Abstract
Introduction: Targeting the IL-5 ligand does not suppress airway eosinophilia in a subset of severe asthmatics. We investigated if targeting the IL-5 receptor with benralizumab would suppress airway eosinophilia leading to greater asthma control.
Methods: Sixteen severe asthmatics (9 females, mean age 58±14 years) on daily high-dose corticosteroid therapy (14 prednisone-dependent, median dose 7.5 mg) with ACQ≥1.5 and sputum eosinophils>3% despite mepolizumab (n=13, 100 mg, subcutaneous) or Reslizumab (n=3, 3mg/kg, intravenous) for ≥6 months were recruited in a sequential placebo-controlled trial (NCT03470311). Clinical outcomes were assessed at baseline (V1), after two months of placebo treatment (V3), and after 5 injections of benralizumab (V10).
Results: Benralizumab completely depleted sputum and blood eosinophils in all 16 patients, with clinical improvements in FEV1, and ACQ-5 (Fig1). However, the decrease in fractional exhaled nitric oxide, FeNO (p>0.05) was modest. Despite complete suppression of eosinophilia and mean decrease in asthma control questionnaire (ACQ-5) by 1.21 points, 37% (6/16) patients still documented ACQ >1.5.
Conclusions: Targeting IL-5R with benralizumab suppresses sputum and blood eosinophilia that is uncontrolled by anti-IL5 neutralizing antibodies in severe asthmatics. Residual symptoms, associated with raised FeNO may indicate IL-4R activity.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 3994.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2022
