Benralizumab for eosinophilic asthma/COPD exacerbations ‘could be a game-changer’

Key takeaways:

• This patient population had “better outcomes” when receiving benralizumab with or without prednisolone vs. prednisolone alone.
• A larger proportion of those receiving prednisolone only reported an adverse event.

Receiving a benralizumab injection during an acute asthma or COPD exacerbation with a blood eosinophil count of at least 300 cells/µL led to fewer treatment failures, according to results published in The Lancet Respiratory Medicine.

“This could be a game-changer for people with asthma and COPD,” Mona Bafadhel, MBChB, MBChB, PhD, FRCP, chair of respiratory medicine at King’s College London and director of the King’s Centre for Lung Health, said in a press release. “Treatment for asthma and COPD exacerbations have not changed in 50 years despite causing 3.8 million deaths worldwide a year combined.”

In the multicenter, double-blind, double-dummy, active placebo-controlled randomized phase 2 ABRA study, Bafadhel and colleagues analyzed 158 adults (mean age, 57 years; 54% women; 95% white) with a blood eosinophil count of at least 300 cells/µL during an asthma or COPD acute exacerbation (n = 88 with asthma; n = 51 with COPD; n = 19 with both) to determine whether a one-time benralizumab (Fasenra, AstraZeneca) injection with and without the current standard of care (prednisolone) is better than prednisolone alone for reducing treatment failures at day 90 and improving VAS symptoms at day 28.

The total cohort was divided into three groups. According to the study, the BENRA group received one placebo tablet a day for 5 days and a single 100 mg subcutaneous benralizumab injection (n = 53), the BENRA plus PRED group received one 30 mg prednisolone a day for 5 days and a single 100 mg subcutaneous benralizumab injection (n = 52) and the PRED group received one 30 mg prednisolone a day for 5 days and a single placebo subcutaneous injection and (n = 53).

After combining the BENRA and BENRA plus PRED cohorts, researchers found that fewer patients in this pooled set experienced treatment failure over 90 days vs. patients receiving prednisolone alone (45% vs. 74%). Similarly, the odds for treatment failure in this timeframe significantly decreased in the pooled-BENRA vs. PRED group (OR = 0.26; 95% CI, 0.13-0.56).

Adding onto this finding, the study reported that the pooled-BENRA set of patients had a significantly longer time to first treatment failure event vs. the PRED set of patients during the 90-day period (HR = 0.39; 95% CI, 0.25-0.61).

In terms of VAS symptoms (cough, wheeze, dyspnea, sputum), the patients who made up the pooled-BENRA group had more improvement vs. the PRED group based on the least-square mean difference in total VAS at day 28 (49 mm; 95% CI, 14-84), according to the study.

Three symptom assessments also revealed that patients receiving benralizumab with and without prednisolone vs. patients receiving prednisolone alone had significant improvements at day 28: Medical Research Council Dyspnea scale, Asthma Control Questionnaire-7 and total Asthma Quality of Life Questionnaire.

Of the 128 patients who experienced an adverse event in this study population, researchers highlighted that a larger proportion of those receiving prednisolone alone reported an adverse event than those receiving benralizumab alone or benralizumab plus prednisolone (91% vs. 77% and 75%). None of the reported adverse events resulted in death.

According to the study, patients who received prednisolone (PRED group and BENRA plus PRED group) reported hyperglycemia and sinusitis/sinus infection, whereas no patients in the BENRA group reported either event.

“We hope these pivotal studies will change how asthma and COPD exacerbations are treated for the future, ultimately improving the health for over a billion people living with asthma and COPD across the world,” Bafadhel said in the release.

Reference:

• First new treatment for asthma attacks in 50 years. https://www.kcl.ac.uk/news/first-new-treatment-asthma-attacks-in-50-years. Published Nov. 28, 2024. Accessed Nov. 28, 2024.