With the increasing prevalence rate of bronchiectasis over the years, patients, physicians, and pharmaceutical companies are seeking effective management and treatment approaches. Bronchiectasis involves the abnormal enlargement of the bronchi in the lungs and the overproduction of mucus, with bronchiectasis patients exhibiting excess of sputum and facing recurrent chest infections, contributing to a poor quality of life (Smith, 2017). Additionally, patients demonstrate cycles of bacterial infections and inflammation caused by neutrophils as a consequence of the impaired airway mucosal defence (Smith, 2017). Patients are diagnosed through chest radiographs, lung function tests, and sputum bacteriological culture, which can be further validated by a high-resolution computed tomography (CT) scan of the chest (King et al., 2006). Nevertheless, studies have reported the need for improvements in the research, diagnosis, treatment, and management of the disease.

Although this disease was first described in 1819, no marketed therapies have been approved for bronchiectasis to date, with off-label therapies being used to fight bacterial infections and to decrease the symptom burden of the disease (Smith, 2017).  Still, there is competition in the treatment development landscape as multiple agents that may be promising against bronchiectasis are in late-stage clinical trials, including AstraZeneca’s benralizumab, Joincare’s tobramycin, Insmed’s brensocatib, and Zambon’s colistimethate sodium.

Physicians are focused on addressing unmet needs in the bronchiectasis disease landscape, urging the need for improved management approaches to allow for its efficient control and treatment (Flume et al., 2023). Specifically, physicians have reported that there is an unmet need for the earlier diagnosis of patients, as patients are frequently diagnosed after symptom onset, and for the development of effective pharmacological agents that can promote airway clearance and reduce inflammation, as there are no approved therapies for bronchiectasis (Flume et al., 2023). Studies have also concluded that the identification of new clinical endpoints for the investigation of treatment benefits in bronchiectasis patients is a key unmet need for the bronchiectasis disease landscape (Flume et al., 2023). Lastly, experts have emphasised the need for improved trial designs that will classify patients through phenotypes and endotypes, and for the reevaluation of inclusion and exclusion criteria in trials, as these will contribute to clinical trial accuracy for bronchiectasis (Flume et al., 2023).

Recent licensing deals taking place within the bronchiectasis disease landscape may be the initial steps to address the unmet needs identified by previous studies. For example, Chiesi entered a licensing agreement with Haisco Pharma in 2023 to develop and manufacture Haisco Pharma’s HSK31858 reversible dipeptidyl peptidase 1 (DPP1) inhibitor outside China. According to GlobalData’s Pharmaceutical Intelligence Center, there are 17 pipeline agents in development for bronchiectasis, of which five are in Phase I, nine are in Phase II, and three are in Phase III, demonstrating the competition in the market. Nevertheless, the aforementioned unmet needs are yet to be addressed, highlighting the opportunities within the bronchiectasis disease landscape.

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