New asthma drug holds hope for some

(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Science & Medicine section on Monday, May 23, 2005)

By Tina Hesman
Of the Post-Dispatch

It doesn’t feel as if Karen Fairbanks even has asthma any more, she says.

Gone are the three different inhalers, the nasal sprays and all the pills the teacher used to keep her allergic asthma in check. The medicines have been reduced to a daily inhaler and a once-a-month shot.

Fairbanks, 55, of Clayton, participated in a study conducted by Washington University and St. Louis University researchers on behalf of drug maker Novartis Pharmaceuticals to test a new therapy against poorly controlled asthma. Dr. Phillip Korenblat, a professor of clinical medicine at Washington University, presented the results Monday at the annual meeting of the American Thoracic Society in San Diego.

The study showed that a new medication can reduce the number of emergency room visits and oral steroid use among people with moderate to severe allergic asthma.

An estimated 20 million Americans suffer from asthma, and about half of those cases are caused by allergies.

About 5 percent of people with asthma require high doses of inhaled steroids and medicines to keep their airways open. Despite the medications and avoiding the things that trigger attacks, people with the severe form of asthma often end up in the emergency room or require oral steroid treatment, Korenblat said.

“I was coughing all the time from sinus stuff and all the phlegm. Just coughing and coughing,” Fairbanks said. She also took several trips to the emergency room when she couldn’t control her breathing.

The culprit producing Fairbanks’ suffering is a chemical called immunoglobulin E, or IgE. The molecules, a type of antibody, probably originally protected people from parasites, Korenblat said. But in people with allergies, IgE antibodies mistake harmless things, such as pollen or animal dander, for dangerous invaders, he said.

The IgE molecules attach themselves to inflammatory cells, called mast cells, causing the cells to release chemicals, such as histamine, that trigger inflammation, narrowing of airways and other symptoms.

Most current asthma medicines treat the symptoms of allergies and asthma, but Novartis developed a drug called omalizumab or Xolair, a monoclonal antibody that combats the cause of the symptoms. Monoclonal antibodies latch on to one specific type of protein – in the case of allergic asthma, to IgE.

More than two dozen monoclonal antibodies are approved for use or in testing for treatment of cancer, psoriasis, rheumatoid arthritis and other diseases, said Dr. James Wedner, chief of the division of allergy and immunology at Washington University School of Medicine. The antibodies haven’t been effective for every condition, “but when they work, they work extremely well,” he said.

The drug keeps IgE from “parking” on the mast cell and setting off an allergic reaction, Korenblat said.

The researchers treated 419 people with severe asthma with either Xolair or a placebo. The drug is given as a shot in the arm once every two weeks to once a month. People taking the drug had 44 percent fewer emergency room visits and needed oral steroids 26 percent less often than people in the placebo group, Korenblat said.

“That’s a big improvement in quality of life,” he said.

And the asthma drug may have other benefits.

“A huge percentage of people who go to the emergency room (with an asthma attack) end up admitted to the hospital,” said Mike Tringale, director of communications for the Asthma and Allergy Foundation of America. Reducing the number of emergency room visits can save money, he said.

But not all asthma sufferers will benefit. “This is not a drug for everybody,” Wedner said. Some people don’t have allergies that trigger asthma or have IgE levels that are too high or low to use the drug. Others’ body weights are too high to get the shots. And going often for an injection won’t appeal to many.

“For the patient, it’s an expense of time,” Wedner said.

Reporter Tina Hesman
Phone: 314-340-8325

Copyright 2005 St. Louis Post-Dispatch, Inc.