Benralizumab effectiveness in severe eosinophilic asthma and co-presence of bronchiectasis: a “real-world” retrospective study

Introduction: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) patients, is quite common. Data about effectiveness of anti-IL-5-targeted therapy in patients with SEA and co-presence of BE (SEA-BE) are lacking. Aim: To evaluate benralizumab effectiveness in patients with SEA and SEA-BE. Methods: We conducted a multicentre, real-world study in Italy. Annual asthma exacerbations rate, daily oral corticosteroids (OCS) intake, patients on OCS, Asthma Control Test (ACT), blood eosinophils count (EOS), chronic mucus hypersecretion (CMH) and comorbidities and were collected at baseline and after 12 months of treatment. Results: We included 74 patients with SEA treated with benralizumab and 47.2% showed SEA-BE with a median BSI of 9 (7-11). Benralizumab treatment showed improvements in annual exacerbations rate [from 6 (4-8) to 1 (0-2)], ACT value [14 (9-17) to 22 (20-24)], OCS intake [from 12.5 mg/day (5-18.3) to 0 (0-2.5)], CMH [from 49 (66.2%) to 19 (25.7%)], and EOS [median 630 cells/μL (435-835) to 0 cells/μL (0-0.0)], in the overall population (P < .0001). Significant changes in number of exacerbation-free patients [25 (64.1% vs 7 (20%) P=0.0002], patients on OCS [-25 (-92.6%) vs -17 (-48.6%), P=0.0003], OCS withdrawal + exacerbation free [24 (61.5%) vs 5 (14.3%), P=0.0011], daily median OCS intake [-5 mg (0 to -12.5) vs -12.5 mg (-7.5 to -20), P=0.011] were found in SEA and SEA-BE groups, respectively. Conclusions: These “real-world” data suggest that benralizumab improves clinically meaningful outcomes such as annual exacerbations, ACT, OCS tapering and withdrawal in SEA patients alone and in the SEA-BE subgroup.