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. 2023 May;10(1):e001472.
doi: 10.1136/bmjresp-2022-001472.

Real-life effects of benralizumab on airway oscillometry in severe eosinophilic asthma

Rory Chan  1 , Brian J Lipworth  2
Affiliations

Real-life effects of benralizumab on airway oscillometry in severe eosinophilic asthma

Rory Chan et al. BMJ Open Respir Res. 2023 May.

Abstract

Introduction: Eosinophil depletion with benralizumab reduces exacerbations and improves disease control and FEV1 in patients with severe eosinophilic asthma. However, few studies have investigated the effect of biologics on small airways dysfunction (SAD) even though the latter correlates better with poor asthma control and type 2 inflammation.

Methods: 21 GINA-defined severe asthma patients who were treated with benralizumab and who had baseline oscillometry-defined SAD were included in this study. Here, SAD was diagnosed only if patients satisfied both R5-R20≥0.10 kPa/L/s and AX≥1.0 kPa/L. The mean duration of follow-up between pre-benralizumab versus post-benralizumab clinical measurements was 8 months.

Results: Mean values for FEV1% and FVC% but not FEF25%-75% significantly increased following benralizumab, along with significant reductions in Asthma Control Questionnaire (ACQ). There were no significant improvements in R5-R20, X5 or AX, while the mean (SEM) PBE count fell to 23 (14) cells/µL. In a responder analysis, n=8/21 and n=12/21 patients experienced improvements exceeding biological variability of 0.04 kPa/L/s and 0.39 kPa/L in R5-R20 and AX, respectively, in severe asthma. N=10/21, n=10/21 and n=11/21 patients experienced improvements in FEV1, FEF25-75 and FVC exceeding biological variability of 150 mL, 0.210 L/s and 150 mL, respectively. In contrast, n=15/21 patients experienced an improvement in ACQ greater than minimal clinical important difference of 0.5 units.

Conclusion: Eosinophil depletion with benralizumab improves spirometry and asthma control but does not improve spirometry-measured or oscillometry-measured SAD in severe asthma in a real-life setting.

Keywords: Asthma; Lung Physiology.

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Conflict of interest statement

Competing interests: RC reports personal fees (talks) and support attending ERS from AstraZeneca, personal fees (consulting) from Vitalograph, and personal fees (talks) from Thorasys. BJL reports non-financial support (equipment) from GSK; grants, personal fees (consulting, talks and advisory board), other support (attending ATS and ERS) and from AstraZeneca; personal fees (talks and consulting) from Sanofi, personal fees (consulting, talks and advisory board) from Circassia in relation to the submitted work; grants, personal fees (consulting, talks, advisory board), other support (attending ERS) from Teva, personal fees (talks and consulting), grants and other support (attending ERS and BTS) from Chiesi, personal fees (consulting) from Lupin, personal fees (consulting) from Glenmark, personal fees (consulting) from Vectura, personal fees (consulting) from Dr Reddy, personal fees (consulting) from Sandoz; grants, personal fees (consulting, talks, advisory board), other support (attending BTS) from Boehringer Ingelheim, grants and personal fees (advisory board and talks) from Mylan outside of the submitted work; and the son of BJL is presently an employee of AstraZeneca.

Figures

Figure 1
Figure 1
Before and after graph depicting individual treatment responses and means for (A) ACQ (B) FEV1% (C) FVC% (D) PBE (E) R5–R20 and (F) AX for pre-benralizumab versus post-benralizumab therapy. ACQ, Asthma Control Questionnaire; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; AX, reactance area; PBE, peripheral blood eosinophils.
See this image and copyright information in PMC

References

    1. Chan R, RuiWen Kuo C, Lipworth B. Pragmatic clinical perspective on Biologics for severe refractory type 2 asthma. J Allergy Clin Immunol Pract 2020;8:3363–70. 10.1016/j.jaip.2020.06.048 - DOI - PubMed
    1. Kuo CR, Chan R, Lipworth B. Impulse Oscillometry Bronchodilator response and asthma control. J Allergy Clin Immunol Pract 2020;8:3610–2. 10.1016/j.jaip.2020.07.031 - DOI - PubMed
    1. Shirai T, Akamatsu T, Hirai K, et al. Oscillometry improves earlier than Spirometry after Benralizumab initiation in severe asthma. Allergy 2020;75:2678–80. 10.1111/all.14339 - DOI - PubMed
    1. Chan R, Misirovs R, Lipworth B. Repeatability of impulse Oscillometry in patients with severe asthma. Eur Respir J 2022;59:2101679. 10.1183/13993003.01679-2021 - DOI - PubMed
    1. Foy BH, Soares M, Bordas R, et al. Lung computational models and the role of the small Airways in asthma. Am J Respir Crit Care Med 2019;200:982–91. 10.1164/rccm.201812-2322OC - DOI - PMC - PubMed

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