Effectiveness of Switching to Benralizumab in Severe Refractory Eosinophilic Asthma

Abstract

Purpose

Benralizumab is a monoclonal antibody that targets the α subunit of the IL-5 receptor. Clinical trials have demonstrated the efficacy of this agent with respect to lung function and symptom control in patients with refractory eosinophilic asthma. However, few studies have evaluated the efficacy of benralizumab after switching previous treatment with other monoclonal antibodies.

Patients and Methods

We performed a multicenter retrospective study under conditions of daily clinical practice. The study population comprised consecutively included patients with severe refractory eosinophilic asthma whose initial treatment with omalizumab or mepolizumab was switched to benralizumab. Patients were evaluated at 4 and 12 months after starting treatment with benralizumab. We analyzed asthma control, number of severe exacerbations, corticosteroid cycles, visits to the emergency department, and hospital admissions, as well as lung function. Similarly, we evaluated the response to treatment according to previously established criteria.

Results

We evaluated 40 patients who switched from omalizumab (n=16) or mepolizumab (n=24) to benralizumab. The reasons for switching were lack of response in 30 cases, adverse effects in 9, and patient request in 1. Switching was followed by a significant decrease in the number of exacerbations, visits to the emergency department, and corticosteroid cycles, as well as improved ACT both at 4 and 12 months. However, no significant improvement in lung function was observed. Asthma control (including complete response and control) was achieved in 55% of patients (n=22) at 12 months. Specifically, a complete response was achieved in 30% of patients at 12 months (66.7% switching from omalizumab and 33.3% from mepolizumab).

Conclusion

Patients diagnosed with severe refractory eosinophilic asthma who experience a partial response with omalizumab or mepolizumab could benefit from switching to benralizumab. This approach can reduce the number of exacerbations, visits to the emergency department, and corticosteroid cycles and improve control of asthma.

Keywords:

• monoclonal antibodies
• severe uncontrolled asthma
• daily clinical practice
• treatment optimization

Acknowledgments

The authors are grateful to María Victoria Maestre and to Vicente Merino for their support during the performance of this study.

Disclosure

AGBF has participated in speaking activities, as a scientific advisor or as a participant in clinical studies in the last 3 years sponsored by AstraZeneca, ALK, Bial, Chiesi, GlaxoSmithKline, Mundipharma, Novartis, Orion-Pharma, Sanofi and Teva. JFMG has received honoraria as a speaker, scientific advisor or participant in clinical studies in the last 3 years sponsored by AstraZeneca, Bial, Chiesi, Gebro Pharma, GlaxoSmithKline, Novartis, Sanofi and Teva. JDR has received honoraria as a speaker, scientific advisor or participant in clinical studies in the last 3 years sponsored by AstraZeneca, Bial, Chiesi, Gebro Pharma, GlaxoSmithKline, Novartis, Sanofi and Teva. ARF declares no conflicts of interest. CBB has participated in speaking activities in the last 3 years sponsored by AstraZeneca, GlaxoSmithKline, Novartis and Sanofi. JGB has received honoraria for scientific advice sponsored by AstraZeneca. FAG participated in speaking activities and advisory boards and provided consultancy services during the period 2016–2021 sponsored by AstraZeneca, ALK, Bial, Boehringer-Ingelheim, Chiesi, GSK, Mundipharma, Novartis, Orion-Pharma and Sanofi. All authors declare not having received, directly or indirectly, funding from the tobacco industry or its affiliates. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.