De-escalation of maintenance inhaler therapy in severe asthma in remission on Benralizumab

<bold>Background:</bold> Monoclonal antibodies have deeply changed the management of severe asthma, now aiming at disease remission. Partial and complete clinical remission are defined by no further need of oral corticosteroids for at least 12 months plus, respectively 2 or 3 of the following criteria: absence of symptoms, absence of exacerbations, stability of lung function. <bold>Aims:</bold> to describe the efficacy of Benralizumab (B) in maintaining clinical remission in severe eosinophilic asthmatics despite the de-escalation of maintenance inhaler therapy (MIT). <bold>Methods:</bold> an observational retrospective study was conducted on a cohort of adult severe eosinophilic asthmatics receiving treatment with B for at least 24 months. Data of patients who achieved clinicalc remission and then arbitrarily carried out a de-escalation of MIT, involving suspension of LAMA and/or reduction of the dosage of ICS/LABA, were recorded. Asthma control, exacerbations and lung function were assessed in the 12 months from the start of treatment for at least 12 months from de-escalation. <bold>Results:</bold> 45 patients on anti IL-5R therapy for at least 24 months were recruited. After 12 months, therapy was able to induce disease remission in 30 patients (66.6%): 10 subjects (22.2%) achieving partial clinical remission (PCR) group and 20 patients (44.4%) complete clinical remission (CCR) group. In the CCR group 14 subjects (70%) underwent de-escalation of MIT while maintaining CCR. In the PCR group, 3 subjects underwent de-escalation of MIT, of whom 2/3 maintained optimal asthma control and did not experience any exacerbations. <bold>Conclusions:</bold> These preliminary findings suggest the efficacy of B in maintaining the CCR despite the de-escalation of MIT.