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. 2024 Jun 6:17:557-572.
doi: 10.2147/JAA.S461800. eCollection 2024.

Benralizumab Reduces Respiratory Exacerbations and Oral Glucocorticosteroid Dose in Patients with Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis

Carlo Mümmler  1 , Pontus Mertsch  1 , Michaela Barnikel  1 , Frank Haubner  2 , Ulf Schönermarck  3 , Ulrich Grabmaier  4 , Hendrik Schulze-Koops  5 , Jürgen Behr  1 , Nikolaus Kneidinger  1   6 , Katrin Milger  1
Affiliations

Benralizumab Reduces Respiratory Exacerbations and Oral Glucocorticosteroid Dose in Patients with Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis

Carlo Mümmler et al. J Asthma Allergy. .

Abstract

Background: Benralizumab reduces exacerbations and long-term oral glucocorticosteroid (OCS) exposure in patients with severe eosinophilic asthma. In patients with eosinophilic granulomatosis with polyangiitis (EGPA), uncontrolled symptoms and exacerbations of asthma and chronic rhinosinusitis (CRS) are important reasons for continued OCS therapies. We aimed to describe outcomes of patients with severe asthma and EGPA treated with benralizumab in real-life.

Methods: We retrospectively analyzed adult patients from the Severe Asthma Unit at LMU Munich diagnosed with severe asthma and EGPA treated with benralizumab, differentiating two groups: Group A, patients with a stable daily OCS dose and diagnosis of EGPA >6 months ago; and Group B, patients treated with high-dose daily OCS due to recent diagnosis of EGPA <6 months ago. We compared outcome parameters at baseline and 12 months after initiation of benralizumab, including respiratory exacerbations, daily OCS dose, and lung function.

Results: Group A included 17 patients, all receiving OCS therapy and additional immunosuppressants; 15 patients (88%) continued benralizumab for more than 12 months, demonstrating a significant reduction in daily OCS dose and exacerbations while FEV1 increased. Group B included 9 patients, all with high-dose daily OCS and some receiving cyclophosphamide pulse therapy for life-threatening disease. Benralizumab addition during induction was well tolerated. A total of 7/9 (78%) continued benralizumab for more than 12 months and preserved EGPA remission at the 12-month timepoint.

Conclusion: In this real-life cohort of patients with severe asthma and EGPA, benralizumab initiation during remission maintenance reduced respiratory exacerbations and daily OCS dose. Benralizumab initiation during remission induction was associated with a high rate of clinical EGPA remission.

Keywords: CRS; EGPA; OCS; anti-IL5R; asthma; benralizumab; biologics; glucocorticoid; vasculitis.

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Conflict of interest statement

CM reports speaker and/or consultancy fees from Sanofi, outside of the submitted work. PM reports speaker and/or consultancy fees from AstraZeneca, ResMed, Insmed, Vertex, all outside of the submitted work. US has received consulting fees from Ablynx, Alexion, and Vifor Pharma and reports research support from Vifor Pharma, Ablynx/Sanofi, and Alexion, all outside the submitted work. UG received speaker honoraria from AstraZeneca outside of the submitted work. HSK served as consultant and advisor or review panel member for AbbVie, Amgen, AstraZeneca, Biogen, BMS, Celgene, Gilead, Galapagos, Hexal Sandoz, Janssen-Cilag, Elli Lilly, Medac, MSD, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, all outside the submitted work. JB reports speaker and/or consultancy fees from AstraZeneca, GSK, Novartis, Sanofi, all outside of the submitted work. NK reports speaker and/or consultancy fees from AstraZeneca and GSK, all outside of the submitted work. KM reports speaker and/or consultancy fees from AstraZeneca, Chiesi, GSK, Novartis, Sanofi, all outside of the submitted work. The author report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
STROBE diagram of patient cohort.
Figure 2
Figure 2
Comparison of parameters of OCS use and symptoms (A), lung function (B), and biomarkers (C) before and after 12 months of benralizumab of patients in maintenance cohort. In this analysis we included all 15 patients who continued benralizumab for 12 months. Statistics: (A), (C): Wilcoxon matched-pairs signed-rank test; (B): paired t-test, *p<0.05, **p< 0.01, ***p<0.001.
Figure 3
Figure 3
Comparison of parameters of OCS use and exacerbations (A), lung function (B), and biomarkers (C) before and after 12 months of benralizumab in induction cohort. In this analysis we included all 7 patients who continued benralizumab for 12 months. Statistics: Wilcoxon matched-pairs signed-rank test, *p<0.05.
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