Breakthrough asthma drug could be held up by high costs

Benralizumab injections hailed as a 'game changer' but steroids likely to remain primary treatment

It is hoped injections may prove a far more effective treatment for chronic respiratory issues, rather than inhaler use, in future. Photo: Getty Images

Cost could be the greatest barrier preventing a breakthrough asthma drug from bringing relief to millions with chronic respiratory issues, doctors have said.

Research by King’s College London into the way the drug benralizumab was administered to people with asthma and chronic obstructive pulmonary disease (COPD) has been hailed as the biggest step forward in alternative treatments to steroids in the past 50 years.

Benralizumab is already widely used in emergency cases, or extreme flare-ups in those with chronic respiratory problems, but a trial carried out between 2021 and 2024 has cast more light on its potential benefits.

In it, 158 people admitted as emergency hospital cases for an asthma or COPD attack in the UK were surveyed and scientists found injecting the drug reduced lung inflammation to help manage the condition long term. A monthly injection of benralizumab was found to reduce the need for further treatment by up to 30 days.

But with injection costs about 20 times more than current steroid inhalers, it could be some time before widespread access to benralizumab becomes available.

“Asthma is very common here in the region because of the dusty climate and indoor air conditioning,” said Dr Muhammed Aslam, a specialist pulmonologist at International Modern Hospital, Dubai. “The most affordable way to manage asthma will still be on an inhaler.”

“Now, most of those with uncontrolled asthma or COPD are getting a triple therapy, three molecule combinations in one inhaler. This monoclonal antibody therapy (benralizumab) will be reserved only for those who can afford it, as it is up to 20 times the price of a standard inhaler.”

Chronic conditions

Asthma, a chronic lung condition, and COPD, are common health conditions in the region worsened by changing temperatures, dust, sand and air pollution.

Fasenra, the commercial name of benralizumab, costs about $5,197 for an injectable 1 millilitre supply. For the most common Ventolin steroid inhaler with beta2-agonists to manage mild symptoms of asthma, costs are typically about $80.

Advair HFA, a combination inhaler that has both corticosteroid and beta2-agonist medicines, is the most expensive asthma inhaler at about $545 per 12 gm actuation, and is used regularly to prevent symptoms. However, more severe symptoms of asthma are managed using Prednisone, a short-acting steroid.

Doctors may prescribe Prednisone instead of other steroids because it only lasts up to 36 hours in the body, and costs about $180 for 10, 20mg tablets, considerably less than benralizumab.

Doctors said they would aim to reduce the use of steroids where possible, due to the long term side effects such as osteoporosis, weight gain and high blood pressure.

In the trial, patients were split into three groups to see how they responded to different treatments. Some were given benralizumab injections and a placebo, others took the usual prednisolone steroid tablets for five days. A third group was administered a combination of steroids and benralizumab, to assess how effective each treatment was.

Four weeks later, the group injected with benralizumab showed fewer signs of wheezing and coughing. The results were also seen long term, with four times fewer people on benralizumab failing their treatment when compared with those on prednisolone.

Treatment failure was defined as a composite of death, admission to hospital, or any need for retreatment requiring systemic glucocorticoids or antibiotics. The research was published in the Lancet Respiratory Medicine journal.

Dr Humam Schakaki, consultant pulmonologist at Burjeel Medical City, said the drug offered hope to many in the Middle East who see chronic respiratory conditions worsen due to poor air quality and pollution. “There are so many patients who can only access a maximum treatment of an inhaler or some kind of anti-inflammatory therapy,” he said.

“Before, we needed to target specific cells to give the patient an injection, so not every asthma patient was suited to this kind of treatment. Injections developed over the last few years have been very good and this one particular treatment injection doesn't need any targeting.”

Global deaths

Asthma and COPD cause about 3.8 million deaths worldwide every year. A 2019 study by the International Study of Asthma and Allergies in Childhood (ISAAC) looked at how common asthma was in children in Dubai and the Northern Emirates. Of the 1,944 children aged 6-7, and 1,793 children aged 13-14, almost 12 per cent were found to have asthma.

Several triggers can cause airways to tighten leading to an asthma attack, including an allergic reaction to pollen, pets, dust, mould or respiratory virus. COPD is caused by permanent damage to lung tissue, usually resulting from long term exposure to smoke, fumes, dust or chemicals.

Symptoms of restricted airways, coughing and wheezing, are similar for both conditions. Extreme attacks often leading to emergency care.

Doctors said new research suggesting the effectiveness of more long term alternatives to steroids, should be welcomed. “We see many patients every day with these conditions,” said Dr Schakaki. “Now, I think every asthma patient has the option, or at least the hope of using these injections.”