Pros of Switching from omalizumab or mepolizumab to Benralizumab in asthma patients

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 the control of asthma, according to the recent research published in the Journal of Asthma and Allergy.

The prevalence of severe refractory asthma in adults ranges from 3% to 10%. The recent discovery of the molecular mechanisms involved in the pathogenesis of asthma has led to the development of new biologic therapies.

By blocking IL-5R, benralizumab directly eliminates eosinophils and basophils via NK cells and antibody-mediated cytotoxicity.8 Several clinical trials have shown that benralizumab significantly reduces the frequency of exacerbations, increases forced expiratory volume in the first second (FEV1), and decreases the need for oral corticosteroids, with a favorable safety profile. These positive results were independent of baseline IgE levels and the presence of allergy.

In this study, the authors tried to analyze the efficacy of benralizumab at 4 and 12 months in a group of 40 patients who had responded inadequately to omalizumab or mepolizumab.

They 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.  

The researchers evaluated 40 patients who switched from omalizumab or mepolizumab to benralizumab.

Switching was followed by a significant decrease in the number of exacerbations, visits to the emergency department, and corticosteroid cycles, as well as improved Asthma Control Test both at 4 and 12 months. However, no significant improvement in lung function was observed. Asthma control was achieved in 55% of patients at 12 months. Specifically, a complete response was achieved in 30% of patients at 12 months.