Benralizumab Effectiveness in Severe Asthma Is Independent of Previous Biologic Use

• DOI: 10.1016/j.jaip.2022.02.014
• Publication Date: 2022-02-22T09:05:14Z
• Authors: David J. Jackson; Hassan Burhan; Andrew Menzies-Gow; Paul Pfeffer; Alexandra Nanzer; Esther Garcia Gil; Tamsin Morris; Trung N. Tran; Ian Hirsch; Sabada Dube
• Keywords: Adult; 0301 basic medicine; Biological Products; 0303 health sciences; Patient-reported outcomes; Biologic; Atopy; Severe eosinophilic asthma; 610; Benralizumab; Fractional exhaled nitric oxide; Real-world study; Antibodies, Monoclonal, Humanized; Asthma; 3. Good health; Eosinophils; 03 medical and health sciences; Adrenal Cortex Hormones; Oral corticosteroids; Disease Progression; Humans; Drug Therapy, Combination; Anti-Asthmatic Agents; Pulmonary Eosinophilia; Retrospective Studies

Benralizumab is an IL-5 receptor alpha-directed cytolytic mAb that depletes eosinophils, reducing exacerbations and oral corticosteroid (OCS) use, and improves asthma control for patients with severe eosinophilic asthma (SEA). Data on response in patients previously treated with other biologic therapies are limited.To describe real-world clinical outcomes with benralizumab for patients with and without prior biologic use for uncontrolled SEA.This retrospective study compared clinical outcomes before and after benralizumab initiation in adults with uncontrolled SEA with 3 or more asthma exacerbations in the previous 12 months or on maintenance OCS treatment. Outcomes included exacerbations, OCS use, patient-reported outcomes, and health care resource utilization, including emergency department visits and hospitalizations.In all, 208 patients were enrolled, including 90 (43.3%) with previous experience with an alternate biologic for SEA. Benralizumab led to an 81% reduction in exacerbation rate, with 48% of patients with previous exacerbations experiencing none after 48 weeks. Overall, 67% of patients requiring baseline maintenance OCS achieved greater than or equal to 50% reduction in daily OCS dosage, and 53% eliminated maintenance OCS. Clinically meaningful improvements in patient-reported outcomes were seen, with response at 4 weeks predicting longer-term benefits. Health care resource utilization also decreased. Improvements were observed irrespective of previous biologic experience, fractional exhaled nitric oxide concentrations, atopic status, or other baseline characteristics.In a multicenter real-world setting, patients with uncontrolled SEA achieved substantial improvements in all clinical outcome measures with benralizumab irrespective of previous biologic use, atopic status, or baseline fractional exhaled nitric oxide concentration.