Patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and a history of frequent ‘attacks’ who were given a medicine called astegolimab reported an increase in health-related quality of life compared to those on a placebo, according to findings from a study published in the Lancet Respiratory Medicine.
The COPD-ST2OP trial took place at the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre – a partnership between Leicester’s Hospitals, the University of Leicester and Loughborough University. It is the first reported clinical trial of an anti-ST2 treatment in COPD.
COPD makes it hard to breathe because of narrowing airways and damage to the lungs. In the UK, three million people are living with COPD and each year the condition causes 115,000 emergency admissions to hospital and 24,000 deaths.
‘ST2’ is a receptor on the outside of some cells that is activated by a substance called interleukin-33 and has been linked to inflammatory conditions as diverse as asthma, rheumatoid arthritis and septic shock. By targeting ST2 receptors, scientists believe that symptoms of these diseases may be reduced.
Eighty-one patients aged 40 and over with moderate to very severe COPD and who had at least two ‘exacerbations’ in the past year were recruited to the trial. Participants were current or ex-smokers who had smoked for at least a ten-year period. They were randomised into two groups: 42 were given an astegolimab injection once every four weeks for a period of 44 weeks. 39 participants were injected with a placebo. Participants were asked to continue with their current medications and inhalers for the duration of the study.
The researchers found that of the rate of exacerbations (or attacks) over 48 weeks was reduced by 22% in those that received astegolimab versus placebo. While this does not represent a statistically significant decrease in exacerbation rate, this benefit is greater than seen previously with treatments directed at other inflammatory pathways in people with COPD. There was a statistically significant improvement in quality of life in those treated with astegolimab versus placebo. The researchers showed that these benefits were greater in those with particular inflammatory signals in the blood and with certain genetic markers.
Professor Chris Brightling, Professor of Respiratory Medicine at the University of Leicester and chief investigator of the COPD-ST2OP trial, said: “In patients with moderate-to-very severe COPD and a history of frequent exacerbations, we found that compared with placebo, patients who received astegolimab for 48 weeks had a reduction in the frequency of attacks and improvement in the way they feel. Improvements were related to measurements in the participants’ blood and their genetic make-up’.
Dr Neil Greening, Associate Professor at the University of Leicester who was involved in the COPD-ST2OP trial, said “We have not had any new treatments for COPD for several years now. This early trial of asteogolimab suggests we can reduce the number of lung attacks they have and improve patients with COPD quality of life. The next few years are going to be an exciting time for COPD research and treatment.”
Dr Ahmed Yousuf, a Clinical Academic Fellow at the University of Leicester a lead author of the paper, said: “These early results are really exciting and represent a potential new treatment for COPD. It will be important to run more trials of anti-ST2 therapeutics in larger patient groups, and to divide patient groups by the type and severity of their COPD symptoms to tailor medicines to different groups.”
The paper, ‘Astegolimab, an anti-ST2, in chronic obstructive pulmonary disease (COPD-ST2OP): a phase 2a, placebo-controlled trial’ is published in the Lancet Respiratory Medicine.