Benralizumab injection: first new asthma and COPD treatment in 50 years

For the first time in half a century, doctors have a genuinely new option for treating serious asthma and COPD attacks. A clinical trial led by researchers at King’s College London found that a single injection of the monoclonal antibody benralizumab outperforms the steroid tablets that have been the only standard emergency treatment since the 1970s — cutting the need for further treatment by 30% and improving patient quality of life over 90 days.

At a glance

Benralizumab injection: A single high-dose shot delivered at the moment of an asthma or COPD attack proved more effective than the five-day steroid tablet regimen that has defined emergency care for decades.
Eosinophilic exacerbations: These inflammation-driven attacks account for roughly 50% of asthma attacks and 30% of COPD episodes, meaning a large share of patients worldwide could be eligible for this approach.
Treatment failure rate: After 90 days, patients who received the injection had four times fewer treatment failures than those on steroids alone, with fewer GP and hospital visits required.

Why this matters

Asthma and COPD together cause an estimated 3.8 million deaths worldwide each year. COPD alone is the third leading cause of death globally. Despite that toll, the core emergency treatment — a short course of oral corticosteroids — has remained essentially unchanged since the 1970s C.E.

Steroids work, but they carry serious risks. Repeated use raises the likelihood of diabetes, osteoporosis, and other complications. For patients who experience frequent flare-ups, the cumulative harm adds up fast. A treatment that reduces dependence on steroids is not just a clinical step forward — it’s a meaningful quality-of-life shift for millions of people.

Lead investigator Professor Mona Bafadhel of King’s College London put it plainly: “Treatment for asthma and COPD exacerbations have not changed in 50 years, despite causing 3.8 million deaths worldwide a year combined.”

How the trial worked

The trial enrolled 158 people who arrived at emergency departments during acute attacks at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust. Patients received a rapid blood test to confirm the attack was eosinophilic — driven by elevated white blood cells in the lungs — and were then randomly assigned to one of three groups: benralizumab injection alone, steroids alone, or both.

At 28 days, patients in the benralizumab groups showed measurably better respiratory symptoms — including coughing, wheezing, breathlessness, and sputum — whether or not they also received steroids. By 90 days, the gap had widened considerably.

The results were published in The Lancet Respiratory Medicine in November 2024 C.E. The drug was supplied by AstraZeneca, which also funded the research, though the company had no role in trial design, analysis, or interpretation.

How benralizumab works

Benralizumab is already approved as a low-dose maintenance therapy for severe asthma. It works by targeting eosinophils, the white blood cells that drive lung inflammation during a flare-up. What this trial demonstrated is that a higher single dose, delivered at the moment of an attack, can suppress that inflammation more rapidly and effectively than steroids.

First author Dr. Sanjay Ramakrishnan, a clinical senior lecturer at the University of Western Australia, called the findings “massive promise” for patients whose condition has been managed with tools developed in the previous century. Researchers also noted that benralizumab could potentially be administered at home or in a GP’s office — a significant advantage for patients and health systems alike.

What still needs to happen

The trial was relatively small at 158 participants, and larger studies will be needed before benralizumab becomes a standard emergency treatment. Regulatory approval for this specific use — a high-dose injection during an acute attack — would also be required in each country before it could reach patients at scale.

Dr. Samantha Walker, director of research and innovation at Asthma + Lung UK, welcomed the findings but noted that the 50-year gap in treatment progress reflects chronic underfunding of lung health research — a structural problem this single trial cannot fix on its own.

Still, for the millions of people who manage serious asthma or COPD and dread the next attack, the prospect of a safer, more effective option at the point of crisis is genuinely significant. The science is moving. For researchers like Professor Bafadhel at King’s College London, the 50-year wait may finally be coming to an end — and the next step is making sure this treatment reaches the patients who need it most, wherever they live.

For more on this story, see: The Guardian

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