Increase in FeNO Levels Following IL5/IL5R-Targeting Therapies in Severe Asthma: A Case Series

Figures & data

Table 1 Characteristics of Cases Before Initiating Anti-IL5/IL5R Therapies and at 3- and 12-Months Post-Treatment Initiation

	Age	Sex	Asthma Onset	BMI (kg/m^2)	Smoking History	Asthma Comorbidities	Time Point	FeNO (ppb)	Blood Eosinophils (x10^6 cells/L)	Sputum Eosinophils (%)	ICS Dose^¥ (mcg/d)	OCS Dose (mg/d)	FEV1 Pre-BD (L/%)		Severe Asthma Exacerbations
Benralizumab
1	63	M	N/D	32.3	Never	Atopy, sleep apnea	T0	16	N/D	0.25	1000		1.87	51	Yes (N=1) No No
							T1	43	0	0.00	1000	0	N/D
							T2	20	N/D	N/D	1000		N/D
2	28	M	N/D	28.4	Past	Atopy, GERD, nasal polyposis	T0	40	300	6.50	2000		4.23	99	Yes (N≥3) No
							T1	244	0	N/D	1000	0	4.61	108
							T2	111	N/D	0.00	500		4.80	113	No
3 *	67	M	N/D	31.5	Never	Atopy, GERD, sleep apnea	T0	154	0	5.00	2000		3.06	100	No
							T1	210	0	N/D	2000	0	3.10	102
							T2	N/D	N/D	N/D	1500		N/D
4 **	52	M	Late	29.9	Past	Atopy, nasal polyposis	T0	78	300		1250		N/D		Yes (N=1) No No
							T1	162	0	N/D	1000	0	N/D
							T2	N/D	N/D		1000		N/D
5	58	F	N/D	29.0	Past	Atopy, nasal polyposis	T0	62	0	N/D	2500		1.99	77	No
							T1	99	N/D		2500	0	N/D
							T2	40	N/D		2500		N/D
Mepolizumab
6	21	F	Early	24.8	Never	Atopy, nasal polyposis	T0	53	700	53.00	2000		3.21	103	No
							T1	N/D	N/D	N/D	2000	0	N/D
							T2	141	100	68.25	2000		3.19	103
7	43	M	Early	31.9	Past	Atopy, GERD, sleep apnea	T0	N/D	100	N/D	1750	20	N/D		Yes (N=3) Yes (N=1) Yes (N=1)
							T1	24	100	0.00	1750	25	2.50	68
							T2	51	0	N/D	1500	15	N/D
8	44	F	Late	30.8	Never	Atopy, nasal polyposis	T0	N/D	600		2500	12.5	2.97	95	Yes (N≥3) No No
							T1	8	0	N/D	0^‡	2.5	2.81	91
							T2	54	100		500	0	2.97	96
9 *	65	M	Late	32.8	Never	Atopy, GERD, sleep apnea	T0	31	200	N/D	2000	10	3.19	101	No
							T1	36	0	N/D	2000	7.5	N/D
							T2	154	0	5.00^†	2000	0	3.06	99
10	48	M	N/D	32.4	Never	Nasal polyposis	T0	66	200	4.00	1500		2.58	63	Yes (N=2) No No
							T1	123	0	N/D	500	0	N/D
							T2	N/D	N/D	N/D	N/D		N/D
11**	51	M	Late	26.6	Past	Atopy, nasal polyposis	T0	65	1810		1000	0	N/D		Yes (N≥3)
							T1	137	100	N/D	500	10	N/D		No
							T2	72	100		1500	0	N/D		No
12	67	M	N/D	23.8	Past	GERD	T0	N/D	N/D	57.50	1250	0	1.07	34	Yes (N≥3)
							T1	12	0	N/D	1250	7.5	1.30	41	No
							T2	64	0	3.00	1000	0	1.10	35	Yes (N=1)
13	44	F	N/D	21.8	Never	Atopy, nasal polyposis	T0	143	900		500	3.5	2.61	86	Yes (N=1)
							T1	49	100	N/D	1500	2.5	3.00	98	No
							T2	93	N/D		1000	0	2.96	98	No

Notes: All Benralizumab patients switched from Mepolizumab to Benralizumab. ^¥Reported as equivalent of fluticasone. ^†The T2 visit of this patient on Mepolizumab is also the baseline (T0) visit of the same patient on Benralizumab. The change of medication was made at this visit. ^‡The patient gradually decreased her ICS between T0 and T1 since she was doing well, so at T1, she was not taking any more.*Same patient under Mepolizumab and Benralizumab at different times. **Same patient under Mepolizumab and Benralizumab at different times.

Abbreviations: N/D, Not done and/or data unavailable in the patient’s file. T0: 0 month. T1: 3 months. T2: 12 months; GERD, Gastroesophageal reflux disease; ICS, Inhaled corticosteroids. OCS: Oral corticosteroids (Prednisone); FEV₁ pre-BD, Forced expiratory volume in 1 second pre-bronchodilator; mcg/d, micrograms/day; mg/d, milligrams/day.

Figure 1 Flow chart of study participants.

Abbreviations: FeNO, fractional exhaled nitric oxide; EGPA, eosinophilic granulomatosis with polyangiitis.

Figure 2 FeNO values at T0, T1 and T2 for patients who experienced a significant increase in FeNO between at least two time points on (A) Benralizumab and (B) Mepolizumab: The background colors (green, yellow, orange, red) help interpret FeNO levels: The green zone is low FeNO (≤25 ppb), which corresponds to normal values: Intermediate-high FeNO = 26–49 ppb, high FeNO = 50–99 ppb, and ultra-high FeNO = ≥100 ppb: Note that the incomplete curves are explained by missing data at T0 or T2: For case #6 who had missing data at T1, we assigned a fictive value at T1, representing the mean of T0 and T2: This estimated value is only used in this graph to help visualize the variation between T0 and T2 but was not considered in data analysis.