Wait for new asthma drug as more evidence is sought

By Joseph Clift, Senior Policy Officer at Asthma UK

A new drug designed to treat a severe form of asthma has initially not been recommended for use on the NHS by the National Institute for Health and Care Excellence (NICE), but this is not the end of the story.

A NICE committee, whose job it is to recommend which new drugs should be made available to patients, today published its draft guidance on reslizumab, opting not to recommend its use – yet. The committee has asked the drug manufacturer Teva Pharmaceuticals to provide more information on the cost effectiveness of the treatment ahead of another meeting in early January to again consider the drug.

Reslizumab is one of two new treatments NICE is currently considering for severe eosinophilic asthma, which involves an inflammation of the airways linked to a particular type of white blood cell (eosinophils). We are expecting a decision on the other drug, mepolizumab, later this month. Both treatments would be delivered by a healthcare professional every four weeks: mepolizumab via injection to the upper arm, thigh, or abdomen; reslizumab via an infusion (drip) into a vein.

The urgent need for new treatments

For the vast majority of people with asthma, their inhalers can help them maintain control of their symptoms if used correctly. But for people with severe asthma, they face a different and unpredictable day-to-day reality because standard treatments are not effective for them.

Our patient representative Nichola spoke to the NICE committee of her own experience with severe asthma, the effect it has on her ability to work, the side-effects from taking frequent courses of oral corticosteroids and the fear that a severe attack may strike without warning. Nichola had to wake up at 5am to take all the medication to enable her to speak at the committee meeting. We can’t thank her enough for helping to give the committee members a clear picture of what it’s like to live with the condition. It’s clear in NICE’s draft response that they recognise this is an area of unmet need for new treatments.

Ensuring new treatments are available

Were reslizumab (or mepolizumab) to be ultimately approved by NICE, it would be the first treatment targeted to this specific type of severe asthma. There have so far not been any clinical trials directly comparing mepolizumab and reslizumab, so current assessments of each drug are based on trials against standard treatments – both have shown in trials that they can reduce the risk of an attack and we believe they could be particularly important in reducing the need to take regular courses of oral steroids.

Our understanding of the different types of asthma is still developing and we need to increase this further to better treat people with severe asthma. Part of this is the need for better diagnostic tools to help assess which treatment would be most appropriate for the individual.

We also need more resources invested in research aimed at developing more treatments for severe asthma. Mepolizumab and reslizumab could potentially help around 40-50% of people with severe asthma if approved, but this would still leave a significant number of people that do not have a targeted therapy or respond well to current medication.

Next steps

We’ll be responding to the NICE guidance and attending future committee meetings to help make the case that these treatments should be made available to people with severe asthma. While it’s clear the NICE has a responsibility to ensure effective treatments are made available to those who need them at a price the NHS can afford, the group of people these drugs could help are currently reliant on treatments with limited effect and severe side-effects – placing costs on the individual and on the NHS as a result. Mepolizumab is already available in Scotland – the rest of the UK needs to now offer new treatments for people with severe asthma.