Brensocatib Approval Sparks New Questions in Bronchiectasis Research: James D. Chalmers, MBChB, PhD

James D. Chalmers, MBChB, PhD, professor of respiratory medicine at the University of Dundee in Scotland, concludes his conversation with The American Journal of Managed Care® by highlighting what he considers the most pressing unanswered questions in bronchiectasis research following the FDA approval of brensocatib (Brinsupri; Insmed) for this patient population.

Revisit parts 1, 2, and 3 to hear Chalmers's insights on brensocatib's role in the bronchiectasis treatment landscape, its safety and tolerability profile, and the broader potential of dipeptidyl peptidase 1 inhibitors in managing other neutrophil-mediated diseases.

This transcript has been lightly edited; captions are auto-generated.

Transcript

Looking ahead, what do you see as the most pressing unanswered questions in bronchiectasis research?

We still have so many questions that we need to answer. The brensocatib approval is fantastic, but it is the start of a journey rather than the end of a journey. We've shown that this treatment can reduce pulmonary exacerbations and slow down the rate of decline in lung function, but patients will still have exacerbations despite brensocatib. The disease still has the potential to progress despite brensocatib.

I think, in relation to brensocatib, we have unanswered questions around the optimal patients that we should be treating with it, because, actually, the subgroup data in the trials were consistent with benefit across virtually all of the subgroups. I think we have interesting questions around what the picture is going to look like after 2, 3 years of therapy and whether those lung function benefits will be sustained or, actually, be even greater over a longer period of time.

In the wider bronchiectasis field, I think we need to build on the success of brensocatib, which shows that this is an inflammatory disease, and you can find benefit for patients and make a big difference for patients by targeting the inflammatory component, working to characterize that inflammation better, and developing even more inflammation-targeting therapeutics.

Just to put some context around that, for, I would say, all of my career, and going back even before I started working in bronchiectasis, this disease has been viewed through the lens of infection. Everything's been about how the patients need more antibiotics, we need to develop better antibiotics, and most of the trials have been of long-term antibiotics.

The unanswered question now is how we can build on what we've learned from brensocatib, which is that inflammation is the treatable trait, and find a way to target that even more effectively and build on this success to mean patients have fewer exacerbations, and we have better ways of preventing lung function decline.