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Review
. 2019 Apr 15:8:212580.
doi: 10.7573/dic.212580. eCollection 2019.

Efficacy and steroid-sparing effect of benralizumab: has it an advantage over its competitors?

Francesco Menzella  1 , Mirella Biava  2 , Diego Bagnasco  3 , Carla Galeone  1 , Anna Simonazzi  1 , Patrizia Ruggiero  1 , Nicola Facciolongo  1
Affiliations
Review

Efficacy and steroid-sparing effect of benralizumab: has it an advantage over its competitors?

Francesco Menzella et al. Drugs Context. .

Abstract

Severe refractory asthma is characterized by a higher risk of asthma-related symptoms, morbidities, and exacerbations. This disease also determines much greater healthcare costs and deterioration in health-related quality of life (HR-QoL). Another concern, which is currently much discussed, is the high percentage of patients needing regular use of oral corticosteroids (OCS), which can lead to several systemic side effects. Airway eosinophilia is present in the majority of asthmatic patients, and elevated levels of blood and sputum eosinophils are associated with worse control of asthma. Regarding severe refractory eosinophilic asthma, interleukin-5 (IL-5) plays a fundamental role in the inflammatory response, due to the profound effect on eosinophils biology. The advent of the biological therapies provided an effective strategy, even if the increased number of molecules with different targets raised the challenge of choosing the right therapy and avoid overlapping. When considering severe refractory eosinophilic asthma and anti-IL-5 treatments, it is not easy to define which drug to choose between mepolizumab, reslizumab, and benralizumab. In this article, we carried out an indirect comparison among literature data, especially between OCS reduction studies (ZONDA-SIRIUS) and pivotal studies (SIROCCO-MENSA), evaluating whether the clinical efficacy and the steroid-sparing effect of benralizumab may represent an advantage over other compounds. This data could help the clinician in the decision process of treatment choice, within the different available therapeutic options for eosinophilic refractory severe asthma.

Keywords: comparison; eosinophils; oral corticosteroids; randomized clinical trials; side effects; steroid-sparing effect.

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Conflict of interest statement

Disclosure and potential conflicts of interest: The authors declare that there is no conflict of interest in preparing this article. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at http://www.drugsincontext.com/wp-content/uploads/2019/03/dic.212580-COI.pdf

Figures

Figure 1
Figure 1
Mechanism of action of mepolizumab, reslizumab, and benralizumab. ADCC, antibody-dependent cell cytotoxicity; IL-5Rα, α subunit of the IL-5 receptor; IL-5Rβ, β subunit of the IL-5 receptor; NK, natural killer.
Figure 2
Figure 2
Outcomes comparison between mepolizumab and benralizumab. FEV1, forced expiratory volume in 1 second; NNT, number needed to treat; OCS, oral corticosteroids.
See this image and copyright information in PMC

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