Low asthma patient adherence shows need for personalised and convenient medicines: GlobalData

GlobalData has revealed that 80 per cent of asthma patients do not take their medication effectively. The reasons for this poor patient adherence are numerous and can include poor inhaler technique, poor perception, complex regimens and the cost of medication. Tiffany Chan, Immunology Analyst at GlobalData, discusses what medicines are currently in the research pipeline for asthma and whether these needs are to be met.

Chan explains, “Low patient adherence hinders the long-term goals of symptom control and could make the effects of respiratory diseases such as COVID-19 continue to take a toll. Although the asthma space is fairly mature, there is a continuing need for more convenient and personalised medications.”

Asthma has a very robust research pipeline* with seven candidates across five drug classes, including products in both existing and novel classes for asthma therapy. There are also several double and triple-combination inhalers in late-stage development for asthma that aim to improve compliance rates.

Chan notes, “GSK’s triple inhaler Trelegy Ellipta is already available in the seven major markets (7MM**) for the treatment of chronic obstructive pulmonary disease (COPD). Meanwhile, Chiesi’s Trimbow received US approval for expanded use in September 2020 and European approval for asthma in February 2021.”

Dual-combination inhalers in the pipeline are Novartis’ ICS/LABA QMF149 (indacaterol + mometasone furoate) and AstraZeneca’s PT027 (budesonide +salbutamol).

Chan adds, “AstraZeneca’s dual-combination offering will aim to replace salbutamol as the future of rescue therapy due to potential higher efficacy compared to single-agent therapy KOLs interviewed by GlobalData believe that combination agents will also improve patient compliance over the next decade.

According to key opinion leaders (KOLs) interviewed by GlobalData, there is a large unmet need for the treatment of severe, persistent asthma that is refractory to the current standards of care.

Chan comments, “The major obstacle to achieving successful treatment of severe asthmatics is the high level of heterogeneity of the disease. Severe asthma is not a single disease, but rather consists of several clinical phenotypes, each with distinct underlying cellular pathologies. Therefore, to address this difficult population of patients, there is a need for therapies that target subgroups of patients whose disease pathogenesis is mediated by a specific pathway.”“There are several monoclonal antibodies that would suit this purpose (Cinquair/Cinqaero, Fasenra and Dupixent) currently at the beginning of their lifecycles, and one (tezepelumab) in the late stages of clinical development. However, these therapies are designated for a small subset of asthma patients.”

* Investigational products include AstraZeneca’s tezepelumab, an IgG2 mAb that binds to thymic stromal lymphopoietin (TSLP), and Chiesi’s oral CRTH2 antagonist timapiprant (CHF6532). The triple inhalers consist of combinations of inhaled corticosteroids (ICS), long-acting beta 2 agonists (LABA) and long-acting muscarinic antagonists (LAMAS) such as GSK’s Trelegy Ellipta (fluticasone furoate + vilanterol), Chiesi’s Trimbow (beclometasone dipropionate + formoterol fumarate dihydrate + glycopyrronium), and Novartis’ QVM149 (glycopyrrolate + indacaterol maleate + mometasone furoate).

** The US, France, Germany, Italy, Spain, the UK and Japan