The Intern At Work: Internal Medicine 281. I@W x RoundsTable - Brensocatib for Bronchiectasis and Alteplase for Posterior Circulation Ischemic Stroke
May 8, 2025
Dr. Laiya and Dr. Mike explore the promising effects of brensocatib for reducing exacerbations in bronchiectasis, addressing a significant unmet need. They delve into the trial design, participant demographics, and efficacy results, noting its potential as a first dedicated therapy. The discussion shifts to alteplase for posterior circulation stroke, examining its efficacy and safety in a late-window scenario. Despite some positive findings, they emphasize critical limitations, leaving the treatment's role in practice uncertain.
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DPP‑1 Inhibitor Lowers Exacerbations
- Brensocatib, a DPP‑1 inhibitor, reduced annualized pulmonary exacerbation rate in non‑CF bronchiectasis versus placebo.
- The 10 mg dose cut exacerbations by ~21% with similar serious adverse events to placebo.
ICU Training Often Misses Respirology
- Laiya notes ICU training often lacks dedicated respirology exposure and fellows may miss niche respiratory conditions.
- She sees bronchiectasis frequently in the ICU and values targeted education.
Match Trial Eligibility To Patients
- Consider enrolling patients with confirmed imaging and recurrent antibiotic‑treated exacerbations when applying trial data.
- Note adolescents were few and trial powered for adults only.