Category: Respiratory Diseases

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South Africa’s Tuberculosis Research Changes Global Medical Practice

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Tuberculosis bacteria. Credit: CDC

A South African clinical study that began in a research unit in Gqeberha (PE), Eastern Cape, has transformed global treatment of drug-resistant tuberculosis. Furthermore, the study’s findings were published this week in the New England Journal of Medicine (NEJM), the highest-ranked medical journal in the world.

The publication recognises that this research study has set the global standard for TB care.

The BEAT Tuberculosis clinical study, conducted at the Clinical Health Research Unit (CHRU) Isango Lethemba TB Research Unit in the Eastern Cape and King Dinizulu Hospital Complex in KwaZulu-Natal, enrolled more than 400 participants over two years during the Covid-19 pandemic.

The study was executed by the University of the Witwatersrand in collaboration with the National Department of Health and funded by the United States Agency for International Development (USAID).

“This project has gone full circle,” says Dr Francesca Conradie, principal investigator of BEAT Tuberculosis and a researcher at the Clinical Health Research Unit (CHRU), University of the Witwatersrand. “The results from this trial have changed international guidelines. Being published in the New England Journal of Medicine is proof that South Africa produces world-class research that improves the lives of patients globally.”

Treatment for the whole family

The primary aim of BEAT Tuberculosis was to evaluate the safety and effectiveness of a novel, shortened treatment regimen for DR-TB compared with the established standard of care. The standard treatment at the time required a seven-drug regimen administered over a minimum of nine months. BEAT Tuberculosis tested a streamlined regimen of four to five medications, including the newer agents bedaquiline and delamanid, administered over six months.

The BEAT Tuberculosis trial enrolled children, pregnant women and breastfeeding mothers alongside adults. These former groups are usually excluded from clinical research. The result is a treatment regimen that can be used across the entire family.

“This is a one-size-fits-all treatment regimen,” explains Conradie. “Adherence is much easier when the three-year-old, the teenager, the mother and the father are all receiving treatment of similar duration and composition. That simplicity saves lives.”

The study enrolled 10 pregnant women. All 10 women gave birth to healthy babies, and nine of them were successfully treated. BEAT Tuberculosis has since been cited internationally as a model for inclusive clinical research methodology, and the findings have influenced World Health Organization policy on the treatment of DR-TB globally, including for pregnant women and children.

South Africa’s National Clinical Advisory Committee already reviews and approves the regimen for pregnant women presenting with Drug-Resistant TB, while other provinces are adopting the treatment, particularly when treating children.

During 2024, South Africa had 249,000 people who were infected with active tuberculosis, and 54 000 died from the disease,” says Professor Norbert Ndjeka, Chief Director: TB Control and Management, National Department of Health. “Not only did BEAT TB produce world-class research, but it is also being implemented progressively across South Africa and globally and is internationally recognised. South Africa has accomplished something exceptional.”

Source: Wits University

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Discovery of 3 Severe Pneumonia Subtypes Could Lead to Tailored Treatments

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Cambridge researchers have shown that severe pneumonia has three different subtypes, helping explain why some patients in intensive care units (ICUs) recover from their illness faster than others, while for other patients the disease can be life-threatening.

Their findings could in future help inform tailored treatments, allowing individual patients to receive the most appropriate therapies.

The current approach of classifying patients by their clinical syndromes without looking at the underlying biology risks missing what’s key

Andrew Conway Morris

Pneumonia is the commonest infectious cause of death worldwide, responsible for an estimated 2.5 million deaths per year. In severe cases, patients may need to be admitted to an ICU and given mechanical ventilation. Severe pneumonia accounts for six in 10 infections managed in intensive care, and spread of the infection within ICUs is a significant concern. 

Doctors have long struggled to understand why patients whose condition looks similar clinically can have very different recoveries. Some respond quickly to treatment, while others remain critically ill for weeks or even die.

Dr Andrew Conway Morris from the Department of Medicine at the University of Cambridge and an ICU consultant at Addenbrooke’s Hospital, Cambridge, said: “Even though we’re able to treat the initial infection, many patients with severe pneumonia still struggle to come off the ventilator and can develop lung failure. Therapies to tackle inflammation in the lungs have had mixed results in clinical trials – some suggest they are beneficial, others that they’re harmful. 

“The current approach of classifying patients by their clinical syndromes – sepsis, acute respiratory distress syndrome and so on – without looking at the underlying biology risks missing what’s key. Instead of asking ‘Does this patient have pneumonia?’, we should be asking ‘What’s the inflammatory pattern in this patient’s lungs?’”

In findings published today in Nature Communications, Professor Conway Morris and team recruited patients admitted with suspected severe pneumonia to the ICU at Addenbrooke’s Hospital, part of Cambridge University Hospitals NHS Foundation Trust.

Severe pneumonia is usually diagnosed through a combination of symptoms, imaging and blood tests. Symptoms typically include fever or hypothermia, low oxygen levels, breathing difficulties and confusion.

Instead of relying only on blood tests or scans, however, the Cambridge team analysed immune cells, inflammatory signals, and gene activity in fluid taken from the lungs of the patients. They discovered that there are three distinct biological types – or ‘pneumotypes’ – of severe pneumonia, none of which could be reliably detected using standard blood tests, even though they were strongly linked to how patients recovered.

The most common pneumotype – accounting for almost half (49%) of cases – was characterised by immune suppression, significant damage to the lining of the lungs, and bleeding in the alveoli (tiny air sacs within the lungs). There were fewer signs of inflammation, which may explain why treatments targeting inflammation can fail or even harm some patients. 

The second pneumotype – accounting for just under a quarter (23%) of cases – was characterised by a balanced immune response and active repair of damage to the lungs. Patients were most likely to recover faster from this pneumotype and require the shortest time on the ventilator, even though they initially looked just as ill as the others.

Patients with the most dangerous pneumotype – the one that most resembles ‘classic’ pneumonia – spent longest on mechanical ventilation and had prolonged critical illness. They had severe and persistent inflammation, with a flood of immature immune cells in the lung. This group may be most likely to respond to anti-inflammatory therapies, say the team.  

Dr Mark Jeffrey from the Department of Medicine at the University of Cambridge, the study’s first author, said: “Even though on the surface, all of the patients seemed to have similar types of pneumonia, with comparable illness severity, oxygen levels and clinical diagnoses, their outcomes were very different.

“It was only when we drilled down and looked at patterns of inflammation that the differences became apparent. Severe pneumonia is not a single disease, but several biologically distinct conditions that happen to look alike. This helps explain why ‘one-size-fits-all’ treatments – including some immune-modulating drugs – have often failed in clinical trials.”

The tests used to determine the pneumotypes are too complex to enable rapid classification, but the researchers hope to develop a simplified tool that could help them stratify the patients and ultimately offer tailored treatments.

Dr Vilas Navapurkar from the John Farman Intensive Care Unit at Addenbrooke’s Hospital said: “If we know which subtype of pneumonia an individual has, we can potentially tailor their treatment more precisely, boosting the immune response in some, while calming harmful inflammation in others. This has the potential to help critically ill patients, reduce deaths from pneumonia, shorten ICU stays and cut unnecessary antibiotic use.”

The study was funded by Addenbrooke’s Charitable Trust, the National Institute for Health and Care Research Cambridge Biomedical Research Centre, and The Forster Foundation. Professor Conway Morris is a Fellow at Emmanuel College, Cambridge.

Reference

Jeffrey, M et al. Pulmonary inflammation in severe pneumonia is characterised by compartmentalised and mechanistically distinct sub-phenotypes. Nat Comms; 23 Jun 2026; DOI: 10.1038/s41467-026-74190-x

Source: University of Cambridge

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Slow Breathing Can Influence Brain Activity and Decision Behaviour

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Credit: Scientific Animations CC4.0

A new study published in the journal Neuron shows for the first time that targeted control of human breathing rhythm can influence decision behaviour by modulating heart and brain function. The research team was able to demonstrate that prolonged exhalation increases heartrate variability and the brain’s reward sensitivity, thus enabling us to make bolder decisions.

Accelerated breathing and rapid heart rate often lead to quick decision–making. Judgements under these circumstances, can lead to a more cautious decisions to minimise potential loss – whether it is making investments under time pressure, during a critical employee meeting, or when quickly selecting a meal. In contrast, slow breathing and a calmer heart could presumably lead to assessing the situation more positively and making bolder decisions.

New Perspective: Body, Brain, and Decision in Harmony

Traditional theories assume that decisions arise in the brain. The present study investigated how the interplay of different organs can influence brain function and thereby control our decisions. It was spearheaded by Prof Soyoung Q Park in cooperation with institutions such as Neuroscience Research Center at Charité – Universitätsmedizin Berlin, Freie Universität Berlin, and German Naval Institute of Maritime Medicine.

“Our decisions are rarely determined solely by external information. Rather, our judgment emerges from the interplay between cognitive processes and our current bodily state. It was previously unknown how the conscious regulation of our body, for example through targeted breathing, could actively control our decision–making process. We wanted to create a physiological shift using slow breathing pattern to change the quality of our decisions,” explains Soyoung Q Park, head of the Department of Decision Neuroscience and Nutrition at DIfE, summarising the research question.

In the study, 41 healthy participants were observed in a state-of-the-art multi-methods research setting as they made risky decisions while adhering to specified breathing protocols. The participants followed visual breathing cues and breathed either in their individual natural rhythm or slower with an extended exhalation (2:8 inhale-exhale ratio). While they breathed, they were asked to make several risk decisions. Meanwhile, the researchers captured brain function using functional magnetic resonance imaging and simultaneously monitored breathing parameters, heart activity, skin conductance, and pupillary reactions. By combining these measurements, the researchers were able to investigate whether extended exhalation not only lowers heart rate but also leads causally to modulated reward processing in the brain.

The Body’s State Influences Our Decisions

The scientists found that extended exhalation led to riskier decisions by slowing down heart rate. Notably, the risky decisions were more guided by potential rewards, while the consideration of potential losses remained unchanged. Furthermore, there was increased activity in the ventromedial prefrontal cortex and the precuneus area. These two key brain regions influence both the time intervals between heartbeats – known as heart rate variability – and reward sensitivity. “Our study thus underscores the transformative role of breath–based interventions. The interplay between breathing and cardiac dynamics makes the brain more receptive to rewards,” explains lead author Wenhao Huang, interpreting the results.

The Practical Benefits of Breathing Techniques

The findings expand the field of body-brain interaction research and support so-called neurovisceral models, which posit that physical condition strongly influences cognitive processes. Park explains: “Breathing techniques have accompanied humanity for millennia across various religions and cultures. With this study, we provide scientific proof that it is a reliable and targeted method capable of controlling our decisions.”

Thus, breathing techniques represent a simple, inexpensive, and easy-to-learn option for everyday self-regulation. Moreover, they have immense potential value in clinical settings as an adjunctive, non-pharmacological strategy – for example, for conditions such as anxiety disorders or depression, which are characterised by autonomic dysregulation and altered reward perception.

The next step should be to investigate whether the observed effects can be generalised to a broader clinical population, such as people with overweight. “Since dietary decisions are strongly influenced by reward assessment and physical state, targeted breath regulation could also play a role in consciously perceiving and more effectively managing eating behavior,” Park summarises for future research activities.

Source: Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

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No Worsening in Children’s Asthma when Living With Cats

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Children with asthma and allergies who live with one or more cats do not experience worse asthma outcomes than children without cats at home. This is according to a comprehensive Swedish registry study from Karolinska Institutet, published in Frontiers in Allergy.

Many families with asthmatic children are advised to avoid keeping furry pets in the home. At the same time, previous studies on how cats as pets affect children with asthma and allergies have often been small and produced conflicting results.

The new study covers over 30 000 children in Sweden aged 4–17 with diagnosed asthma and allergies. The researchers followed the children for two years, comparing those living in households with cats with those who did not. Data on cat ownership was obtained from the national cat register and combined with data from several Swedish health and quality registers.

“We found no evidence that living with cats worsens asthma in children who already have asthma and allergies,” says Resthie R. Putri, postdoctoral researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “Unfortunately, however, we had no information on the specific allergies the children had, so we do not know whether they were allergic to cats or not.” 

Individual advice is needed

The researchers analysed asthma exacerbations leading to emergency care, asthma severity based on medication use, asthma control, and lung function in the children. Children living with one or more cats experienced similar asthma outcomes to those without a cat. Nor could the number of cats in the home, or the age or sex of the cat, be linked to differences in asthma outcomes.

One strength of the study is the large number of participants from across Sweden. However, differences between countries may limit the applicability of the results to other contexts. As the Cat Register is relatively new, some cat exposure may not have been captured in the study. Furthermore, there was no information on how long the children had been exposed to cats for, or how much time the cats spent indoors. The researchers also cannot rule out the possibility that families with children suffering from more severe allergies may have chosen not to keep a cat.

“Clinical advice always needs to be tailored to the individual, and our study can contribute to the evidence base in discussions with families about pets and asthma,” says Catarina Almqvist Malmros, professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and paediatrician at Astrid Lindgren Children’s Hospital.

Will continue to follow the children

The researchers now plan to continue studying how different types of allergies may affect the outcome, and whether it makes a difference if the child is allergic to cats. They also plan to follow the children for a longer period to see how cat ownership may affect asthma over time.

Source: Karolinska Institutet

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TB is Curable. South Africans Can’t Wait Around for Someone Else’s Rescue.

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Tuberculosis (TB) is not a medical mystery, writes AI Diagnostics CEO, Braden van Breda. It’s a detection failure. And with technology like AI at our disposal, he believes the MedTech industry has the power to step up and fix it.

Tuberculosis bacteria. Credit: CDC

TB remains the deadliest infectious disease in the world, but it’s not killing people indiscriminately, it’s killing people in poor, developing countries.

Data from the World Health Organization makes this very clear. In 2024, most TB cases were concentrated in developing regions, especially South-East Asia, the Western Pacific, and Africa. In South Africa, an estimated 54 000 people died of TB in 2024. That’s a soccer stadium full of people wiped out by TB in a single year. Meanwhile, the Americas accounted for just 3.3% of global cases and Europe 1.9%.

The danger is that we get complacent about these numbers because we’re so used to hearing them. It’s not normal that people’s loved ones are dying from TB by the tens of thousands in some parts of the world, while in others, the incidence is low enough to be almost negligible.

Detection is the crisis

We already know what causes TB. We know how it spreads, how to diagnose it, and how to treat it. South Africa is losing this fight because the tools we currently have don’t catch cases early enough.

Since TB is easiest to treat (and least likely to spread) when it’s found early, the result compounds. Too many people are only diagnosed once they become seriously ill. By then, they’ve already infected others, and the cost and effort of accessing care often becomes a barrier in itself.

The science is there; the failure now lies in access to quality screening. The question we need to ask ourselves is whether we’re serious about bringing healthcare to people instead of forcing people to chase healthcare.

Start designing TB screening around the communities that need it most

Too much of our TB diagnostic infrastructure remains concentrated in too few facilities, and that depends on expensive equipment, medical specialists, and referral pathways.

For many people, especially in rural areas and poorer communities, getting to a hospital means losing a day’s wages, while having to pay for transport they can’t afford. The result is that people wait or don’t go at all. In 2024, only about 184 000 of the estimated 249 000 South Africans who fell ill with TB were diagnosed and started on treatment. That leaves around 65 000 people who were missed altogether.

This is why community-level screening matters so much. We can’t build specialist diagnostic centres next to every rural clinic. Even if we could, we don’t have enough specialists to run them. The answer is to put simpler, portable, and locally workable screening tools into the hands of frontline healthcare workers, especially nurses in primary care settings.

South Africa can’t wait around to be rescued

If the bottleneck is access, then innovation has to begin where access fails. That means building around the healthcare system we have, not the one we wish we had. How do we equip the nurse at the overcrowded community clinic? If we’re serious about combating TB, that’s the question we have to answer.

It’s also why South Africa can’t keep assuming that imported solutions from European or American healthcare systems will automatically fit our realities. We need tools designed for our burden of disease, clinic environments, and constraints. The countries carrying the heaviest burden should also be shaping the next generation of practical, scalable solutions.

The local MedTech sector needs to decide whether it’s serious about that responsibility. It’s one thing to produce impressive technology for conferences and investor decks, but can it be used in a crowded community clinic by a healthcare worker at the end of an 18-hour shift? If the answer is no, it’s not solving the real problem.

When a curable disease is killing tens of thousands of people, we can’t afford to sit around and wait to solve the problem. Thanks to advances in technology, the tools to close the screening gap are no longer beyond our reach. Failing to use them is inexcusable.

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How Macrophages Fail Their Jobs in Cystic Fibrosis

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Respiratory tract. Credit: Scientific Animations CC4.0

Researchers have discovered how part of the body’s immune system could better combat a leading cause of death for people with cystic fibrosis (CF). 

A team led by The University of Queensland’s Professor Peter Sly and Dr Abdullah Tarique has identified how macrophages – the white blood cells that fight infection in the body – function differently in people with CF, compared to others.

“Macrophages play a critical role in fighting infection, especially in the lungs,” Professor Sly said.

“They’re the ‘Pac-Man’ cells that find and ‘gobble up’ bacteria and pathogens such as mycobacterium abscessus (MABS). 

“We found people with CF have multiple defects in their macrophages that leave them more vulnerable to infection, even when taking the most effective CF drug treatment available.”

Professor Sly said MABS posed the biggest infection risk for people with CF.  

“MABS is resistant to many antibiotics which makes treatment complex and often unsuccessful,” he said. 

“The infection can exclude a patient from being eligible for a lung transplant and is a leading cause of death for people with CF.

“And because of antibiotic resistance, MABS infections are increasing at alarming rates.”

Professor Sly said in people with CF, macrophages aren’t as efficient at both recognising and killing off bugs in the body.

“CF involves a defect in the CFTR protein, the channel on the cell’s surface responsible for transporting ions and chlorine in and out of cells,” he said.

“That lack of chlorine transport means macrophages don’t activate their killing functions to ‘eat’ the bugs. 

“A second important mechanism in macrophages is also deficient – the zinc transport of proteins. 

“Zinc is a potent antibacterial mechanism used to poison bacteria, but with less zinc and less zinc transporter proteins in CF macrophages, they’re less able to fight the infection.”

Professor Sly said a third defect – in the mitochondria – is perhaps the most significant.

“Mitochondria are the batteries or power packs of cells, and produce things called reactive oxygen species to kill bacteria.

“In CF, not only are macrophages less able to make these reactive oxygen species, but they’re also not able to keep reproducing them to increase their mitochondrial mass when infected.”

The research also examined treatments for CF and found even the most effective drug doesn’t boost macrophage’s ability to kill MABS.

“Elexacaftor-tezacaftor-ivacaftor (ETI) has been revolutionary in CF treatment by improving lung function in many people, meaning fewer exacerbations and hospitalisations,” Professor Sly said.

“But it doesn’t fix this part of the immune system, which is why people with CF still get these infections.

“Our findings show we now need to accelerate research into different mechanisms of increasing macrophage function, to identify and initiate killing strategies for MABS. 

“This could significantly reduce the impact of these infections for people with CF.”

Read the research in Proceedings of the National Academy of Sciences.

Source: University of Queensland

Categories : Metabolic Disorders Respiratory DiseasesTags :

New Study Links GLP-1 Agonists to Reduction of Asthma Exacerbations and Inhaler Use

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New research presented at this year’s European Congress on Obesity in Istanbul, Turkey (12-15 May) shows the use of the new GLP-1 class of obesity drugs in people with asthma is associated with a 26% fall in the number of asthma exacerbations and a 14% drop in use of asthma inhaler reliever use. The study is by Simon Høj and Dr Kjell Erik Julius Håkansson Copenhagen University Hospital, Copenhagen Denmark and colleagues.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now widely used to treat overweight, obesity and type 2 diabetes (T2DM), with growing evidence of benefits that extend beyond blood sugar control.

In asthma, where overweight, obesity and metabolic dysfunction can lead to increased severity of symptoms and adverse events such as acute exacerbations, the authors suggest that GLP-1 RAs may improve asthma outcomes through weight loss, modulation of airway inflammation, and improvements in metabolic functions. Reductions in occurrence of asthma exacerbations are likely to reduce systemic corticosteroid exposure (a common treatment for acute asthma exacerbations orally or intravenously) and thus may reduce the risk of corticosteroid exposure-associated adverse events such as osteoporosis or new-onset T2DM. As such, as the clinical use of GLP-1 RAs expands, reliable estimates of their impact on asthma control are needed for individuals living with both asthma and overweight, obesity or T2DM.

The researchers conducted a nationwide self-controlled cohort study using linked Danish health registers. Adult individuals with a prior asthma diagnosis or ≥2 asthma inhaler prescriptions redeemed within 12 months) were included on the date of their first GLP-1 RA dispensing (index date). Eligible individuals had continuous registration data for at least 12 months before and after the index date.

Individuals with COPD or patients with severe asthma treated with new and relatively expensive biologic drugs within 12 months before or after the index date were excluded. Overweight or obesity was defined using ICD-10 codes for those conditions. Those who had no evidence of T2DM – with no diagnosis recorded or no evidence of other first line diabetes drugs prescribed – were also placed in the with obesity/overweight group. Those with a T2DM diagnosis or prescriptions recorded for first line diabetes drugs such as metformin were placed in the T2DM group.

The primary outcome was exacerbations, defined as an inpatient asthma hospital contact(s) and/or systemic oral or intravenous corticosteroid course(s). Secondary outcomes were the use of rescue medication (inhaled short-acting β2-agonists), inhaled corticosteroid exposure, and chest infection events defined as redemption of antibiotics commonly used for lower airway infections

The cohort comprised 27,523 individuals (mean age 54 years, 66% female) with asthma and comorbid overweight or obesity (49%) or T2DM (61%) and 26% recorded as having both conditions. Around 50% of the GLP-1 prescriptions were liraglutide, 48% semaglutide, and 2% others (exenatide, dulaglutide, lixisenatide).

Compared with the year before GLP-1 RA treatment, GLP-1 RA treatment was associated with a 26% lower exacerbation rate overall; and 28% lower in men compared with 23% lower in women. When stratified according to GLP1 RA treatment indication, the analysis showed individuals with asthma and comorbid overweight or obesity and individuals with asthma and comorbid T2DM had similar effect estimates – a 22% reduction in those with overweight or obesity and a 26% reduction in those with T2D.

Reliever medication use fell by 14% overall, suggesting fewer symptoms despite daily inhaled corticosteroid exposure also decreasing by 23% (inhaled corticosteroids are used to prevent exacerbations and treat symptoms in asthma). Furthermore, pneumonia events were reduced by 10%. People also living with allergic rhinitis saw similar decreases (23%) in exacerbations to those living without allergic rhinitis (28%). The authors are also working on updated analyses to show differences between men and women for these specific outcomes.

The authors conclude: “In this nationwide cohort of over 27,000 individuals with asthma and also overweight, obesity or type 2 diabetes, use of GLP-1 drugs  was associated with significant reductions in exacerbation burden as well as reliever use, exposure to inhaled corticosteroids and pneumonia events, irrespective of whether the drugs were being used to treat obesity or type 2 diabetes.”

The authors explain that their study did not have access to clinical records (just if people had used GLP-1 and hospital admissions), so data on BMI and weight loss for participants were not available.

But Dr Håkansson says: “There’s a high chance that the weight loss is a major contributor to these results. A common symptom in both asthma and obesity is shortness of breath, and the presence of excess fatty tissue creates a pro-inflammatory state in the body in general. There’s also evidence from other studies suggesting that the inflammation caused by excess adipose tissue is distinct from the ‘classic’ asthma inflammation which often is driven by allergies or cells called eosinophils.”

And he adds: “As the use of GLP-1 therapies increase, researchers are finding an increasing number of effects outside of weight loss.”

Source: EurekAlert!

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Once-Nightly Pill Treats Causes of Airway Collapse to Control Sleep Apnoea

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A once-nightly oral pill helped control obstructive sleep apnoea in a large, phase 3 clinical trial presented at the 2026 ATS International Conference. The drug, called AD109, is the first therapy to treat OSA by addressing its underlying mechanisms and targeting the neuromuscular causes of airway collapse. The trial results will be published in the American Journal of Respiratory and Critical Care Medicine. 

The trial, called SynAIRgy, showed that patients who took AD109 had fewer breathing interruptions during sleep, less oxygen deprivation, and improved blood oxygen levels overall. More than 40 percent of patients saw their OSA disease severity category improve, and 18 percent achieved complete disease control.

“These results provide encouraging evidence that targeting neuromuscular dysfunction can translate into meaningful clinical outcomes, aligning with our evolving understanding of the disease biology,” said first author Patrick John Strollo, MD, a sleep medicine physician at the University of Pittsburgh Medical Center.

Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA, but many patients are unable to tolerate treatment. AD109 could help fill that gap with an easier treatment option, Dr Strollo said.

“In many other chronic diseases, such as cardiovascular disease, asthma, or type 2 diabetes, it would be unthinkable for the majority of diagnosed patients to remain untreated or undertreated. Yet that remains the reality in OSA,” he said. “An oral pill that targets the underlying neuromuscular drivers of airway collapse during sleep could help address this gap and broaden the range of effective options for patients who remain untreated today.”

AD109 combines two medications, aroxybutynin and atomoxetine, which work together to support muscles in the throat and prevent the airway from sagging or collapsing during sleep.

For the trial, which ran for six months at 69 sites across the U.S. and Canada, researchers enrolled 646 adults with mild to severe OSA who couldn’t tolerate or refused CPAP.

Patients taking AD109 saw their apnea-hypoxia index, which measures the number of breathing interruptions per hour, decrease by about 44 percent, compared with 18 percent in the placebo group. Oxygen desaturation index (the number of times during the night that blood oxygen drops) and hypoxic burden (oxygen deficiency) also improved in the AD109 group.

Importantly, improvements were observed consistently across a broad range of patients, including those with varying severity levels and body types.

Along with improved outcomes, the drug showed an acceptable safety profile with mild, expected side effects. The most common side effects were dry mouth, nausea, insomnia, and difficulty urinating. Around 21 percent of patients discontinued therapy due to side effects.

Dr Strollo noted that the results will be published alongside a companion mechanistic review by ATS in the American Journal of Respiratory Cell and Molecular Biology.

“Together, these peer-reviewed articles connect late-stage clinical outcomes with the biological mechanisms that drive the disease, targeted by the mechanism of action of AD109, providing a more complete and integrated view of OSA and strengthening confidence in the approach,” he said.

AD109 has received Fast Track designation from the FDA for the treatment of OSA, recognising the significant unmet need for effective, well-tolerated pharmacologic therapies for OSA. Apnimed has submitted its New Drug Application (NDA) for AD109 to the FDA. Based on FDA feedback, Apnimed expects a potential PDUFA target action date in 1Q 2027, subject to FDA acceptance of the NDA for review.

Source: American Thoracic Society

Categories : Metabolic Disorders Respiratory DiseasesTags :

Could an Asthma Medication Also Protect Against MASH?

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Credit: Pixabay CC0

Join our podcast as we unpack a study exploring the potential of the asthma medication formoterol as a novel treatment for Metabolic Dysfunction-Associated Steatohepatitis (MASH), a severe liver condition often linked to diabetes.

The researchers used experiments involving high-fat diet mice and human liver cell cultures to show that this beta 2 adrenergic receptor agonist effectively reduces liver fat accumulation. It does so by stimulating mitochondrial biogenesis and enhancing metabolic efficiency. In addition, a massive retrospective analysis of nearly 60 000 patients revealed that those using long-acting versions of these drugs experienced significantly lower rates of liver complications and reduced mortality.

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Good News on Long-term Cure Rates of Multidrug-resistant Tuberculosis

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Tuberculosis bacteria. Credit: CDC

A new national cohort study from Latvia, conducted in collaboration with researchers from the clinical tuberculosis infrastructure (ClinTB) at the German Center for Infection Research (DZIF) at the Research Center Borstel, Leibniz Lung Center (FZB), provides important insights into the treatment of multidrug-resistant tuberculosis (MDR-TB). The study shows that long-term disease-free survival rates are significantly higher than previous standard indicators suggest. The results, published in the renowned journal The Lancet Regional Health Europe, are based on the analysis of data from 1299 adult patients treated between 2005 and 2021.

Multidrug-resistant tuberculosis poses a significant challenge to healthcare systems worldwide. Whilst the effectiveness of treatment is traditionally assessed on the basis of treatment outcomes at the end of therapy, the new study shows that these criteria underestimate the actual long-term success of treatment. According to WHO standard definitions, only 4.8% of patients in Latvia were considered cured. However, during long-term follow-up, 76.9% of those affected remained permanently relapse-free.

The researchers linked clinical data with national registry information for long-term follow-up, enabling them, for the first time, to systematically evaluate long-term treatment outcomes in a former European country with a high incidence of MDR-TB. A key factor in treatment success was the use of at least three effective drugs in the individual treatment regimen.

Furthermore, the analysis showed that very short treatment durations of less than nine months, using the treatment options available at the time, were associated with an increased risk of relapse or death. Treatment durations of between ten and seventeen months, however, achieved comparable results to longer courses of treatment. After the end of the observation period, MDR-TB treatments became more effective. Today, the treatment duration for MDR-TB has aligned with the six months required for drug-sensitive tuberculosis.

“The study underscores the importance of long-term follow-up in MDR-TB and suggests that tuberculosis control programmes should broaden their measures of success. Including recurrence-free survival rates allows for a more realistic assessment of the quality of care and the actual benefit to patients,” says Sophie Meier, a medical PhD student at the FZB and the University of Lübeck under DZIF researcher Professor Christoph Lange. 

“The findings also support the role of expert panels, known as consilia, in selecting treatments and assessing treatment success for MDR-TB. In Latvia, the decisions made by the consilium were significantly superior to the results obtained by applying WHO definitions for MDR-TB treatment outcomes. Consilia are also an element of effective ‘antimicrobial stewardship’ against the development of new antibiotic resistance,” says PD Dr Thomas Brehm from the FZB and University Medical Center Hamburg-Eppendorf (UKE), DZIF researcher and senior author of this study.

The findings of this study provide important impetus for future treatment strategies for MDR-TB and support the use of individualised treatment regimens with sufficiently effective drugs. Prospective studies are now required to test these findings in the context of new, shortened treatment regimens using modern active substances. If necessary, the definitions of treatment outcomes for MDR-TB will need to be revised.

Source: German Center for Infection Research