Difficult Choices in Respiratory Pharmaceuticals
Severe asthma affects about 35 million people worldwide, and an estimated 600 million people have asthma and chronic obstructive pulmonary disease (COPD), according to AstraZeneca. Costs in the European Union for treatment, hospitalizations, and lost productivity due to lung disease is estimated to be around 82 billion euros ($92 billion US dollars).1 Based on this data, the respiratory pharmaceutical market has greatly expanded over the past 10 years with more than 10 new respiratory delivery device products approved by the US Food and Drug Administration. Products have included newer, longer-acting beta agonists, anticholinergics, and corticosteroids with combination products composed of two different agents to target different mechanisms of airflow limitations. GlaxoSmithKline (GSK) is presently studying the effects of a new “triple therapy” for the treatment of COPD. The once-daily triple inhaler is a combination of fluticasone, umeclidinium, and vilanterol. The idea is to use three different mechanisms of drug action to help promote bronchodilation. The preliminary results presented at the European Respiratory Society meeting in London determined that patients taking the triple therapy once daily for 24 weeks had 35% fewer moderate or severe exacerbations when compared to patients receiving budesonide/formoterol (Symbicort). In addition, the reduction was 44% in a subset of patients who were treated up to 52 weeks.2
Also, AstraZeneca presented data from two late-stage tests of injectable benralizumab for the treatment of asthma at the European Respiratory Society meeting. Since eosinophils are a major mechanism of airway inflammation, this agent will lower eosinophil counts which would result in preventing asthma attacks. The drug is similar to GSK’s mepolizumab the injectable 100 mg subcutaneously injection administered every 4 weeks as add-on maintenance treatment for patients with severe asthma.3 These agents recognized as interleukin-5 antagonists monoclonal antibodies are the new class of agents used for asthma.
However, due to the cost of many of these agents, including mepolizumab’s cost of $2,575 per monthly injection and a single inhaler costing more than $200, many patients may find it difficult or impossible to afford these medications. As we continue to expand the number of products to treat these diseases, it is becoming more difficult to choose the best agents. I believe pharmacists will be needed more to assist patients with not just the right drug therapy product but also delivery device to meet patients’ needs and improve quality of life.
Michael J. Cawley, PharmD, RRT, CPFT, FCCM, is a professor of clinical pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has more than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.
References:
1. Gokhale K. AstraZeneca, Glaxo explore prevention potential of asthma shots. www.bloomberg.com. September 2, 2016.
2. Hirschler B. GSK’s triple drug cuts flare-ups in chronic lung disease. www.reuters.com. September 6, 2016.
3. GlaxoSmithKline. Nucala prescribing information. gsksource.com. Accessed September 29, 2016.
