Brensocatib and NTM Overlap in Bronchiectasis, With Ashwin Basavaraj, MD

One year after the US Food & Drug Administration (FDA) approved brensocatib (Brinsupri) as the first disease-modifying therapy for non-cystic fibrosis bronchiectasis, HCPLive spoke with Ashwin Basavaraj, MD, FCCP, ATSF, on the overlap between this treatment and nontuberculous mycobacteria (NTM) overlap.1,2 NTM is present in roughly half of US patients with the disease according to data from the US Bronchiectasis and NTM Research Registry and remains an open question for the drug's real-world outcomes.3

"NTM is not a contraindication to using DPP-1 inhibitors such as brensocatib, and we are not seeing any worsening of the chronic infectious process with use of these therapies," said Basavaraj, section chief of pulmonary, critical care, and sleep medicine at NYC Health + Hospitals and director of the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue. "We really have to do a deep dive into the data to see what the outcomes are in patients with concurrent NTM and bronchiectasis."

Basavaraj said brensocatib and other dipeptidyl peptidase-1 (DPP-1) inhibitors target neutrophilic airway inflammation to reduce exacerbations, independent of the chronic infections many patients with bronchiectasis carry. Approval was based on the phase 3 ASPEN trial, which enrolled > 1700 patients and showed both the 10-mg and 25-mg doses reduced annualized exacerbation rates by 20% versus placebo, with the 25-mg dose also slowing lung function decline over 12 months.4 Basavaraj said his group is now collecting data on whether DPP-1 inhibition affects outcomes specifically in patients with concurrent NTM.

NTM Prevalence and Geographic Variation in Bronchiectasis

Basavaraj said the NTM and brensocatib overlap has a greater prevalence in Europe. He attributed part of the geographic difference to environmental exposure, noting NTM is more common among patients in coastal US states, while Pseudomonas aeruginosa dominates chronic infection patterns in European bronchiectasis cohorts. Basavaraj said water supply differences across regions may contribute to divergent airway microbiome profiles in patients with bronchiectasis, though the mechanism remains unconfirmed.

The disparity carries implications for how DPP-1 inhibitor therapy is studied and applied, since a drug developed largely on populations with lower NTM burden may perform differently once used broadly across the United States. Basavaraj said the field needs more outcomes data comparing brensocatib's effect on exacerbations and lung function in patients with and without concurrent NTM before treatment algorithms can fully account for the overlap.

Real-World Diversity and Access to Brensocatib

Basavaraj oversees 2 distinct bronchiectasis populations in New York City: the bronchiectasis program at NYU, where he serves as associate director, and the Bronchiectasis and NTM Program at NYC Health + Hospitals/Bellevue, the public hospital affiliate. The Bellevue cohort includes more Asian and Black patients with bronchiectasis than are typically represented in clinical trial populations, which Basavaraj said underscores the need to enroll broader patient groups in future studies of DPP-1 inhibitors and other emerging therapies.

"We have patients with bronchiectasis who have suffered for years, not knowing where to turn for improvement in their symptoms, and now there is an available therapy where we have seen a dramatic improvement in some patients," said Basavaraj. "Each patient responds differently, but overall, it's exciting there's a new therapy patients can benefit from."

References

1. Insmed Incorporated. FDA approves BRINSUPRI (brensocatib) as the first and only treatment for non-cystic fibrosis bronchiectasis, a serious, chronic lung disease. Published August 12, 2025. Accessed August 24, 2026. https://investor.insmed.com/2025-08-12-FDA-Approves-BRINSUPRI-TM-brensocatib-as-the-First-and-Only-Treatment-for-Non-Cystic-Fibrosis-Bronchiectasis,-a-Serious,-Chronic-Lung-Disease

2. HCPLive. One year of brensocatib: how bronchiectasis care has changed. https://www.hcplive.com/view/one-year-brensocatib-bronchiectasis-care-has-changed. Published August 13, 2026. Accessed August 24, 2026.

3. Drysdale M, Choate R, Brunton AE, et al. Nontuberculous mycobacterial (NTM) infections in bronchiectasis patients: A retrospective US registry cohort study. Pulm Pharmacol Ther. 2023;83:102260. doi:10.1016/j.pupt.2023.102260

4. Chalmers JD, Metersky M, Aliberti S, et al. Phase 3 trial of the DPP-1 inhibitor brensocatib in bronchiectasis. N Engl J Med. 2025;392(17):1665-1678. doi:10.1056/NEJMoa2411664