Switching to benralizumab improves OCS dosing, QoL in patients with severe eosinophilic asthma

Switching from mepolizumab to benralizumab led to a significant reduction in oral corticosteroid (OCS) dose and a better QoL* in patients with severe eosinophilic asthma (SEA), according to a small study presented at ATS 2019.

“Mepolizumab and benralizumab have proven steroid-sparing efficacy in SEA … Mechanistically, it is possible that the greater eosinophil-depleting properties of benralizumab may confer superior clinical efficacy over mepolizumab in these patients,” said Dr Joanne Kavanagh from the Department of Respiratory Medicine at Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust in London, UK.

The researchers retrospectively analysed 15 OCS-dependent patients with SEA (mean age 47.67 years, 60 percent female, mean BMI 32.86 kg/m²) who were treated with subcutaneous mepolizumab 100 mg for ≥6 months, and then switched to subcutaneous benralizumab 30 mg for another 16 weeks, with an ongoing OCS requirement of prednisolone ≥7.5 mg or equivalent. [ATS 2019, abstract A2675/P510]

The daily OCS dose was reduced by 25 percent among OCS-dependent patients treated with benralizumab compared with mepolizumab at the last visit (median OCS dose, 7.5 vs 10 mg/day; p=0.046).

Patients who received benralizumab also had a significantly higher score on the Asthma Quality of Life Questionnaire, indicating no impairment, than those treated with mepolizumab (4.08 vs 3.56; p=0.041).

An improved Asthma Control Questionnaire-6 score, as shown by a lower score, was also observed in patients who received benralizumab compared with mepolizumab (2.89 vs 3.13; p=0.68), although this was not significant.

Changes in FeNO** and post-bronchodilator FEV₁*** ratios, as well as exacerbation rates were not significantly different between the benralizumab and mepolizumab treatment groups.

“[Even] in a small cohort of such patients, we have observed that switching some of these subjects to benralizumab appears to result in a significant reduction in their maintenance OCS dose and an improvement in their quality of life scores,” Kavanagh said.

“[However,] we also observed that some patients with an eosinophilic phenotype fail[ed] to adequately respond to either mepolizumab or benralizumab … Controlled studies in larger numbers are required to explore this possibility further,” she noted.

*QoL: Quality of life

**FeNO: Fractional concentration of exhaled nitric oxide