Mode
Text Size
Log in / Sign up

Subcutaneous astegolimab reduced COPD exacerbations in phase 2b and 3 trials versus placeboNew drug cuts COPD flare-ups for some smokers in large trials

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Consider subcutaneous astegolimab 476 mg every 2 weeks for COPD exacerbation reduction in patients with limited options.

A randomized, double-blind, placebo-controlled phase 2b and 3 trial enrolled 1301 participants in the ALIENTO study and 1375 participants in the ARNASA study. The population consisted of current or former smokers with COPD and a history of frequent exacerbations, irrespective of baseline blood eosinophils. Participants received subcutaneous astegolimab 476 mg every 2 weeks or every 4 weeks, or placebo.

In the ALIENTO trial, the annualised rate of moderate or severe exacerbations was lower with astegolimab every 2 weeks versus placebo, with a 95% CI of 0.72-1.00 and p=0.049. The same dosing schedule in the ARNASA trial showed a 95% CI of 0.72-1.01 and p=0.068, which was not statistically significant. Astegolimab every 4 weeks versus placebo was not statistically significant in ALIENTO with a 95% CI of 0.79-1.10 and p=0.38. In ARNASA, the every 4 weeks schedule showed a 95% CI of 0.70-0.98 and p=0.024, indicating a lower annual rate of exacerbations.

Most participants experienced one or more adverse events, occurring in 1093 [84.0%] of 1301 in ALIENTO and 1176 [85.5%] of 1375 in ARNASA. The most common non-COPD adverse event was nasopharyngitis in ALIENTO and upper respiratory chest infection in ARNASA. Adverse events were balanced between treatments. Serious adverse events and discontinuations were not reported. The study was funded by Genentech, a member of the Roche Group, and F Hoffmann-La Roche.

People with chronic obstructive pulmonary disease, or COPD, often face sudden breathing flare-ups called exacerbations. These events make life harder and can lead to hospital visits. A new study looked at a drug called astegolimab to see if it could stop these attacks. The trials involved over 2,600 current or former smokers who had frequent flare-ups in the past. They received the drug under the skin every two weeks or every four weeks, or a fake treatment. The goal was to lower the yearly rate of moderate or severe breathing attacks.

The results showed mixed but promising signs. In one trial group, taking the drug every two weeks clearly lowered the number of flare-ups. Another group taking it every four weeks also saw fewer attacks. However, in other trial groups, the difference between the drug and the fake treatment was not statistically significant. This means the benefit depended on the specific trial design and how often patients took the medicine.

Safety checks found that most participants experienced side effects, but these were mostly common colds or chest infections. Serious problems were not reported, and the side effects were balanced between those taking the drug and those taking the placebo. The findings suggest this new approach might help people who have few other treatment choices for their breathing issues.

What this means for you:
A new drug reduced COPD flare-ups for some patients, but results varied by how often they took it.

Study Details

Study typeRct
Sample sizen = 433
EvidenceLevel 2
Follow-up0.5 mo
PublishedMay 2026
View Original Abstract ↓
BACKGROUND: Interleukin-33 and its receptor, ST2, are implicated in neutrophilic and eosinophilic inflammation during chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to assess the efficacy and safety of astegolimab, an anti-ST2 human IgG2 monoclonal antibody, which were evaluated in two COPD pivotal trials. METHODS: In two randomised, double-blind, placebo-controlled trials (phase 2b ALIENTO and phase 3 ARNASA), current or former smokers with COPD and a history of frequent exacerbations, irrespective of baseline blood eosinophils, were randomly assigned (1:1:1; stratification by smoking status and region) to receive subcutaneous astegolimab 476 mg every 2 weeks, every 4 weeks, or placebo, alongside optimised inhaled maintenance therapy over 52 weeks. The primary endpoint (analysed in participants receiving one or more doses) was annualised rate of moderate or severe exacerbations. Missing data were considered similar to data from other participants in the same treatment group with the same baseline characteristics. The trials were registered with ClinicalTrials.gov (NCT05037929 and NCT05595642). FINDINGS: In ALIENTO, 1301 participants (astegolimab every 2 weeks, n=433; astegolimab every 4 weeks, n=437; and placebo, n=431) initiated treatment between Oct 5, 2021, and Feb 19, 2024. In ARNASA, 1375 participants (astegolimab every 2 weeks, n=459; astegolimab every 4 weeks, n=459; and placebo, n=457) initiated treatment between Jan 9, 2023, and June 25, 2024. Adjusted rate ratios versus placebo for the primary endpoint were 0·85 (95% CI 0·72-1·00; p=0·049) for astegolimab every 2 weeks and 0·93 (0·79-1·10; p=0·38) for astegolimab every 4 weeks in ALIENTO, and 0·85 (0·72-1·01; p=0·068) for astegolimab every 2 weeks and 0·82 (0·70-0·98; p=0·024) for astegolimab every 4 weeks in ARNASA. Adverse events were balanced between treatments, with most participants experiencing one or more adverse events (1093 [84·0%] of 1301 participants in ALIENTO and 1176 [85·5%] of 1375 in ARNASA). The most common non-COPD adverse event was nasopharyngitis in ALIENTO and upper respiratory chest infection in ARNASA. Deaths occurred in 40 (3·1%) of 1301 participants in ALIENTO and in 44 (3·2%) of 1375 participants in ARNASA, and were balanced across treatment groups. Across both trials, a total of three deaths (0·1%) were considered to be related to treatment by investigators. INTERPRETATION: In ALIENTO, astegolimab every 2 weeks was associated with a lower annual rate of exacerbations versus placebo in patients with COPD and a history of frequent exacerbations. In ARNASA, these findings did not meet statistical significance. Together, these findings suggest a role for targeting the ST2/IL-33 pathway to reduce the frequency of COPD exacerbations in patients with limited treatment options. FUNDING: Genentech, a member of the Roche Group, and F Hoffmann-La Roche.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.