Charles Daley

@PGeorgeMD No difference meeting similar findings to the total study population

Neutrophil elastase levels were lower with both brensocatib doses compared with placebo and returned to normal within 4 weeks of stopping the drug. #NTMTwitterJC

@PGeorgeMD No difference in any of the many subgroup analyses including Pseudomonas

@NJHealthMedEd The study met both primary and secondary outcomes which is impressive. The overall sample size was not that large.

Q2: What do you think of the efficacy results in this trial? Type your response starting with A2 and use #NTMTwitterJC

@PGeorgeMD A1 - Good question! The two doses were so similar they are using both again.

If the results are confirmed in the ongoing Phase 3 ASPEN study, we may have our first drug for treatment of bronchiectasis! #NTMTwitterJC

@NJHealthMedEd A1 - I am impressed with the study design. They were able to enrich for sicker higher exacerbators which helped meet the outcomes

Q1: What is your impression of the results of the Phase 2 trial of brensocatib in patients with bronchiectasis? Type your response starting with A1 and use #NTMTwitterJC

Skin and dental issues that were adverse events of special interest were also more common in the brensocatib groups but discontinuation was unusual, occurring in only 7% in the brensotatib arms vs 11% in the placebo. #NTMTwitterJC

It was also safe. SAEs were more common in the placebo group. Headache and dyspnea were more common with brensocatib affecting 4-10% of patients. #NTMTwitterJC

It worked! Brensocatib reduced the time to first exacerbation compared with placebo (primary) and decreased the frequency of exacerbations including severe exacerbations (secondary). #NTMTwitterJC

416 patients were screened (256 were eligible for randomization). The study population had a median age of around 65 years, over 60% were female, 80% white, most had moderately severe bronchiectasis with 30-40% experiencing ≥ 3 exacerbations in prior 12 months. #NTMTwitterJC

Patients were randomized in a 1:1:1 fashion to receive 10 mg brensocatib, 25 mg brensocatib or placebo given daily. Patients were stratified by Pseudomonas aeruginosa in sputum and use of macrolides. #NTMTwitterJC

The Willow Study was a Phase 2 randomized, placebo-controlled trial of brensocatib in adult patients with non-CF bronchiectasis who had a history of at least two exacerbations in the previous 12 months. Primary outcome-time to first exacerbation. #NTMTwitterJC

Let’s discuss the results of the Phase 2 clinical trial of the DPP-1 inhibitor brensocatib in the treatment of patients with non-CF bronchiectasis. #NTMTwitterJC

NSP’s are activated during neutrophil maturation in the bone marrow by an enzyme, dipeptidyl peptidase 1 (DDP-1). Brensocatib is a potent inhibitor of DPP-1 that prevents activation of nonserine proteases like neutrophil elastase. May be good! #NTMTwitterJC

Neutrophil elastase has been associated with disease severity, bacterial load, frequency of exacerbations and shorter time to exacerbation. Not good! #NTMTwitterJC

Patients with bronchiectasis have frequent exacerbations associated with neutrophilic inflammation. Neutrophil serine proteases (NSPs), including neutrophil elastase, are increased in the sputum of patients with bronchiectasis. #NTMTwitterJC

First, I will touch on the high points of the article and then will pose some discussion questions about clinical implications of the article #NTMTwitterJC

Thank you so much for the introduction! I'm excited to chat tonight about the Phase 2 Trial of the DPP-1 Inhibitor Brensocatib in Bronchiectasis, nejm.org/doi/full/10.10…. #NTMTwitterJC

@JakeWoodrow3 @NJHealthMedEd What about the increased risk of pulmonary NTM? The use of ICS have been associated with a higher risk of pulmonary NTM. In one study, in a dose dependent fashion.

@NJHealthMedEd I do counsel patients especially regarding increased risk of pneumonia. I also mention bone health and ocular disease as unlikely but possible adverse effects. #COPDTwitterJC

Q3: Do you counsel patients about potential adverse reactions from inhaled steroids prior to starting an ICS? #COPDTwitterJC