RX Review: A New Era of Disease-Modifying Therapy for Bronchiectasis - Episode 4
In this video, the fourth in a 5-part series, panelists discuss who may benefit from brensocatib's approval.
In this portion of the HCPLive RX Review Special Report, Albert Rizzo, MD, and James Chalmers, MBChB, PhD, discuss whether specific patient subgroups may benefit more from brensocatib, the first FDA-approved therapy for bronchiectasis as of August 2025, marketed under the name Brinsupri. Chalmers explains that the ASPEN trial broadly included most phenotypes of bronchiectasis, with the exception of cystic fibrosis, active NTM infection, allergic bronchopulmonary aspergillosis, and severe immune deficiencies—conditions where neutrophil-targeting therapy may not be effective. For the vast majority of patients, including those with idiopathic, post-infective, or autoimmune-related disease, outcomes were consistent across subgroups, underscoring the central role of neutrophilic inflammation across bronchiectasis phenotypes.
Chalmers highlights that primary ciliary dyskinesia was well represented in ASPEN, making brensocatib a viable option for these patients, while cystic fibrosis remains excluded from the current approval. He notes that across sex, age, comorbidities, and underlying causes, treatment effects were strikingly consistent, reinforcing brensocatib’s broad applicability. However, he stresses that while this represents a major advance, the field still lacks predictive biomarkers that could guide precision use of anti-inflammatory therapies, a gap that remains an important research priority moving forward.
The discussion also touches on patients with overlapping COPD or asthma, which affected about 20% of the ASPEN population. Chalmers cautions that mislabeling is common, as many patients carry COPD or asthma diagnoses without objective confirmation, complicating interpretation of trial outcomes. While individuals labeled with COPD appeared to benefit in ASPEN, he emphasizes the need for properly designed studies in well-defined COPD or asthma cohorts to determine brensocatib’s true role in overlap disease. For now, he advises clinicians to focus primarily on the presence of clinically significant bronchiectasis when considering brensocatib, while recognizing that more data are needed to guide treatment in patients whose primary pathology is COPD or asthma.
Part 1: Shifting Bronchiectasis Treatment Toward Disease Modification
Part 2: Brensocatib Brings DPP1 Inhibition to the Bronchiectasis Field
Part 3: Understanding Brensocatib's Mechanism and Safety in Bronchiectasis
Part 4: Brensocatib's Place in Clinical Care of Bronchiectasis
Part 5: Redefining Bronchiectasis Research and Management With First FDA Approval
Our Panelists:
Albert Rizzo, MD, is a pulmonologist at ChristianaCare Pulmonary Associates at the ChristianaCare in Newark, Delaware, and clinical assistant professor of medicine at Thomas Jefferson University Medical School, Philadelphia. Triple board certified in internal medicine, pulmonary, critical care and sleep medicine, he also served as the former Chief Medical Officer of the American Lung Association.
James Chalmers, MBChB, PhD, is a Clinical Professor (Teaching and Research) of Respiratory Research, Respiratory Medicine and Gastroenterology, at University of Dundee, United Kingdom, where he also serves as Asthma and Lung UK Chair of Respiratory Research. He was a primary investigator on Insmed's ASPEN trial of brensocatib.
Editor's note: Rizzo's disclosures include Pfizer, AstraZeneca, and Genentech. Chalmer's disclosures include AstraZeneca, Boehringer Ingelheim, Genentech, Gilead, Grifols Biologicals, Insmed, Novartis, and Zambon.
