Real-world characteristics of “super-responders” to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis

Andrea Portacci; Raffaele Campisi; Enrico Buonamico; Santi Nolasco; Corrado Pelaia; Nunzio Crimi; Alida Benfante; Massimo Triggiani; Giuseppe Spadaro; Maria Filomena Caiaffa; Giulia Scioscia; Aikaterini Detoraki; Giuseppe Valenti; Francesco Papia; Alessandra Tomasello; Nicola Scichilone; Girolamo Pelaia; Claudia Crimi; Giovanna Elisiana Carpagnano

doi:10.1183/23120541.00419-2023

ERJ Open Research (Oct 2023)

Real-world characteristics of “super-responders” to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis

Andrea Portacci,
Raffaele Campisi,
Enrico Buonamico,
Santi Nolasco,
Corrado Pelaia,
Nunzio Crimi,
Alida Benfante,
Massimo Triggiani,
Giuseppe Spadaro,
Maria Filomena Caiaffa,
Giulia Scioscia,
Aikaterini Detoraki,
Giuseppe Valenti,
Francesco Papia,
Alessandra Tomasello,
Nicola Scichilone,
Girolamo Pelaia,
Claudia Crimi,
Giovanna Elisiana Carpagnano

Affiliations

Andrea Portacci: Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
Raffaele Campisi: Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
Enrico Buonamico: Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
Santi Nolasco: Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
Corrado Pelaia: Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
Nunzio Crimi: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
Alida Benfante: Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
Massimo Triggiani: Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
Giuseppe Spadaro: Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
Maria Filomena Caiaffa: Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
Giulia Scioscia: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
Aikaterini Detoraki: Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
Giuseppe Valenti: Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
Francesco Papia: Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
Alessandra Tomasello: Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
Nicola Scichilone: Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
Girolamo Pelaia: Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
Claudia Crimi: Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
Giovanna Elisiana Carpagnano: Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy

DOI: https://doi.org/10.1183/23120541.00419-2023
Journal volume & issue: Vol. 9, no. 5

Abstract

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Background The current definition of severe eosinophilic asthma (SEA) super-responders to biologic treatment does not include patients with other eosinophil-based comorbidities. Although eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases. We aim to assess super-responder features in real-life patients with SEA and EGPA treated with mepolizumab and benralizumab. Methods We enrolled 39 patients with SEA and EGPA eligible for treatment with mepolizumab or benralizumab. Super-responder assessment was performed considering oral corticosteroid (OCS) cessation, lack of exacerbations, forced expiratory volume in 1 s and Asthma Control Test (ACT) improvement. Results Super-responders showed worse clinical baseline characteristics than non-super-responder patients, with a greater improvement in severe asthma exacerbations, OCS dose reduction and ACT score increase. Definition of super-responders was consistent only considering a 12-month course of monoclonal antibody, lacking sensitivity in earlier evaluations. Conclusion Mepolizumab and benralizumab are safe and effective in patients with EGPA and SEA, since a consistent proportion of patients show a super-response after 12 months of treatment. Further studies will address specific criteria for super-responder assessment in these patients.

Published in ERJ Open Research

ISSN: 2312-0541 (Online)
Publisher: European Respiratory Society
Country of publisher: United Kingdom
LCC subjects: Medicine
Website: https://openres.ersjournals.com/

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