AstraZeneca and its global biologics research and development arm, MedImmune, announced that the European Commission (EC) has approved Fasenra (benralizumab) as an add-on maintenance treatment in adult patients with severe eosinophilic asthma inadequately controlled despite high-dose inhaled corticosteroids plus long-acting beta-agonists.

The approval is based on the results from the WINDWARD programme, including the pivotal phase III exacerbation trials, SIROCCO and CALIMA, and the phase III OCS-sparing trial, ZONDA.

Sean Bohen, executive vice president, Global Medicines Development and chief medical officer at AstraZeneca, said: “Fasenra is our first respiratory biologic medicine. The decision from the EC follows the recent approval of Fasenra in the US and is another positive step towards our ambition to transform care for severe asthma patients whose disease is driven by eosinophilic inflammation.”

Tim Harrison, Professor of Asthma and Respiratory Medicine, University of Nottingham, UK, and investigator in the WINDWARD trial programme, said: “Many patients with severe eosinophilic asthma experience debilitating symptoms and face increased risk of emergency room visits, hospitalisations and death, despite current treatments. I look forward to being able to offer Fasenra as a new anti-eosinophilic monoclonal antibody which has demonstrated efficacy versus placebo in pivotal clinical trials and has the convenience of an 8-week maintenance dosing regimen.”

Eosinophils are a type of white blood cell that are a normal part of the body's immune system. Elevated levels of eosinophils, seen in about half of severe asthma patients, impact airway inflammation and airway hyper-responsiveness, resulting in increased asthma severity and symptoms, decreased lung function and increased risk of exacerbations. Fasenra binds directly to the IL-5a receptor on an eosinophil and attracts natural killer cells to induce apoptosis (programmed cell death). Fasenra will be available as a fixed-dose subcutaneous injection via a prefilled syringe administered once every 4 weeks for the first 3 doses, and then once every 8 weeks thereafter.

In November 2017, the US Food and Drug Administration (FDA) approved Fasenra for the add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype.8 Fasenra is also under regulatory review in Japan and several other countries, with expected regulatory decisions in H1 2018.

Fasenra is a monoclonal antibody that recruits natural killer cells to induce direct, rapid and near-complete depletion of eosinophils. Depletion of circulating eosinophils is rapid, with an onset of action within 24 hours as confirmed in early phase I/II trials. Eosinophils are the biological effector cells in approximately 50% of asthma patients, leading to frequent exacerbations, impaired lung function and asthma symptoms.

Fasenra is now approved in the US and EU, and under regulatory review in Japan and several other countries.

Fasenra is the foundation of AstraZeneca’s respiratory biologics portfolio of potential new medicines targeting underlying causes of respiratory disease. Fasenra is also being evaluated in chronic obstructive pulmonary disease (COPD).

Fasenra was developed by AstraZeneca with MedImmune, the company’s global biologics research and development arm and is in-licensed from BioWa, Inc., a wholly-owned subsidiary of Kyowa Hakko Kirin Co., Ltd., Japan.

The WINDWARD programme in asthma is made up six phase III trials, including SIROCCO, CALIMA, ZONDA, BISE, BORA and GREGALE. The two pivotal trials SIROCCO and CALIMA, are randomised, double-blinded, parallel-group, placebo-controlled trials designed to evaluate the efficacy and safety of a regular, subcutaneous administration of benralizumab (fixed 30mg dose) for up to 56-weeks in exacerbation-prone adult and adolescent patients 12 years of age and older.

A total of 2,510 patients (1,204 in SIROCCO and 1,306 in CALIMA) received standard-of-care medicine (including high-dosage inhaled corticosteroids and long-acting-agonists) and were randomised globally to receive either benralizumab 30mg every 4-weeks; benralizumab 30mg every 4-weeks for the first three doses followed by 30mg every 8-weeks; or placebo administered via subcutaneous injection using an accessorised pre-filled syringe.

In SIROCCO and CALIMA, patients with severe, uncontrolled eosinophilic asthma receiving Fasenra experienced significant reduction in asthma exacerbations and improved lung function and asthma symptoms compared to patients receiving placebo, on top of their standard treatments. The most commonly reported adverse reactions during treatment were headache (8%) and pharyngitis (3%). Other common adverse reactions included fever, hypersensitivity reactions and injection site reactions.

A pooled post hoc analysis of the SIROCCO and CALIMA studies, demonstrated an association between enhanced benralizumab efficacy and certain easily identifiable clinical features of severe eosinophilic asthma, including baseline blood eosinophil counts, history of more frequent exacerbations, chronic OCS use and a history of nasal polyposis.

The third registrational trial, ZONDA, demonstrated a statistically-significant and clinically-meaningful reduction in daily-maintenance, OCS use compared with placebo for patients with severe, uncontrolled OCS-dependent eosinophilic asthma receiving benralizumab. The results were published in the New England Journal of Medicine in May 2017.

In addition to WINDWARD, the phase III VOYAGER programme is currently underway, which is evaluating the efficacy and safety of Fasenra in patients with severe COPD.