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MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC:
REPORT:
NEW ASTHMA DRUG STOPS ATTACKS
MB #3989
BACKGROUND: Asthma is a chronic disease of the lungs where the airways are affected by
allergens and other environmental triggers. The body responds to triggers in two ways, through
a hyper reactive response and an inflammatory response. During the hyper reactive response
the lungs narrow and contract, making it difficult for the patient to breathe normally. The
inflammatory response then follows, causing the body to release white blood cells and produce
thick mucus. Asthma triggers can include cigarette smoke, dust mites, mold, pets and pollution.
It is estimated that 18.7 million adults and 6.8 million children suffer from asthma. According to
the CDC, nearly 9 people die from asthma each day. (Source:
http://www.cdc.gov/asthma/default.htm,
http://www.nytimes.com/health/guides/disease/asthma/background.html)
TREATMENTS: In addition to identifying and avoiding triggers, there are some medications that
can help control the disease:

Quick-Relief Medication: These are medications that can open the lung’s airways and
relieve any moderate to severe asthma attack. Quick-relief medications include inhalers,
bronchodilators, corticosteroids (taken orally) and anticholinergic drugs. Typically, the inhaler or
bronchodilator contains a short-acting drug called beta-adrenergic agonist and only treats the
symptoms, not the actual disease.

Long-term Control Medications: For patients that have fewer, less severe asthma
attacks, doctors may prescribe a long-term control medication to help regulate the chronic
symptoms of the disease like inflammation. These medications can include inhaled
corticosteroids, leukotriene modifiers and combination inhalers that contain both a corticosteroid
and long-acting beta agonists (LABAs). (Source: http://www.mayoclinic.org/diseasesconditions/asthma/in-depth/asthma-medications/ART-20045557,
http://www.nytimes.com/health/guides/disease/asthma/treatment.html)
NEW TECHNOLOGY: A recent study performed at the Washington University School of
Medicine in St. Louis, found that a new drug, reslizumab, has reduced the risk of severe asthma
attacks in patients that have not found relief through traditional medications. Patients in the
study had high levels of a type of white blood cell called eosinophils. These white blood cells
contribute to the inflammation caused by triggers in asthma patients and are suspected of
increasing the severity of the attacks. Pulmonologist and principal author on the study, Mario
Castro, MD, MPH, estimates that 30 to 40 percent of asthma patients have high levels of
eosinophils in their system. (Source: https://news.wustl.edu/news/pages/investigational-drugreduces-asthma-flareups.aspx)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Judy Martin
Director, Media Relations, Washington School of Medicine
314-286-0105
[email protected]
If this story or any other Ivanhoe story has impacted your life or prompted you or
someone you know to seek or change treatments, please let us know by contacting
Marjorie Bekaert Thomas at [email protected]
Mario Castro, M.D., M.P.H., Pulmonologist at Barnes-Jewish Hospital at the
Washington University School of Medicine talks about a new investigational asthma
drug.
Interview conducted by Ivanhoe Broadcast News in April 2015
Can you give me some overall numbers, how many people have asthma and how many
people have severe asthma?
Dr. Castro: We estimate, overall, about eight percent of the population has asthma, a little bit
higher in kids. And then, severe asthma represents about ten to twenty percent of overall
asthma.
What’s the life like for severe asthma sufferers?
Dr. Castro: Patients with severe asthma are really disabled. Often, patients with severe asthma
are debilitated from their disease by shortness of breath, wheezing, and chest tightness that
really restricts what they’re able to do in daily activities. They find it difficult to just going
shopping or going outdoors because they encounter things that will trigger acute asthma
attacks.
I think when people think of asthma they don’t ever think of it as something that can
really almost destroy your life.
Dr. Castro: People often think that asthma is a chronic disease. It’s just something that you live
with, but it can actually be quite disabling from the standpoint that some of my patients can
hardly leave their house. They’re so fearful of encountering somebody that’s smoking a
cigarette or someone wearing perfume that they really restrict their activities. And unfortunately,
a lot of our patients miss going to work or school just because their asthma is flaring up and
they can’t make it there.
Is there a reason why a certain medicine doesn’t work for some patients’ asthma?
Dr. Castro: We know that, fortunately, the vast majority of asthma is triggered by allergies and
we have ways to control those allergies and the inflammation that occurs in asthma. Those
medicines work very well and are usually inhaled steroids that decrease the inflammation in the
bronchial tubes, so our patients can control their asthma and breathe better. But, there is a
group of patients that even when we try to use those “state of the art” medications, they just
don’t respond to them. Then we start resorting to giving even higher doses of those medicines,
often orally, in a form of steroids and we know that works but there are so many side effects
from them.
Like what?
Dr. Castro: The main things that our patients complain about are weight gain, fluid retention,
and not being able to sleep. It can also contribute to high blood pressure, diabetes, thinning of
the bones, and thinning of the skin. Many different serious complications, so we’d like to avoid
using steroids for long periods of time.
And now there’s a new investigational drug out there?
Dr. Castro: Yes, there is now a new class of medications that we call biologic therapy. These
are medications that are injectable and bind to molecules that are in the blood, called cytokines.
They’re inflammatory proteins in your body that are being released because of allergies or
asthma. In the past, the steroids would dampen them but, as I mentioned, the steroids have
side effects. So the idea is: could you give a biologic therapy that will tackle that specific
molecule? The investigational drug that we looked at here in this study is called reslizumab, or
RES. It’s a specific monoclonal antibody against a cytokine called interleukin 5. Interleukin 5 is a
very common cytokine in patients with allergies or asthma that causes inflammation in the
windpipes of our patients with asthma.
How does it work?
Dr. Castro: The antibody is basically a protein that is injected and will bind up all those
molecules that are in your bloodstream so it doesn’t allow that molecule to bind to your lung
tissue or your windpipe, then it can’t cause the inflammation. And what we see when we treat
these patients is that their inflammation goes down. The particular type of white blood cell that
we’re inhibiting is called the eosinophils, and we see that the eosinophils levels go way down in
the blood stream and in the airways from our patients that are being treated with reslizumab.
So this RES, is it given once a week?
Dr. Castro: It’s given every four weeks, once a month, by injection. Most of the biologic
therapies are in that time frame, where we have to give it about once a month or every couple of
weeks. And this therapy suppresses those eosinophils and the IL 5 and it’s sustained over that
one month period of time.
How do the patients react to this, has it reduced their flare-ups?
Dr. Castro: Yes, the main effect we see is that it takes some of our severe asthma patients
from being really out of control to being well-controlled. They’re not having those repeated
attacks where they have to go on steroids or go in to the emergency room or the hospital. We
find that this really kind of calms things down, stabilizes their disease and it takes away that
inflammation that’s triggering their underlying problem. In the reslizumab study that we
completed, almost a thousand patients were randomized and we saw that there was about a
fifty percent reduction in severe asthma attacks. These are attacks that would have required
steroids, or an emergency room visit or hospital stay.
Are there any risks to these biologics?
Dr. Castro: The main concern whenever we do an injection with a biologic therapy is a reaction
at the injection site and we saw some patients with reactions. Usually, those are very mild and
they resolve with time. This is very well tolerated and we feel that this is a very specific therapy
that doesn’t have all those side effects that we see from the oral steroids and it still controls the
underlying problem. We also noted that patients’ lung function improved, which, as a lung
doctor, that’s something I want to see! I know patients with severe asthma see their lung
function begin to decline over time and I’d like to improve lung function so that they can have
better quality of life.
And no risks with the biologic, with RES?
Dr. Castro: With the biologic, the main side effect we saw was the injection site reactions. Out
of the almost thousand patients treated there was one allergic reaction and that was treated. It
was significant so it is something that will always be administered in a doctor’s office because of
the possibility that you could have an allergic reaction to the medication.
So, could this replace steroids?
Dr. Castro: I don’t think so because it’s not as quick-acting as steroids. It’s not likely going to be
as inexpensive as inhaled steroids.
How fast does this work?
Dr. Castro: It will take usually a few weeks for this to work because it has to work throughout
your body and lower those eosinophils counts. But over time the idea is that it will control that
inflammation and you won’t have all those repeated attacks.
Is this treatment that could be used for other conditions that have inflammation?
Dr. Castro: Yes. It’s being looked at for other diseases that are being caused by increased
eosinophils, the white blood cells. There are other types of allergies - like allergic skin diseases
or allergies that can affect your esophagus, your swallowing tube. There are other conditions
that we’ve seen eosinophils being part of the process there that we believe that this medication
would be helpful for.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used
as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical
professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for
the depth or accuracy of physician statements. Procedures or medicines apply to
different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Mario Castro, M.D., M.P.H.
4921 Parkview Place, Suite 8B
Saint Louis, MO 63110
314-454-8917
[email protected]
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