One Year Later: How Brensocatib Has Changed Bronchiectasis Care

On August 12, 2025, the United States Food and Drug Administration approved Insmed’s brensocatib (Brinsupri), marking the first disease-modifying therapy for non–cystic fibrosis bronchiectasis.1 The approval, based on the phase 3 ASPEN trial enrolling more than 1700 patients, showed that both the 10-mg and 25-mg doses of brensocatib—an oral, reversible inhibitor of dipeptidyl peptidase-1 that dampens neutrophil-driven airway inflammation—reduced annualized exacerbation rates by 20% compared with placebo, with the higher dose also slowing lung function decline over 12 months.2 One year later, HCPLive spoke with 2 pulmonologists who have been prescribing the therapy since its approval about what has changed in day-to-day management of a disease that, until recently, had no targeted treatment options at all.

Mark L. Metersky, MD, FCCP, FACP, professor of medicine and director of the Center for Bronchiectasis Care at UConn Health, said the drug has been well received by patients, many of whom had followed its development before approval. Most patients report subjective improvement, with less coughing, easier sputum clearance, and less discoloration.

“I think that the study results suggest that even in patients who may not have frequent exacerbations but have poor quality of life due to severe symptoms, that there may be benefit in those patients, although clearly it was not tested in such patients. But if you look at the pathophysiology and the way the drug works, and the results of the studies, it looks promising for patients such as those who have a lot of symptoms,” Metersky said. :Also, patients who are rapidly losing lung function, since we know that the higher dose slows down the loss of lung function - those are patients in my mind that should be potential candidates for the drug.”

Ashwin Basavaraj, MD, FCCP, ATSF, 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, echoed that sentiment, describing the past year as an exciting period for a field that had gone decades without a dedicated therapy.

What else has changed in bronchiectasis?

The 1-year anniversary also followed shortly after the American College of Chest Physicians' first North American clinical practice guideline for adult bronchiectasis, published in 2026, which includes long-term brensocatib among 13 conditional recommendations for patients with frequent exacerbations.3 Metersky noted that the guideline fills gaps left by earlier documents produced before the drug's approval, though he emphasized that meaningful unmet needs—chronic cough, sputum burden, and disease progression—persist even with expanded treatment options.

Patient selection remains an evolving question, particularly regarding nontuberculous mycobacteria (NTM), which Basavaraj noted affects roughly half of bronchiectasis patients in the US, a substantially higher proportion than in Europe. While NTM is not a contraindication to DPP-1 inhibitor therapy, and Basavaraj reported no signal of worsening infection with brensocatib use, he stressed that outcomes data in this overlapping population are still being collected. Notably, brensocatib's development in other inflammatory indications has not been uniformly successful: a phase 2b trial in hidradenitis suppurativa failed to meet its efficacy endpoints in 2026, leading the manufacturer to discontinue that program, underscoring that its benefit to date is specific to bronchiectasis.4

On tolerability, Metersky said the drug's distinctive adverse event profile—including periodontal and skin changes—has not been a significant barrier to uptake in his practice, with the phase 3 trial data showing no significant periodontal disease signal and skin changes remaining uncommon. One year on, both physicians describe a field that has gained its first genuine treatment option, alongside a clearer, though still incomplete, picture of who benefits most.

Basavaraj and Metersky’s disclosures include Insmed and others.

References

1. FDA approves first bronchiectasis therapy, brensocatib, for ages 12 and up. HCPLive. Accessed August 11, 2026. https://www.hcplive.com/view/fda-approves-first-bronchiectasis-therapy-brensocatib-12-up

2. CHEST guideline 2026: 13 recommendations for non-CF bronchiectasis. HCPLive. Accessed August 11, 2026. https://www.hcplive.com/view/chest-guideline-2026-13-recommendations-bronchiectasis

3. Brensocatib phase 2b study in HS does not meet endpoints, program discontinued. HCPLive. Accessed August 11, 2026. https://www.hcplive.com/view/brensocatib-phase-2b-study-hs-does-not-meet-endpoints-program-discontinued