esanum: Professor Vogelmeier, when you look back at this year's ERS Congress, which three sessions or presentations impressed you the most and why? Were there any new research results or approaches that you think could have a significant impact on clinical practice?
Prof. Claus Vogelmeier: The first major topic, which took up a considerable amount of space at the congress, is the topic of cardiovascular complications in COPD. Entire sessions were devoted to this. To summarise the problem briefly, patients can develop severe cardiovascular complications in the further course of their disease after a COPD exacerbation. The risk is greatly increased in connection with the exacerbation. And the question is whether patients can be protected from this in some way.
A Dutch group has presented very interesting data on this question from 100 general practices in the Netherlands. They have investigated the benefits of evaluating patients with COPD in terms of their cardiovascular risk profile and then possibly starting treatment, e.g. with a lipid-lowering agent and/or an antihypertensive. It turned out that this is very effective, patients can benefit greatly from it after an exacerbation and are significantly less likely to develop cardiovascular events after this acute problem if they have been evaluated and treated for cardiovascular risk factors beforehand.
The second very interesting topic was biologics in COPD, i.e. biological therapies that we have known for quite a while from severe asthma. There are now a lot of studies that are either ongoing or have just been completed in connection with COPD. One of the substances, dupilumab, has now been approved by the EMA for the treatment of selected bCOPD patients. And at the congress, the key data from two large phase III studies were presented again in a joint session. It was impressively shown that the rate of exacerbations can be reduced, that patients have better lung function and that their well-being, as measured by quality of life, was significantly better than in the comparison group.
And the third presentation – which for me was actually the most exciting thing at the congress – was an abstract from the United Kingdom. The question here was whether there might be a better therapy for acute exacerbations of asthma and COPD than the systemic steroid therapy that has always been used. And for this purpose, Benralizumab, an anti-IL-5 receptor antibody, was tested. In the chosen design, patients were selected who had elevated eosinophil granulocytes in their blood and asthma or COPD. If they developed an exacerbation, they were divided into three groups. One group received only cortisone, the second group received only Benralizumab and the third group received both. It was then examined in the further course whether the patients developed a relapse of this exacerbation. The research showed that the groups treated with benralizumab were significantly better than the cortisone group. This is just a first finding hinting that there could be something better than cortisone in acute exacerbations of asthma and COPD.
However, caution is still advised, as this is only a single study, and of course, must be replicated. The second problem is that these patients were selected and characterised beforehand. It was therefore clear that they had elevated eosinophil granulocytes and were therefore fundamentally eligible for such a therapy. It also remains to be clarified how this can be implemented in an emergency situation in patients who are still unknown. We know that the previous practice of always giving patients steroids, especially if it happens frequently, can cause significant problems in the long term. Therefore, a successful further development of this new therapy would be highly desirable. All in all, the congress was exciting and interesting. There were many noteworthy presentations, but these three, which I have just described, were my personal highlights.
esanum: What recent developments in respiratory therapy presented at the ERS Congress do you consider particularly promising? How might these new findings improve the management of patients with respiratory diseases in the clinic and in practice?
Prof. Claus Vogelmeier: That would have to be split in two. In the area of asthma, a new antibody, a new biologic, has been presented that only needs to be given every six months. Compared to the placebo, it worked extremely well. This is an anti-L5 antibody and is along the same lines as mepolizumab, but it has completely different pharmacokinetics and therefore only needs to be administered twice a year. This means that there is a tendency to find new pharmacokinetic modalities, so to speak, that require less frequent application.
A lot is happening at the moment in the field of COPD, as a large number of studies are being conducted on the topic of biologics in COPD. We should be a little cautious, as a lot is still unclear, since the data available so far for most biologics comes mainly from phase II studies. However, it has been shown that certain patient groups could benefit from a therapy with anti-IL-33, for example, a so-called anti-alarmin. This would open up completely new therapeutic approaches, since it would potentially no longer be just a matter of treating symptoms and preventing complications, but of using an endotype-based therapy. This would mean that, if treatment were started early, there would be a chance of positively influencing the natural course of the disease. However, this is still a long way off. It remains to be seen what results the ongoing large phase III studies will deliver.
esanum: Were there any topics or developments at this year's ERS Congress that you found disappointing or that fell short of expectations? What would you have liked to have seen in these areas?
Prof. Claus Vogelmeier: Yes, we all had high hopes that we would find a better treatment for patients suffering from severe shortness of breath. This is a major problem, especially for patients with severe COPD. So far, we don't have many options. We can use opiates, but these are associated with significant side effects at higher dosages. Oxygen therapy, respiratory physiotherapy or the use of small ventilators are also options, but only partially effective. At the congress, a very elaborate study was presented in which the antidepressant mirtazapine was tested for the relief of shortness of breath. Unfortunately, it showed no positive effect. In other words, there was absolutely no detectable effect on the extent of shortness of breath experienced by the patients. For me, this was certainly the big disappointment of the ERS Congress.
The European Respiratory Society (ERS) Congress took place from 7-11 September 2024 in Vienna, Austria.