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

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:

• EGPA
• asthma
• CRS
• vasculitis
• glucocorticoid
• OCS
• anti-IL5R
• biologics
• benralizumab

Abbreviations

ACT, asthma control test; ANCA, antineutrophil cytoplasmic antibodies; anti-IL5, anti-interleukin 5; anti-IL5R, anti-interleukin 5 receptor; BEC, blood eosinophil count; BMI, body mass index; CNS, central nervous system; CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; EGPA, eosinophilic granulomatosis with polyangiitis; ENT, ear nose and throat; FEV1, forced expiratory volume in 1 second; FEV1%, % predicted value of MEF25-75; FVC, forced vital capacity; FVC%, % predicted value of FVC; ICS, inhaled corticosteroid; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; MEF25-75, mean expiratory flow at 25 to 75% of FVC; MEF25-75%, % predicted value of MEF25-75; MPO, myeloperoxidase; MTX, methotrexate; OCS, oral glucocorticosteroid; PFT, pulmonary function testing; RCT, randomized controlled trial; RV, residual volume; RV%, % predicted value of RV.

Acknowledgment

We thank Christina Rullo, Nicole Seeling and Patricia Sklarek for excellent technical assistance, and all patients for their participation in the registry.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

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.

Additional information

Funding

No funding was received for this study.