Due to the heterogeneity of bronchiectasis as well as the complex pathophysiology of the disease, the current bronchiectasis market suffers from a lack of disease modifying therapies, says GlobalData. The leading data and analytics company notes that 14 drugs are currently under development in the bronchiectasis pipeline focussing on a variety of disease modifying mechanisms which will hopefully create a dynamic market with a variety of treatment options for bronchiectasis patients in the near future.

Bronchiectasis is defined by damage to the bronchi, causing abnormal dilation and scarring. The airways become inflamed with thick mucus which is difficult to clear, this builds up creating an environment for bacterial growth; uncontrolled bacterial growth leads to frequent infections.

Ramla Salad, Pharma Analyst at GlobalData, comments: “Currently, there are no approved therapies for the treatment of bronchiectasis, but medicines do exist, notably antibiotics, which span multiple routes of administration (ROA)—inhalation, oral, and intravenous (IV). Antibiotics are widely used in the management of bronchiectasis because they clear the frequent infections and improve symptoms, and thus remain a key part of the treatment paradigm.”

Short- and long-acting bronchodilators, such as albuterol and formoterol, are also used in the management of bronchiectasis to alleviate symptoms such as tight airways and to aid mucociliary clearance. Mucolytics are another key group of therapies used to treat bronchiectasis as they act as mucus-thinning agents, making the phlegm less thick and sticky, which helps patients to clear mucus and cough it up, which in turn provides relief for patients.

Although limited, there are several pipeline agents with different mechanisms of action (MOAs) expected to provide and expand treatment options for bronchiectasis patients as there is currently no marketed therapy available.

Salad notes: “Among the 14 agents in development, 28% (4 agents) are in Phase I trials, 43% (6 agents) are in Phase II trials, and 28% (4 agents) are in Phase III trials. There is an array of targets within this market with diverse MOAs but the most notable is AstraZeneca’s interleukin (IL)-5 inhibitor, Fasenra (benralizumab), which is currently being investigated in the Phase III trial MAHALE (NCT05006573). Fasenra is not new to the respiratory market as it had been approved for treating severe eosinophilic asthma and expansion to bronchiectasis is part of its lifecycle management strategy.”

There are also some small pharma companies hoping to make their mark in this untapped market, including Kamada Pharmaceuticals, Insmed, Zambon, and Thirty Respiratory. Other agents in the Phase III pipeline include Insmed’s brensocatib and Zambon’s NCFBE-1 and NCFBE-2; however, the latter two assets are just antibiotics which are already widely used for the treatment of bronchiectasis, thus limiting their potential in this market.

Salad concludes: “Despite the limited pipeline activity in the bronchiectasis space, there seems to be a variety of agents with different MOAs hoping to enter the market. AstraZeneca’s Fasenra is the biggest player, due to the size and resources of its developer.”