Response To Benralizumab In Severe Eosinophilic Asthma After Intermediate-To-Poor Response To Mepolizumab : A Retrospective Study

Backgound: Severe eosinophil asthma (SEA) can be treated with mepolizumab (MEPO), an anti-IL-5 Ab, or benralizumab (BENRA), an anti-IL-5R Ab. No data exist on the efficacy of switching from one drug to another that targets the same inflammatory pathway. The aim of this study was to evaluate the impact on asthma control of BENRA, given as a second-line treatment for patients with a non-optimal response to MEPO. Methods: Retrospective evaluation of clinical response to BENRA in patients with SAE and intermediate or poor response to a 12-month trial of MEPO in one asthma expert centre in France. Results: We included 22 patients (36% females; age 49±11, BMI 27±6; FEV1 53±16%). According to the global evaluation of treatment efficiency (GETE), 95.5% of patients had moderate or poor response (score 3-4) to MEPO. Eosinophil count significantly decreased from 521±316 to 167±230 (p=0.039) after MEPO. After a 6-month trial with BENRA, without any wash-out period, 48% of patients had good response (score 1-2) (p=0.012). The proportion of patients with ACT score \u003e20 increased from 15.8% to 25% and that without any exacerbation from 4.5% to 36.6% (p=0.021). Mean ACT score increased from 13±5 to 16±5 and exacerbation rate decreased from 5.7±3.5 to 3±3 (p Conclusions: In real life settings, half of patients with physician-judged incomplete response to MEPO seem to benefit from a switch to BENRA after 6 months, without any significant steroid-sparing effect. Future studies should evaluate the best second-line treatments after anti-IL-5/5R treatment failure.