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. 2023 Oct 30;9(5):00419-2023.
doi: 10.1183/23120541.00419-2023. eCollection 2023 Sep.

Real-world characteristics of "super-responders" to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis

Andrea Portacci  1   2 , Raffaele Campisi  3   2 , Enrico Buonamico  1 , Santi Nolasco  3   4 , Corrado Pelaia  5 , Nunzio Crimi  4 , Alida Benfante  6 , Massimo Triggiani  7 , Giuseppe Spadaro  8 , Maria Filomena Caiaffa  9 , Giulia Scioscia  10 , Aikaterini Detoraki  11 , Giuseppe Valenti  12 , Francesco Papia  12 , Alessandra Tomasello  6 , Nicola Scichilone  6 , Girolamo Pelaia  5 , Claudia Crimi  3   4 , Giovanna Elisiana Carpagnano  1
Affiliations

Real-world characteristics of "super-responders" to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis

Andrea Portacci et al. ERJ Open Res. .

Abstract

Background: The current definition of severe eosinophilic asthma (SEA) super-responders to biologic treatment does not include patients with other eosinophil-based comorbidities. Although eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases. We aim to assess super-responder features in real-life patients with SEA and EGPA treated with mepolizumab and benralizumab.

Methods: We enrolled 39 patients with SEA and EGPA eligible for treatment with mepolizumab or benralizumab. Super-responder assessment was performed considering oral corticosteroid (OCS) cessation, lack of exacerbations, forced expiratory volume in 1 s and Asthma Control Test (ACT) improvement.

Results: Super-responders showed worse clinical baseline characteristics than non-super-responder patients, with a greater improvement in severe asthma exacerbations, OCS dose reduction and ACT score increase. Definition of super-responders was consistent only considering a 12-month course of monoclonal antibody, lacking sensitivity in earlier evaluations.

Conclusion: Mepolizumab and benralizumab are safe and effective in patients with EGPA and SEA, since a consistent proportion of patients show a super-response after 12 months of treatment. Further studies will address specific criteria for super-responder assessment in these patients.

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Conflict of interest statement

Conflict of interest: A. Portacci reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline, Chiesi and Sanofi. Conflict of interest: N. Crimi reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline and Sanofi. Conflict of interest: A. Benfante reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline and Sanofi. Conflict of interest: M. Triggiani reports consulting fees from AstraZeneca, GlaxoSmithKline and Novartis. Conflict of interest: G. Scioscia reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline and Sanofi. Conflict of interest: A. Detoraki reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline, Sanofi, Novartis and Lofarma. Conflict of interest: G. Valenti reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from GlaxoSmithKline and Sanofi. Conflict of interest: N. Scichilone reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline, Chiesi and Sanofi. Conflict of interest: G. Pelaia reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Chiesi, Sanofi, Guidotti, Menarini and Novartis. Conflict of interest: C. Crimi reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi, Menarini, ResMed and Fisher&Paykel. Conflict of interest: G.E. Carlagnano reports grants or contracts from AstraZeneca, Chiesi, GlaxoSmithKline, Sanofi and Grifols; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline and Sanofi; and support for attending meetings and/or travel from Astrazeneca, Menarini and Chiesi.

Figures

FIGURE 1
FIGURE 1
Severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis features variation in super-responders according to different follow-up times. a) Oral corticosteroid (OCS) dose; b) blood eosinophil (EOS) count; c) Asthma Control Test (ACT); d) Birmingham Vasculitis Activity Score (BVAS). *: p<0.05, **: p<0.01, ***: p<0.001.
FIGURE 2
FIGURE 2
Baseline features of super-responders versus non-super-responders. Data are reported in percentages. Blood eosinophil count (BEC) and oral corticosteroid (OCS) dose cut-offs have been chosen for graphical purposes. ACT: Asthma Control Test; SABA: short-acting β-agonist; ED: emergency department.
FIGURE 3
FIGURE 3
Changes in super-responder and non-super-responder classification during a 12-month follow-up. Yellow and white patients did not change their status over time. T3, T6, T12: 3 months, 6 months and 12 months, respectively, from the start of monoclonal antibody administration.
See this image and copyright information in PMC

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