Combining DPP1 Inhibition With Existing Bronchiectasis Therapies

In "Combining DPP1 Inhibition With Existing Bronchiectasis Therapies," Dr. Sala explains how he decides whether to add, combine, or substitute therapies as his treatment options expand.

With DPP1 inhibitors like brensocatib now available, Dr. Sala says his approach to combining them with existing therapies like inhaled antibiotics and thrice-weekly azithromycin hasn't fundamentally changed, largely because no data yet supports de-escalating azithromycin once a patient starts brensocatib. For patients already on azithromycin with severe disease, he typically adds brensocatib rather than replacing it. For patients approved for brensocatib who haven't yet started azithromycin, he may use brensocatib alone instead. Dr. Sala considers the two therapies complementary rather than substitutes for one another, noting that real-world treatment sequencing, whether to start one therapy at a time or combine several from the outset, remains an open area ripe for further clinical study and research in the years ahead for this growing patient population overall.

One clear exception, Dr. Sala explains, involves patients who culture nontuberculous mycobacteria, where azithromycin is contraindicated due to the risk of inducing drug resistance. For these patients, brensocatib becomes an especially valuable option since macrolide therapy isn't safely available to them. He describes being "grateful" to finally have a non-macrolide option for immune modulation in this population, who previously had fewer therapeutic paths available to them. More broadly, Dr. Sala frames the expanding toolbox, inhaled antibiotics, azithromycin, and now DPP1 inhibition, as complementary approaches he draws on based on each patient's specific clinical picture, acknowledging that while he tends to use all available tools when appropriate, certain patient circumstances can limit him to a single option by necessity rather than preference in his day-to-day clinical practice.

Up next, in "Insurance Barriers to Bronchiectasis Treatment: What Clinicians Are Seeing," the conversation turns to real-world payer access for this new therapy class.