Benralizumab: an updated treatment of eosinophilic asthma

ABSTRACT

Introduction: An estimated 5–10% of people with asthma have disease which remains uncontrolled despite maximal treatment with inhaled corticosteroids and long-acting beta-agonists. Benralizumab is currently licensed for use in patients with severe asthma who have an eosinophilic phenotype. Benralizumab depletes eosinophils by binding to the anti-IL5 receptor on the surface of eosinophils, mitigating the effect of IL-5 on eosinophil proliferation and survival, and induces natural killer cell-mediated eosinophil apoptosis.

Areas covered: The authors review the mechanism of action and pharmacokinetic profile of Benralizumab and summarize the scientific data supporting its clinical efficacy and safety in severe asthma. Further, the authors highlight future studies of Benralizumab in asthma and other diseases.

Expert opinion: Benralizumab lowers exacerbation rates, symptom burden, and oral glucocorticoid use, and improves lung function, in patients with severe eosinophilic asthma. Benralizumab is well tolerated and is an attractive choice for patients and physicians due to its eosinophil-depleting mechanism of action and less frequent dosing schedule. More data is needed to guide the selection of biologic therapy in severe asthma patients.

KEYWORDS:

• Asthma
• anti-IL5 therapy
• anti-eosinophilic therapy
• Benralizumab
• efficacy
• safety

Article Highlights

• Eosinophils are important mediators of inflammation in asthma and associated with poor clinical outcomes.

• Benralizumab depletes eosinophils by binding to both the alpha subunit of the IL5-receptor on the eosinophil surface and to natural killer cell receptors inducing eosinophil apoptosis.

• In Phase III clinical studies, Benralizumab reduced exacerbations by 40–70% compared to placebo in patients with severe uncontrolled asthma with a baseline eosinophil count ≥300 cells/µL.

• Benralizumab is effective as a steroid-sparing agent in patients who are glucocorticoid-dependent.

• The efficacy of Benralizumab increases with increased baseline eosinophil counts and higher frequency of exacerbation pre-treatment.

• In clinical studies to date, Benralizumab is safe and well tolerated across a diverse severe asthma population.

Declaration of Interest

Andrew Menzies-Gow has participated in research for which his host institution has been remunerated with AstraZeneca. He has attended advisory boards for AstraZeneca, GlaxoSmithKline, Novartis, Teva, and Sanofi, has consultancy agreements with AstraZeneca, Vectura, and Sanofi. Andrew Menzies-Gow and Breda Cushen have attended international conferences with Teva. The authors have no other relevant conflicts of interest to declare.

Reviewer Disclosures

A peer reviewer on this manuscript discloses that they have received research grants from Astra Zeneca, Teva, and Sanofi-Aventis. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.