Revolutionary COPD injection given to patients for first time

Patients at Guy’s and St Thomas’ have become the first in the country to receive a revolutionary new treatment for chronic obstructive pulmonary disease (COPD).
 
The new injection, developed by King’s College London, is called dupilumab. It can be self-administered like an insulin pen and provides additional therapy to prevent acute flare ups of COPD – a progressive, long-term lung disease that makes it hard to breathe.

Every day in the UK 85 people with COPD will tragically die. The condition has a major impact on quality of life and mortality. COPD costs the NHS around £2 billion a year and is the 2nd leading cause of hospital admissions. 

Current treatments, including medicines that open up the airways, known as brochodilators, improve breathing but do not target the inflammation driving COPD symptoms. Other therapies, like steroid inhalers, broadly reduce inflammation but do not offer a targeted approach, so work inconsistently across patients. 

The new treatment has been developed for those with a subtype of COPD which is affected by white blood cells known as eosinophils. This impacts about 80 million people globally.

In clinical trials dupilumab reduced COPD flare ups, known as exacerbations, by 30-34% each year. Exacerbations result in increased shortness of breath, coughing and mucus production, and even lead to deaths – often resulting in the need for extra treatment including steroid medication and hospital admissions.

The medicine, approved by NICE earlier this year, works by reducing inflammation in the body. Dupilumab targets proteins in the body that cause inflammation, like IL-4 and IL-13. This reduces swelling in the airways and mucus build up, helping patients breathe easier and reducing exacerbations.

In a milestone in the treatment for COPD, patients received their first injection of dupilumab today at St Thomas’ Hospital. Following the first injection, they will receive their medication every two weeks and will be taught to self-inject from the second dose, similar to how people with diabetes administer insulin.

Patients will be monitored for the following year to review their symptoms. If there has been an improvement the medication will be continued in the longer term.

The first patient to receive the treatment was Patrick Regan, 67, from Catford, who was diagnosed with COPD around 15 years ago. Patrick said: “I was happy to have it, anything to make me feel a bit better and breathing better. COPD affects me a lot and stops me doing things I want to do like walking and going out with my kids and grandkids. That’s one of the most important reasons to get this new medication so I can do more things with the kids.”

Patrick’s wife, Dionne Regan, said: “Over the last 15 years Patrick has significantly deteriorated, and it’s had a huge impact on him and the family. When he gets rushed to hospital that affects me and the children and grandchildren. The aim is to keep Pat well, but this new treatment will also have a knock-on effect for the whole family.”

Brian Dodsworth, 70, from Southwark, who also received the injection, added: “I have been feeling worse than usual recently and I’m hoping it will help me get a decent night's sleep. I only get around 4 hours of sleep at night and then I end up falling asleep in the day, it takes my life away.”

While COPD affects people across the UK and around the world, the research team at King’s and Guy's and St Thomas’, have seen the direct impact of COPD locally.

Dr Amy Dewar, a consultant in integrated respiratory medicine and lead for COPD at Guy's and St Thomas', said: “This is very much a new avenue of treatment for COPD and will make a truly meaningful impact on patients to reduce admissions and flare ups of their condition.”

Dr Dewar, who is also COPD lead for Royal Brompton & Harefield hospitals, added: “Exacerbations remain the dominant driver of admissions and cost locally, particularly during winter months, placing sustained pressure on urgent and emergency services.

“For a high need cohort of COPD patients within south east London, this new treatment offers the opportunity to improve outcomes, reduce disease instability, enhance patient experience and reduce pressure on the healthcare system.”

The role of eosinophils in COPD has been the focus of two decades of research by Professor Mona Bafadhel at King’s College London.  Professor Bafadhel was one of the first to identify the involvement of the eosinophil in COPD.

Professor Mona Bafadhel, NIHR Research Professor and Director of the King’s Centre for Lung Health, King’s College London, said: “We don’t know the exact role of the eosinophil in COPD, but patients with this type of inflammation often have more exacerbations.

“Identifying the patients with this type of inflammation means that we can be much more precise in our treatments. This is because the drug will be able to accurately bind to these types of cells to block the inflammatory response. These cells have been studied in detail by groups across the world, including our group here in King’s College London.

“This is just one type of inflammation in patients living with COPD. We are starting to discover more and hope that these medicines and newer ones, will continue to benefit our patients locally and across the world.”

King’s and Guy’s and St Thomas’ are united as part of King’s Health Partners (KHP) – a partnership between King’s and three local hospitals, which brings together patients, academics, industry, and health and social care professionals.