Benralizumab effectiveness in severe eosinophilic asthma with and without nasal polyposis

Published: August 14, 2021

Severe eosinophilic asthma is a heterogeneous disease often associated with several comorbidities. Chronic rhinosinusitis with nasal polyposis represents one of the most frequent, with a prevalence of around 60%, contributing substantially to symptoms and risk of exacerbations. Benralizumab, a humanized monoclonal antibody, induces eosinophils apoptosis and decreases type 2 inflammation which underlies both severe eosinophilic asthma and nasal polyposis. However, limited evidence exists about benralizumab effectiveness in patients with the copresence of both diseases.

In a recent research article published in The Journal of Allergy and Clinical Immunology: In Practice, Nolasco and colleagues evaluated the efficacy of benralizumab in patients with severe eosinophilic asthma with and without chronic rhinosinusitis with nasal polyps during 24 weeks of treatment, reporting also the changes in nasal symptoms. The authors conducted a real-world, multicenter, observational study on 137 patients with severe eosinophilic asthma treated with subcutaneous benralizumab (30 mg, once every 4 weeks for the first 3 doses, and then once every 8 weeks) who were referred to 12 specialized Italian secondary care facilities, all of which were part of the “Southern Italy Network on Severe Asthma Therapy”. An extensive registry was created to collect clinical data on asthma exacerbations, upper and lower airways symptoms, sinus computed tomography scan, lung function, oral corticosteroid intake, eosinophil and basophil count in the periphery during 24 weeks of treatment. Safety was also assessed.

A high prevalence of chronic rhinosinusitis with nasal polyps was reported among the study cohort (57.7%). Considering the total population involved, the authors showed a marked reduction of asthma exacerbations. Indeed, 77.4% of patients were exacerbation free throughout the entire duration of the study. Simultaneously, 63% were able to stop oral corticosteroid long-term use. Furthermore, patients’ respiratory symptoms were also reduced at week 4 after the first dose. Benralizumab also improved nasal symptoms and exerted a more beneficial response in asthma control and lung function improvement when severe eosinophilic asthma was associated with nasal polyps. To this extent, 38% of patients affected by both diseases reported a clinically meaningful improvement in nasal symptoms. Finally, about 93% of patients with nasal polyps reported a clinically relevant reduction in respiratory symptoms, and a significant increase in pulmonary function, including small airways, compared to those without sinonasal involvement. No serious adverse events related to benralizumab occurred throughout the 24 weeks.

In summary, this real-world study showed that benralizumab is a valuable therapeutic option for patients with severe eosinophilic asthma, particularly if associated with nasal polyps, in which this biologic may determine synergistic beneficial effects for both diseases.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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