An injection that relieves itchy skin has been hailed as a breakthrough in the treatment of a devastating lung disease that affects more than a million Britons.
Dupilumab is currently used to treat severe eczema, but a clinical trial has shown that it reduces hospital admissions in some patients with chronic obstructive pulmonary disorder (COPD), a generic term for incurable and disabling lung diseases such as emphysema and chronic bronchitis.
Patients taking the drug were about a third less likely to have severe flare-ups requiring hospital treatment. The results, published in the New England Journal of Medicine, also show that it increased lung capacity, reducing shortness of breath and making simple tasks like walking to the store or climbing stairs easier.
Experts told The Mail on Sunday that dupilumab is potentially the biggest breakthrough for COPD treatment in decades.
“This is a breakthrough,” says Ian Pavord, a professor of respiratory medicine at the University of Oxford. ‘The results are really exciting and better than anyone expected. For a long time it has been something of a desert when it comes to COPD treatment.’
Chronic obstructive pulmonary disorder (COPD) is a generic term for incurable and disabling lung diseases, such as emphysema and chronic bronchitis.
Professor Sir Peter Barnes, from the National Heart and Lung Institute at Imperial College London, says: “Most of the treatments currently used in COPD only alleviate symptoms such as breathlessness, persistent cough and wheezing.”
“But this is the first to address the underlying mechanism that drives the disease.”
COPD, which causes inflamed, damaged or blocked lungs, is the fourth leading cause of death worldwide. It affects about 1.2 million people in the UK, mostly over the age of 65, and NHS England has said it will rise another 40 per cent by the end of the decade due to increased life expectancy.
The condition already accounts for one in eight of all emergency hospital admissions.
The main cause is smoking, responsible for up to 90 percent of cases, but studies suggest that even former smokers remain at risk for up to 30 years after quitting. However, air pollution and genetics have also been implicated.
In some types of COPD, the walls of the airways thicken over time and mucus is produced, leaving less room for air to get in and out.
One of the first signs is coughing, but it eventually causes extreme shortness of breath and wheezing. Patients may end up needing to carry an oxygen cylinder with them just to breathe.
Dupilumab “is a breakthrough,” according to Ian Pavord, a professor of respiratory medicine at the University of Oxford.
Current treatment includes drugs to dilate the airways or exercise programs to boost lung capacity, but there have been no new drugs for more than a decade.
Although the treatment works for some patients, it is much less effective in those who have a particularly severe type of COPD caused by type 2 inflammation: swelling in the airways as a result of the immune system going into overdrive, causing sudden shortness of breath in nearly 200,000 patients in the UK. Type 2 inflammation is also a major trigger for eczema and some people with difficult-to-treat asthma.
Dupilumab was initially developed to address these conditions by blocking the process that leads to severe inflammation. However, the latest results show that the drug can also transform the lives of many COPD patients in whom inflammation is a trigger.
Doctors evaluated 939 patients and put half on biweekly injections of dupilumab and the rest on a placebo, before following them for at least a year.
The results showed that there were a third fewer outbreaks in those who took the drug. Some patients began to see improvement in just two weeks.
Most of the patients more than doubled the amount of air they could expel from their lungs in one second, the standard test for the condition.
Although the drug, which costs about £600 per injection, will work only for those with type 2 inflammation as a trigger, doctors say it’s still the biggest advance in years.
Professor Pavord adds: “There is another large trial of dupilumab in COPD due to be published next year, and at least six other similar drugs in the pipeline that are expected to be just as good.”
He says the drug could be recommended by the NHS watchdog, the National Institute for Health and Care Excellence, and available to patients, within two years.
