Abstract
Introduction
Bronchiectasis is a chronic inflammatory airway disease. Brensocatib, an oral, reversible inhibitor of dipeptidyl peptidase 1 (DPP1), reduces pulmonary inflammation by preventing the activation of neutrophil serine proteases. In the phase II WILLOW trial, brensocatib prolonged time to first exacerbation in patients with bronchiectasis. In this post hoc analysis we compare clinical outcomes in patients from WILLOW according to baseline disease characteristics.
Methods
Adults with bronchiectasis treated with brensocatib (10 or 25?mg) or placebo once daily were analysed by baseline Bronchiectasis Severity Index (BSI) score (?4 (mild), 5–8 (moderate), or ?9 (severe)), exacerbation history (2 or ?3 in the previous year), blood eosinophil count (<300?cells per µL or ?300?cells per µL), long-term macrolide use (?6?months; no or yes) and Pseudomonas aeruginosa culture at screening (negative or positive). End-points were time to first exacerbation, annualised exacerbation rate, change in lung function from baseline, and safety. All patients who received brensocatib were pooled and compared with placebo.
Results
Treatment with brensocatib versus placebo was associated with a longer time to first exacerbation (hazard ratio (95% confidence interval), BSI: ?4, 0.28 (0.08–0.96); 5–8, 0.75 (0.35–1.60); ?9, 0.61 (0.35–1.04); prior exacerbations: 2, 0.56 (0.34–0.90); ?3, 0.71 (0.32–1.59); blood eosinophils per µL: <300, 0.66 (0.42–1.06); ?300, 0.49 (0.20–1.20); long-term macrolide use: no, 0.60 (0.38–0.94); yes, 0.60 (0.25–1.45); P. aeruginosa culture: negative, 0.54 (0.32–0.92); positive, 0.68 (0.37–1.27)). Safety results were similar across subgroups.
Discussion
Patients treated with brensocatib had a numerically longer time to first exacerbation and reduced annualised rate of exacerbation versus placebo across all key baseline disease characteristics.
