Real-Life Effectiveness of Benralizumab Compared to Other Biological Therapies for Severe Asthma.

Abstract

Background: Severe asthma affects a small proportion of patients, remaining uncontrolled despite high-dose medications. It encompasses phenotypes including allergic, non-allergic, eosinophilic, and neutrophilic severe asthma. Biologic therapies such as anti-IgE, anti-IL5, and anti-IL4 may be used for severe asthma. The aim of this research is to evaluate and compare the efficacy of benralizumab in the treatment of severe asthma and eosinophilic asthma to that of other biological therapies, including dupilumab, reslizumab, mepolizumab, and omalizumab. Methods: In a cross-sectional study utilising the Birmingham Regional Severe Asthma Registry data, outcomes of benralizumab versus other biologic treatments were compared in terms of oral corticosteroid use, FeNO levels, blood eosinophils count, lung function, quality of life indices, emergency visits, and hospital admissions. Parametric (t-test) or non-parametric (Kruskal-Wallis) analyses were undertaken to compare continuous variables depending on data distribution, whilst cross-tabulation was performed to compare categorical data underwent evaluation via cross-tabulation (Chi-square tests). Results: The study included 516 patients using biological treatments, distributed across the following groups, benralizumab (n=97), omalizumab (n=196), dupilumab (n=16), and mepolizumab (n=207). Medians, accompanied by p-values were utilised to compare outcomes across the biologics. Just around 29.9% of benralizumab remained on oral steroids, similar to other biologics (25-31%). Benralizumab, dupilumab, and omalizumab showed an FEV1% improvement ranging from 77% to 102.5% compared to pre-biological treatment database 71.2%. While all biologics demonstrated clinically meaningful improvements in quality-of-life scores greater than 55 compared to the pre-biological treatments database, the differences in pre-bronchodilator FEV1 and quality-of-life scores among biologics were not statistically significant. Unique to benralizumab was an elevated FeNO level with a median of 48 ppb (IQR 9, 239) and a reduced blood eosinophil count to a median of 0 x109 /L (IQR 0, 2), aligning with its anti-IL5 mechanism and distinguishing it from anti-IL4 and anti-IgE medications. Furthermore, emergency visits decreased across biologics, with benralizumab, dupilumab and mepolizumab reducing median visits to 0 and omalizumab lowering to 1 visit, compared to 5 median visits pre-biologics database. Furthermore, all biologics, on average, reduced hospital admissions to a median of 0 hospital admission, down from a median of 1 in the pre-biological treatment database. Conclusion: Real-world data suggest that benralizumab may demonstrate differences in FeNO levels and blood eosinophils. However, other clinical outcomes appeared consistent when compared with other biologics in patients with severe asthma. In general, all biologics including benralizumab showed improvements in clinical outcomes when compared to the pre-biologics database.