Benralizumab is effective in patients with nasal polyposis. Severe eosinophilic asthma also exhibits improved SNOT-22 and asthma outcomes with benralizumab.
The combination of chronic rhinosinusitis (CRS) and nasal polyposis (NP) is a common chronic inflammatory disease. Patients may suffer from headaches and severe sinonasal symptoms that include increased nasal congestion, nasal polyp growth, loss or reduction of the sense of smell, and facial pain. NP usually presents with elevated immunoglobulin E (IgE), tissue eosinophilia, interleukin (IL)-4, IL-5, IL-13, and other type 2 inflammatory cytokines. As many as 40.6% of individuals with severe asthma also present with CRS and NP. Patients with asthma and NP experience reduced asthma control and increased airway obstruction, inflammatory cells, and blood eosinophil counts (BEC). In these individuals, asthma control can be optimized by addressing the NP symptoms. Benralizumab, an IL-5 receptor monoclonal antibody, enhances antibody-dependent cell-mediated cytotoxicity to cause nearly complete depletion of eosinophils. In patients suffering from mild to severe asthma, benralizumab significantly reduces sputum and airway wall eosinophil counts.
This randomized placebo-controlled, parallel-group, and double-blind ANDHI trial, published in the journal Allergy, randomized patients with severe eosinophilic asthma to 24 weeks of placebo or benralizumab. The study participants had ≥ 2 years of exacerbations of asthma despite the administration of high-dosage inhaled corticosteroids and additional controllers. The effect of benralizumab on the symptoms of NP was evaluated by the Sino-Nasal Outcome Test-22 (SNOT-22). The outcomes related to chronic asthma were assessed using annualized asthma exacerbation rate (AER), forced expiratory volume (FEV1), Asthma Control Questionnaire-6 (ACQ-6), and St. George’s Respiratory Questionnaire (SGRQ) total score.
Out of the 153 study participants, 57 participants were included in the placebo group and 96 participants were included in the benralizumab group. The study findings reflect the efficacy of benralizumab in the management of patients with NP and severe eosinophilic asthma. The study findings revealed high baseline SNOT-22 scores, reduction in annualized AER, and improvement in baseline ACQ-6, SGRQ total score and FEV1 in the benralizumab group. Benralizumab was well-tolerated among the study participants with a similar frequency of adverse events in both the placebo and benralizumab groups. Frequent and prevalent adverse events in the benralizumab group included influenza, headache, sinusitis, and pyrexia.
This study evaluated the safety profile and efficacy of benralizumab in patients with severe asthma and NP. Clinically significant improvement was observed in multiple asthma outcomes (lung function, asthma control, quality of life, and exacerbations) and SNOT-22 scores. This study supported the use of benralizumab NP in patients suffering from severe eosinophilic asthma.
Reference
Canonica, G. W., Harrison, T. W., Chanez, P., Menzella, F., Louis, R., Cosio, B. G., . . . Garcia Gil, E. (2022). Benralizumab improves symptoms of patients with severe, eosinophilic asthma with a diagnosis of nasal polyposis. Allergy, 77(1), 150-161. https://doi.org/10.1111/all.14902
