Asthma drugs in head-to-head battle

Feb 8 2019

Professor Peter Wark

Hunter researchers will be conducting a head-to-head comparison of two new-generation drugs designed to help those with severe asthma.

Professor Peter Wark, a senior respiratory specialist at John Hunter Hospital and conjoint professor with the University of Newcastle, has received over $600,000 for an investigator-led clinical trial of Omalizumab [Xolair] and the newer contender Mepolizumab [Nucala].

“There’s a group of patients who are candidates for both drugs, and a clinician could quite reasonably choose one or other as the first line of treatment,” Professor Wark explained.

“Previous trials have clearly demonstrated efficacy of these therapies yet they don’t discriminate between which drug is best for those who qualify for both. We’re hoping for greater clarity in choosing the right treatment for the right person, first time around.”

A challenge for physicians is that the drugs take some time to work, with the assessment period lasting up to six months. Under present PBS guidelines there’s also a waiting period of six months before a patient can be switched to another treatment.

“We’re embedding our trial very much into clinical practice, with the only difference being that the choice of drug is randomised. It takes out our bias, or the patient’s bias,” Professor Wark said. “They’ll go on as normal and be assessed to see if the drug is working. If it fails, the patient can then be switched to the other agent with no waiting period.”

Both drugs treat airway inflammation caused by white blood cells known as eosinophils, but take different approaches.

Omalizumab blocks antibodies called IgE that are expressed in allergies and immune cells. Mepolizumab, conversely, targets a compound called IL-5, owing much of its success to HMRI-based researchers Laureate Professor Paul Foster and Professor Peter Gibson who respectively made the initial laboratory discoveries then proved its effectiveness in a tailored patient group.

“All these patients have severe asthma and high eosinophil counts,” Professor Wark added. “There’s some differences in administering the drugs, but that’s not where clinicians should be making the choice. We have to predict which drug will work best for a particular patient.

“Over the next three years we’re hoping to recruit as many patients as we can from as many sites as possible across Australia and New Zealand. We’ve lined up a large number of collaborators but will be coordinating the trial from the Hunter.”

For further information about how to be involved, email or call (02) 4042 0173.

* Professor Peter Wark researches in conjunction with the HMRI VIVA Program. HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community. Trial supported by GSK Australia,