Astegolimab for COPD With Frequent Exacerbations: Pooled Analysis of the ALIENTO and ARNASA Trials

Abstract Rationale The efficacy and safety of astegolimab, an anti-ST2 monoclonal antibody, was evaluated in participants with chronic obstructive pulmonary disease (COPD) and frequent exacerbations in the pivotal ALIENTO and ARNASA trials. Objectives To report the prespecified pooled analysis of ALIENTO and ARNASA. Methods ALIENTO and ARNASA were randomized, double-blind, placebo-controlled trials with similar designs and included participants with COPD, a history of frequent exacerbations, and who were current/former smokers, irrespective of blood eosinophil count and chronic bronchitis. Participants were randomized 1:1:1 to astegolimab 476 mg every 2 weeks, every 4 weeks or placebo for 52 weeks, plus optimized maintenance therapy. The primary endpoint was annualized rate of moderate/severe exacerbations. Secondary endpoints included annualized rate of severe exacerbations. A hierarchical statistical plan was followed with hypothesis testing of secondary efficacy endpoints gated on the primary efficacy endpoint success. Measurements and Main Results 2682 participants were included in the pooled intent-to-treat population. Astegolimab significantly reduced the annualized rate of moderate/severe exacerbations by 15% in the every 2 weeks arm (adjusted rate ratio 0.85 95% CI, 0.76-0.96; P = .0077) and by 12% in the every 4 weeks arm (rate ratio 0.88 95% CI, 0.78-0.99 P = .0265). A nominally significant reduction in the annualized rate of severe COPD exacerbations (rate ratio 0.68 95% CI, 0.52-0.87; P = .0028) was observed for astegolimab every 2 weeks vs. placebo. Astegolimab was well tolerated. Conclusions Astegolimab every 2 weeks reduced the annualized rate of moderate/severe exacerbations in a clinically heterogeneous population of participants with COPD and frequent exacerbations. Trial registration numbers ClinicalTrials.gov: NCT05037929; NCT05595642