item Asthma Control Questionnaire to qualify the patient’s asthma as severe. Participants began taking benralizumab before starting the study. When the study began, 208 patients were randomly assigned to continue their high dose ICS or to start tapering their steroid medication over 32 weeks, and then continue at that level of medication for another 16 weeks. These were the key findings for the patients who were in the taper group as compared to those in the continue-steroid-meds group…

  • Almost all patients (92 percent) were able to significantly reduce steroid use and maintain control of their asthma.
  • Sixty percent of patients were able to stop all steroid use.
  • Most patients did not experience flare-ups (exacerbations) during the study period: 87 percent in the taper group and 88 percent in the full-strength ICS group.

The research team concludes that this study highlights the role of eosinophils in severe asthma, and that the biologic drug-controlled eosinophils curbs asthma safely and with minimal or no use of high-dose ICS. They hope their study and others will highlight the opportunity to shift away from high-dose steroids for severe asthma.

Source: Study titled “Reduction of Daily Maintenance Inhaled Corticosteroids in Patients with Severe Eosinophilic Asthma Treated with Benralizumab (SHAMAL): A Randomised, Multicentre, Open-Label, Phase 4 Study,” led by researchers at Kings College London, published in The Lancet.

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