Repurposing Roche’s legacy: Breathing new life into COPD treatment

Melbourne researchers have discovered a promising new approach to treating Chronic Obstructive Pulmonary Disease (COPD) by repurposing a drug originally marketed by Roche and approved for idiopathic pulmonary fibrosis. The findings point to a potential alternative to steroids, long considered the mainstay of treatment despite their significant side effects.

In Australia, COPD affects around two million people and remains a major cause of morbidity and mortality, particularly among those over the age of 40. Obstructive lung diseases such as asthma and COPD impact more than a third of Australians, with COPD accounting for 3.6% of the total disease burden and half of the total burden from respiratory conditions.

The researchers found that pirfenidone reduced disease severity in COPD, lowering both virus replication and airway inflammation, without compromising the immune response, a known drawback of steroids.

The study, conducted by a collaborative team from Hudson Institute, Monash Health, and the Monash Biomedicine Discovery Institute, was led by respiratory physician Professor Philip Bardin, alongside Dr Belinda Thomas and Professor Jane Bourke.

“Compared to steroids, Pirfenidone reduced disease severity, lowering both virus replication and airway inflammation, without reducing the immune response, which is what the steroids do,” said Dr Thomas. “Steroids are really packed with adverse effects but there’s been nothing to replace them until now and we believe Pirfenidone is an exciting option.”

Professor Bardin, who oversaw the research, said the side effects of steroids can be “horrendous”, including diabetes, hypertension, heart disease, osteoporosis, obesity, skin changes and disrupted sleep.

“They’re wonderful for inflammation, but it comes at a price,” Professor Bardin said. “Pirfenidone had the opposite effect to steroids, in a way, because it dampened down infection and it helped with inflammation, whereas with steroids the infection was made worse, though it helped somewhat with inflammation.”

“The great benefit if this treatment is translated into the clinic is that people could come off steroids,” he added. “Detrimental effects of steroids build up over time so that by the age of 60 many people start having severe side effects such as cardiac disease, hypertension, diabetes, skin problems and osteoporosis.”

Professor Bardin noted that drug repurposing offers enormous potential. He said, “Repurposing aspirin for alternative medical conditions has been a success story. Initially used for pain relief, basic research showed its effect on platelet function and blood clotting, and since then it has had great success in reducing coronary events.”

He believes artificial intelligence (AI) will be central to unlocking such opportunities. He explained, “AI can review physical and chemical properties of millions of compounds with the potential to independently perform the complex process of drug repurposing, albeit with final human oversight. Large online databases contain details of more than 100 million compounds and more than 300 million biomolecular targets.”

“There has never been a systematic way of integrating a mountain of disease pathologies and existing drug information; AI now provides a tool that can connect these domains.”

Dr Thomas further added, “We have a robust pre-clinical model showing that it works and there is likely to be a lot of interest in repurposing Pirfenidone in COPD.”

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