Brensocatib (BRINSUPRI™): A Breakthrough for Bronchiectasis

“This multi-modality strategy has long been the standard for other chronic diseases, such as congestive heart failure, and bronchiectasis warrants an equally nuanced approach.” Dr PJ McShane

In a recent editorial published by Dr. Pamela McShane of the National Institutes of Health (NIH), she describes brensocatib, now marketed as BRINSUPRI™, as a breakthrough for the bronchiectasis community. This first-in-class DPP-1 inhibitor marks an important step forward in reducing inflammation and exacerbations for people living with bronchiectasis.
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However, Dr. McShane emphasizes that it is unrealistic to expect one drug to meet every patient’s needs. Instead, she encourages both clinicians and patients to view BRINSUPRI™ as part of a broader treatment plan that includes mucoactive agents, airway-clearance techniques, and, when appropriate, macrolide therapy.

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Where BRINSUPRI™ Fits in the Treatment Landscape

For individuals already receiving long-term macrolide therapy, adding BRINSUPRI™ may further improve outcomes by targeting inflammation through a different mechanism.

​For those living with nontuberculous mycobacterial (NTM) infections, where macrolide therapy may not be possible due to resistance concerns, a DPP-1 inhibitor such as BRINSUPRI™ could represent an alternative strategy to interrupt the ongoing cycle of inflammation, infection, and mucus dysfunction that drives bronchiectasis progression.

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Evidence from the WILLOW Study

Dr. McShane referenced findings from a subgroup analysis of the WILLOW study, where participants with Pseudomonas aeruginosa infection experienced a significant reduction in exacerbations when treated with brensocatib compared with placebo.
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This suggests that BRINSUPRI™ could benefit patients with chronic bacterial colonization, one of the most challenging aspects of managing bronchiectasis.

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The Importance of Multi-Mechanism Strategies

During her guest appearance at a Bronchiectasis and NTM Association support group, Dr. McShane reiterated that while DPP-1 inhibitors represent an exciting advance, they do not address every biological mechanism involved in bronchiectasis.
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She emphasized that future therapies must also target airway-epithelial health, mucus viscosity, and host-pathogen interactions to achieve long-term improvement.

Dr. McShane also compared this approach to the multi-modality treatments already used for other chronic diseases such as congestive heart failure. Bronchiectasis, she argued, deserves an equally comprehensive and individualized model that combines medications, airway clearance, exercise, and infection control for the best outcomes.

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BRINSUPRI™ represents a long-awaited milestone, but it is only the beginning. The future of bronchiectasis management depends on integrated, multi-mechanism treatment plans that address both airway inflammation and mucus dysfunction, two central challenges of this complex condition.

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Editorial Reference:

P.J. McShane. Are Dipeptidyl Peptidase-1 Inhibitors the Future Anti-inflammatory Treatment in Bronchiectasis? Archivos de Bronconeumología. DOI: 10.1016/j.arbres.2025.09.002