Benralizumab: a unique IL-5 inhibitor for severe asthma

Figures & data

Figure 1 NAEPP stepwise approach to managing asthma with grades of recommendations.⁷²

Note: Grading of Recommendations Assessment, Development and Evaluation (GRADE), (A) High quality of evidence, (B) Moderate, (C) Low, (D) Very low.
Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β-agonist bronchodilators; LTRA, leukotriene antagonist; NAEPP, National Asthma Education and Prevention Program.

Table 1 Clinical trials with anti-interleukins

Medication	Mechanism	Targeted cytokine	Eosinophils	FEV1	Key findings
Daclizumab	Monoclonal antibody to alpha subunit of IL-2	IL-2	Serum: ↓	↑	Decrease in β-agonist use and asthma symptoms but did not continue throughout the study.^Citation68
Dupilumab	Monoclonal antibody to alpha subunit of IL-4 receptor (IL-4α), inhibits both IL-4 and IL-13	IL-4/IL-13	Serum: ↓/↑	↑	Decreased asthma exacerbations with sputum eosinophilia when LABA and ICS were withdrawn.^Citation60
Benralizumab	Monoclonal antibody to	IL-5/(IL-5α)	Serum: ↓ sputum	↑	Benralizumab decreased eosinophils in the airways, sputum, bone marrow, and peripheral blood.^Citation55
Reslizumab	IL-5 or alpha-chain of				Reslizumab decreased exacerbations and improved asthma symptoms.^Citation21
Mepolizumab	IL-5 receptor (IL-5α)				Mepolizumab decreased exacerbations, oral steroid use in dependent asthmatics, and lung function in patients on high dose ICS.^Citation53,Citation69
MEDI-528	Monoclonal antibody to IL-9	IL-9	Serum: ↓/↑	↓/↑*	No significant improvement in exacerbation rates or ACQ scores.^Citation70
Lebrikizumab	Monoclonal antibody to IL-13	IL-13	Serum: ↑ (slight increase)	↑	Improvement in FEV1 in patients with elevated serum periostin.^Citation71

Note:

* The indicates no significant improvement in FEV₁ with some subjects showing and increase and FEV₁ and other a decrease.

Abbreviations: ACQ, Asthma Control Questionnaire; FEV₁, forced expiratory volume in 1 second; IL, interleukin; LABA, long-acting β-agonist bronchodilators; ICS, inhaled corticosteroid.

Figure 2 The mechanism of action of therapies targeting IL-5 and its receptor.

Abbreviations: IL, interleukin; ADCC, antibody-dependent cell-mediated cytotoxicity; NK, natural killer; mAB, monoclonal antibody.

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