AstraZeneca faced a significant setback as the U.S. Food and Drug Administration (FDA) rejected its application for Fasenra (benralizumab) in treating chronic rhinosinusitis with nasal polyps (CRSwNP). The regulatory agency has requested additional clinical data before considering approval for this indication.
Clinical Trial Results and Development Status
The rejection comes despite positive results from the Phase 3 OSTRO trial, where Fasenra demonstrated statistically significant improvements in both endoscopic total nasal polyp score and nasal blockage score compared to placebo. These results were observed in patients with severe disease who remained symptomatic despite standard care.
AstraZeneca is currently conducting a second Phase 3 trial, ORCHID, with results expected in September 2023. This additional study may provide the supplementary data required by the FDA to support a future approval.
Market Impact and Competition
The regulatory setback delays AstraZeneca's entry into a growing market for CRSwNP treatments, where two major competitors have already established their presence:
- Sanofi/Regeneron's Dupixent (dupilumab), an IL-4 and IL-13 inhibitor, approved in 2019
- GSK's Nucala (mepolizumab), an IL-5 inhibitor, approved in 2022
Dupixent has shown remarkable commercial success, generating $5.7 billion in sales last year across its various indications, while Nucala achieved $1.4 billion in revenue.
Disease Burden and Treatment Landscape
CRSwNP affects approximately 2% of the U.S. population, with 25-30% of chronic rhinosinusitis patients developing nasal polyps. The condition can be particularly challenging, often requiring surgical intervention, with severe cases leading to multiple operations due to polyp recurrence.
Current standard care relies on corticosteroids administered nasally and systemically, particularly following surgery. However, these treatments frequently demonstrate limited efficacy, highlighting the need for additional therapeutic options.
Fasenra's Broader Development Program
While this setback affects the nasal polyp indication, Fasenra continues to perform well in its approved indication as an add-on maintenance treatment for severe eosinophilic asthma, generating $1.3 billion in sales last year. AstraZeneca is also pursuing additional indications, including:
- Hypereosinophilic syndrome (HES)
- Eosinophilic oesophagitis
Phase 3 trial results for both conditions are expected later this year, potentially expanding Fasenra's therapeutic reach despite this temporary setback in the nasal polyp indication.
