Real-world oral glucocorticoid-sparing effect of benralizumab in severe asthma

Introduction: Benralizumab is a monoclonal antibody against IL-5R and is licensed for the treatment of severe eosinophilic asthma (SEA). The phase 3 ZONDA study reported significant oral glucocorticoid (OCS) sparing efficacy with benralizumab. However, real-world data on the magnitude and speed of any OCS dose reduction with Benralizumab is lacking. Methods: Patients with SEA attending Guy’s Severe Asthma centre, UK, who required continuous OCS at the time of commencing benralizumab were included in this analysis, if they had completed a minimum of 24 weeks treatment. OCS dose and other clinical measures were recorded at baseline and at each benralizumab dosing visit. Results: Forty-two patients were included in the analysis (61.9% female, mean age 52.1±12.9, 80.9% atopic, 52.4% adult-onset, baseline annual exacerbation rate 3.95±3.89, highest eosinophil count in previous year 630±290 cells/mcL). Following commencement of benralizumab the median OCS dose reduced by 70% from 10mg (IQR 5-15mg) at baseline to 3mg (IQR 0-7mg) at week 24 (p Conclusion: In a real-world tertiary asthma centre setting, benralizumab led to a 70% reduction in maintenance OCS dose, which was observed by week 16. Despite this reduction, 79% of subjects remained exacerbation-free at week 24.