Benralizumab Phase III trials show positive results in severe asthma

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Results from pivotal Phase III trials presented at the European Respiratory Society (ERS) International Congress has demonstrated that adding benralizumab to standard-of-care medicine significantly reduced exacerbations and improved lung function and asthma symptoms in severe asthma patients with an eosinophilic phenotype, as indicated by the presence of eosinophils in their blood, it was reported in Mississauga this week.

The SIROCCO and CALIMA trials evaluated the effect of two dosing regimens of benralizumab 30mg administered in 4-week and 8-week regimens as add-on therapy to standard-of-care medicine across primary and key secondary endpoints. Results showed:

  • Reductions in the annual rate of asthma exacerbations (up to 51 per cent)
  • Improvement in lung function (change in FEV1 of up to 159 mL), which was seen at 4 weeks after the first benralizumab dose and sustained throughout the treatment period
  • Improvement in asthma symptoms, such as wheeze, cough, chest tightness and shortness of breath

The outcomes were demonstrated for the 8-week dosing regimen, with no additional benefit observed with 4-week dosing, which may support less-frequent dosing. In addition, post-hoc analysis showed greater improvements in exacerbation rate reduction, FEV1 and total asthma symptom scores in patients with a history of more frequent asthma exacerbations (≥ 3 in the previous year).9, 10 Detailed results were published on September 5 in The Lancet for the Phase III SIROCCO and CALIMA trials.

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250,000 asthma patients

“Statistics show that up to 250,000 Canadians suffer from severe asthma, and new treatment options are needed to help this patient population regain control of their disease and reduce exacerbations,” said Mark FitzGerald, MD, research scientist at the Vancouver Coastal Health Research Institute, University of British Columbia, and Principal Investigator in the CALIMA trial. “This study demonstrates that the anti-eosinophil effect of benralizumab within the appropriate patient population improved outcomes for patients whose severe asthma is driven by eosinophilic inflammation.”

Sean Bohen, Executive Vice President, Global Medicines Development and Chief Medical Officer, said: “Severe asthma affects the lives of millions of patients around the world and can be life threatening. The SIROCCO and CALIMA Phase III trials have shown that benralizumab can offer a meaningful treatment option for patients as evidenced by reductions in exacerbations, improvement in lung function and symptoms, with the promise of fewer doses a year. Benralizumab has a unique way of working in patients with severe asthma with an eosinophilic phenotype and reflects AstraZeneca’s progress in bringing the next generation of respiratory medicines to patients.”

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The adverse event frequency was similar between benralizumab-treated patients versus placebo-treated patients for both SIROCCO and CALIMA (72 per cent and 74 per cent for all benralizumab treated patients vs. 76 per cent and 78 per cent for placebo-treated patients observed in SIROCCO and CALIMA, respectively).   The most common (≥5 per cent) adverse events in benralizumab-treated patients observed in SIROCCO were asthma, nasopharyngitis, upper respiratory infection, headache, bronchitis, sinusitis, influenza and pharyngitis;and in CALIMA were nasopharyngitis, asthma, bronchitis, upper respiratory tract infection, headache and sinusitis.

Severe uncontrolled asthma is a debilitating and potentially fatal form of the disease, where patients experience frequent exacerbations every year and have significant limitations on lung function and quality of life.Uncontrolled asthma can lead to a dependence on oral corticosteroids (OCS), with systemic steroid exposure leading to serious and irreversible adverse effects.

Benralizumab is an anti-eosinophil monoclonal antibody that induces direct, rapid and near-complete depletion of eosinophils, with an onset of action within 24 hours as confirmed in early phase I/II trials. Eosinophils are the biological effector cells that drive inflammation and airway hyper-responsiveness in approximately 50 per cent of asthma patients, leading to frequent exacerbations, impaired lung function and asthma symptoms.

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The data from the SIROCCO and CALIMA trials will be included in regulatory submissions for benralizumab that are planned for the US and EU later in 2016.

About Severe Asthma
Asthma currently affects the health and day-to-day lifestyles of 315 million individuals worldwide, including an estimated 3 million Canadians. Up to 40 per cent of asthma cases remain uncontrolled on current standard of care medicine. A further 5 to 10 per cent of all asthma patients have severe uncontrolled asthma that can lead to a dependence on OCS. Systemic steroid exposure can lead to serious and irreversible adverse effects, including osteoporosis, anxiety, depression, weight gain, glaucoma and diabetes. There is also a significant physical and socio-economic burden of severe asthma with these patients accounting for 50 per cent of asthma-related costs. A conservative estimate developed by the Conference Board of Canada suggests that without concerted action, the cost of asthma alone in Canada will rise to $4.2 billion by 2030.

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