Monthly injection could replace daily steroid pills for severe asthma

People with severe asthma sometimes rely on daily steroid pills, which raise the risk of diabetes, infections and bone problems. Now, a study supports the idea that a monthly antibody injection is a safer alternative.

Asthma that is not controlled by inhalers may be treated via steroids pills, which are effective at lowering inflammation in the airways – reducing symptoms and the risk of an asthma attack – but come with severe side effects. “We’d like to get people off oral steroids as much as possible,” says Fan Chung at Imperial College London, who wasn’t involved in the study.

Prior trials have shown that tezepelumab, a monthly antibody injection, reduces symptoms of severe asthma better than a placebo injection. This has led to its approval in dozens of countries, including the UK and US, over the past few years. But it was unclear whether the drug could reduce, or even eliminate, the need for steroid pills.

To explore this, David Jackson at Guy’s and St Thomas’ hospital in London and his colleagues recruited 298 people with severe asthma, aged between 18 and 80, from 11 countries. The participants, who were taking daily inhalers and steroid pills, were asked to also take tezepelumab for one year. A control group wasn’t needed because trials have already shown the injections bring benefits beyond just the placebo effect, says Chung.

The researchers found that the participants’ oral steroid doses were gradually reduced over the course of the study, under the supervision of their doctors.

By the end of the year, about half of the participants no longer required any steroid pills, and 40 per cent of them were able to lower their dosage to a level that “the side effects are going to be minimal”, says Chung. “It’s a very successful outcome,” he says. “The trial confirms that tezepelumab is a useful treatment for severe asthma patients, reducing their need for daily pills.”

Side effects, such as worsening of asthma symptoms, were seen in 9 per cent of the participants, but it’s unclear whether these were caused by the injections or would have happened anyway, says Chung. Either way, it’s a proportion that is reasonable given the potential benefits of coming off steroid pills, he says.