I love it when a plan...

..comes together.

In this case the plan is a paradigm shift in the way we will manage the treatment of severe asthma in years to come. The plan involves a 9-year journey taking 3 years of planning to realisation (MRC grant awarded 2014), a year of preparation and 4.5 years of clinical research.

With an investment of over £10M, the first of several key RASP-UK studies  into treatment paradigms for severe asthma reports in the Lancet Respiratory Medicine journal today [1]. The findings are simultaneously being presented at the European Respiratory Society meeting.

No science is ever completed in isolation. I paraphrase Newton when I say we are all standing on the shoulders of giants. In this case our work is greatly complemented by that of GSK's CAPTAIN study [2]. In brief. the over-arching message will be that what goes up (steroid doses) doesn't necessarily come down – at least not easily. This means that we have a great combined message: "Before patients progress to high-dose corticosteroid treatment, predictive biomarkers of therapeutic response should be assessed to guide treatment decisions, because once they are established on high-dose corticosteroid treatment, corticosteroid reduction can be difficult to achieve in symptomatic patients."

References

1. Heaney LG, et al. Composite type-2 biomarker strategy versus a symptom-risk-based algorithm to adjust corticosteroid dose in patients with severe asthma: a multicentre, single-blind, parallel group, randomised controlled trial. Lancet Respir Med. 2021 Jan;9(1):57-68.
2. Lee LA, et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med. 2021 Jan;9(1):69-84.