Effectiveness of Switching to Benralizumab in Severe Refractory Eosinophilic Asthma

Abstract

Ana Gómez-Bastero Fernández,1 Juan Francisco Medina Gallardo,2 Julio Delgado Romero,3 Auxiliadora Romero Falcón,2 Cristina Benito Bernáldez,1 Javier Gallego Borrego,4 Francisco Javier Álvarez-Gutiérrez2 1Asthma Unit of Pneumology, Virgen Macarena University Hospital, Seville, Spain; 2Asthma Unit of Pneumology, Virgen Del Rocio University Hospital, Seville, Spain; 3Asthma Unit of Allergy, Virgen Macarena University Hospital, Seville, Spain; 4Asthma Unit of Pneumology, Valme University Hospital, Seville, SpainCorrespondence: Cristina Benito Bernáldez, Asthma Unit of Pneumology, Virgen Macarena University Hospital Avenue Doctor Fedriani, Seville, s/n. CP 41009, Spain, Tel [phone], Fax [phone], Email [email protected]: 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

Keywords

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