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24 June 2020 — Full outcomes from the optimistic Part III ETHOS trial confirmed AstraZeneca’s triple-combination remedy Breztri Aerosphere (budesonide/glycopyrronium/formoterol fumarate) demonstrated a statistically vital discount within the charge of average or extreme exacerbations in contrast with two dual-combination therapies in sufferers with average to very extreme continual obstructive pulmonary illness (COPD).1

In contrast with Bevespi Aerosphere (glycopyrronium/formoterol fumarate), Breztri Aerosphere achieved a 24% discount (p<0.001) in exacerbations. Breztri Aerosphere achieved a 13% discount (p=0.003) in contrast with PT009 (budesonide/formoterol fumarate). The twin-combination therapies used as comparators within the trial characterize really helpful therapeutic lessons for the remedy of COPD.2

In a key secondary endpoint, Breztri Aerosphere confirmed a 46% discount within the danger of all-cause mortality in contrast with Bevespi Aerosphere (unadjusted p=0.01).3

The outcomes had been revealed within the New England Journal of Medicine1 and concurrently introduced on the American Thoracic Society digital Scientific Symposium, Medical Trial Ends in Pulmonary Medication.3 AstraZeneca will proceed to evaluation these information with well being authorities.

Klaus Rabe, Professor of Pulmonary Medication on the College of Kiel, Director of the Division of Pneumology at Clinic Grosshansdorf, Germany, and Lead Investigator of the ETHOS trial, stated: “The Part III ETHOS trial outcomes are necessary and display the advantage of Breztri Aerosphere in decreasing the speed of exacerbations on this progressive illness. The findings additionally present that decreasing danger of all-cause mortality is achievable and will rework remedy targets in continual obstructive pulmonary illness.”

Mene Pangalos, Government Vice President, BioPharmaceuticals R&D, stated: “Continual obstructive pulmonary illness is the third main reason for loss of life worldwide and exacerbations can contribute to a rise in mortality in these sufferers. The outcomes of the Part III ETHOS trial assist the sturdy medical profile of Breztri Aerosphere in decreasing exacerbation charges in contrast with dual-combination therapies. We’re excited to have the info on all-cause mortality, which is a key consideration for COPD administration.”

The protection and tolerability of Breztri Aerosphere had been in line with the identified profiles of the twin comparators. Within the trial, probably the most ceaselessly reported opposed occasions had been nasopharyngitis, COPD and higher respiratory tract an infection. The incidence of confirmed pneumonia was 4.2% with Breztri Aerosphere, 2.3% with Bevespi Aerosphere and 4.5% with PT009.

These outcomes are based mostly on Breztri Aerosphere at the usual dose of budesonide (budesonide/glycopyrronium/formoterol fumarate 320/14.4/9.6mcg), an inhaled corticosteroid (ICS). Within the trial, Breztri Aerosphere at half the dose of budesonide (budesonide/glycopyrronium/formoterol fumarate 160/14.4/9.6mcg) additionally demonstrated a statistically vital discount within the charge of average or extreme exacerbations in contrast with Bevespi Aerosphere (glycopyrronium/formoterol fumarate 14.4/9.6mcg) and PT009 (budesonide/formoterol fumarate 320/9.6mcg).1

Breztri Aerosphere is accredited in Japan and China for sufferers with COPD. It’s underneath regulatory evaluation within the US and EU.


COPD is a progressive illness which may trigger obstruction of airflow within the lungs leading to debilitating bouts of breathlessness.2 It impacts an estimated 384 million people4 and is the third main reason for loss of life globally.5 Bettering lung perform, decreasing exacerbations and managing every day signs equivalent to breathlessness are necessary remedy targets within the administration of COPD.2 Even a single COPD exacerbation could also be related to a big improve within the charge of decline in lung perform,6 a big deterioration in high quality of life,7 and may considerably scale back life expectancy and improve the danger of mortality.8,9

ETHOS and the ATHENA medical trial programme

ETHOS is a randomised, double-blinded, multi-centre, parallel-group, 52-week trial to evaluate the efficacy and security of Breztri Aerosphere in symptomatic sufferers with average to very extreme COPD and a historical past of exacerbation(s) within the earlier 12 months. Outcomes within the ETHOS trial included, as a major endpoint, the speed of average or extreme exacerbations.

Bevespi Aerosphere is a fixed-dose twin bronchodilator in a pressurised metered-dose inhaler (pMDI), combining glycopyrronium, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta2-agonist (LABA). PT009 is a single inhaler, fixed-dose dual-combination remedy of budesonide, an ICS, and formoterol fumarate, a LABA. It was developed as a related comparator in medical trials for Breztri Aerosphere.

ETHOS concerned greater than 8,500 sufferers who had skilled ≥1 average/extreme exacerbation within the earlier 12 months and had been receiving a minimum of two inhaled upkeep therapies at entry into the trial.

ETHOS is a part of AstraZeneca’s ATHENA Part III medical trial programme for Breztri Aerosphere, which included greater than 15,500 sufferers globally throughout 11 trials. The outcomes of the sooner pivotal Part III KRONOS trial had been revealed in Lancet Respiratory Medication.10

Breztri Aerosphere

Breztri Aerosphere (budesonide/glycopyrronium/formoterol fumarate) is a single-inhaler, mounted dose triple-combination of budesonide, an ICS, with glycopyrronium, a LAMA, and formoterol fumarate, a LABA.

Below the phrases of the settlement to amass Pearl Therapeutics Inc., AstraZeneca anticipates making a $150m milestone fee upon US regulatory approval of Breztri Aerosphere for COPD. This fee can be the ultimate growth and regulatory milestone underneath that settlement.

AstraZeneca in Respiratory & Immunology  

Respiratory & Immunology is one in all AstraZeneca’s three remedy areas and is a key progress driver for the Firm.

AstraZeneca is a longtime chief in respiratory care, and its inhaled and biologic medicines reached greater than 53 million sufferers in 2019. Constructing on a 50-year heritage, the Firm goals to remodel the remedy of bronchial asthma and COPD by specializing in earlier biology-led remedy, eliminating preventable bronchial asthma assaults, and eradicating COPD as a top-three main reason for loss of life. The Firm’s early respiratory analysis is targeted on rising science involving immune mechanisms, lung injury and irregular cell-repair processes in illness and neuronal dysfunction.

With frequent pathways and underlying illness drivers throughout respiratory and immunology, AstraZeneca is following the science from continual lung ailments to immunology-driven illness areas. The Firm’s rising presence in immunology is targeted on 5 mid- to late-stage franchises with multi-disease potential, in areas together with rheumatology (together with Systemic Lupus Erythematosus), dermatology, gastroenterology, and systemic eosinophilic-driven ailments. AstraZeneca’s ambition in Respiratory & Immunology is to attain illness modification and sturdy remission for tens of millions of sufferers worldwide.


AstraZeneca (LSE/STO/NYSE: AZN) is a worldwide, science-led biopharmaceutical firm that focuses on the invention, growth and commercialisation of prescription medicines, primarily for the remedy of ailments in three remedy areas – Oncology, Cardiovascular, Renal and Metabolism, and Respiratory & Immunology. Primarily based in Cambridge, UK, AstraZeneca operates in over 100 international locations and its progressive medicines are utilized by tens of millions of sufferers worldwide. Please go to  and comply with the Firm on Twitter @AstraZeneca.


1. Rabe KF, Martinez FJ, Ferguson GT, et al. Inhaled Triple Remedy at Two Glucocorticoid Doses in Reasonable-to-Very Extreme COPD. NEJM 2020; revealed on June 24, 2020, at DOI: 10.1056/NEJMoa191604. 2. GOLD. World Technique for the Prognosis, Administration and Prevention of COPD, World Initiative for Continual Obstructive Lung Illness (GOLD) 2020. [Online]. Accessible at: [Last accessed: June 2020]. 3. Rabe KF. Inhaled Triple Remedy at Two Glucocorticoid Doses in Reasonable-to-Very Extreme COPD: The ETHOS Research. ATS Scientific Symposium. Breaking Information: Medical Trial Ends in Pulmonary Medication. June 24, 2020. 4. Adeloye D, Chua S, Lee C, et al. World Well being Epidemiology Reference Group (GHERG). World and regional estimates of COPD prevalence: Systematic evaluation and meta-analysis. J Glob Well being. 2015; 5 (2): 020415. 5. Quaderi SA, Hurst JR. The unmet world burden of COPD. Glob Well being Epidemiol Genom. 2018; 3: e4. Revealed 2018 Apr 6. doi:10.1017/gheg.2018.1 6. Halpin DMG, Decramer M, Celli BR, et al. Impact of a single exacerbation on decline in lung perform in COPD. Respiratory Medication 2017; 128: 85-91. 7. Roche N, Wedzicha JA, Patalano F, et al. COPD exacerbations considerably influence high quality of life as measured by SGRQ-C complete rating: outcomes from the FLAME examine. Eur Resp J. 2017; 50 (Suppl 61): OA1487 8. Ho TW, Tsai YJ, Ruan SY, et al. In-Hospital and One-12 months Mortality and Their Predictors in Sufferers Hospitalized for First-Ever Continual Obstructive Pulmonary Illness Exacerbations: A Nationwide Inhabitants-Primarily based Research. PLOS ONE. 2014; 9 (12): e114866. 9. Suissa S, Dell’Aniello S, Ernst P. Lengthy-term pure historical past of continual obstructive pulmonary illness: extreme exacerbations and mortality. Thorax. 2012; 67 (11): 957-63. 10.  Ferguson GT, Rabe KF, Martinez FJ, et al. Triple mixture of budesonide/glycopyrrolate /formoterol fumarate utilizing co-suspension supply know-how versus twin therapies in continual obstructive pulmonary illness (KRONOS): a double-blind, parallel-group, randomised managed trial. Lancet Respir Med. 2018; 6: 747–758.  

Supply: AstraZeneca

Posted: June 2020