Reducing inhaled corticosteroids in patients well controlled on benralizumab: experience from a tertiary severe asthma service

<bold>Introduction:</bold> The SHAMAL study (Lancet, 2024) raises the possibility of dose reduction in inhaled corticosteroids (ICS) in patients with severe eosinophilic asthma controlled with benralizumab (defined as Asthma Control Questionnaire, ACQ-5 ≤1.5 and no oral corticosteroids (OCS)). We aim to describe our real-world experience of reducing ICS in patients controlled on benralizumab prior to publication of this study. <bold>Methods:</bold> Retrospective review of patients commenced on benralizumab from January 2019-January 2022 at a tertiary severe asthma centre with no OCS, acute or maintenance, and an ACQ-6 ≤1.5 in the first 24 months. <bold>Results:</bold> In total, 112 patients were commenced on benralizumab during the reference period. After 1 year of treatment, 18 (18/112, 16%) patients had a documented ACQ-6 ≤1.5 and required no OCS. 83% (15/18) were using additional controllers as well as ICS/LABA. Three (3/18, 17%) patients were using an ICS/LABA combination inhaler only. None had the ICS dose reduced. At 24 months, 17 (17/112, 15%) patients were well-controlled on benralizumab, of which 5 (5/17, 29%) were using ICS/LABA only. Healthcare provider ICS dose reduction to a moderate dose maintenance and reliever therapy was initiated in only 1 patient (1/5, 20%) which was sustained at 36-month review. No further ICS dose reductions were observed in those maintaining symptom control at 36 months. <bold>Conclusion:</bold> Most of our patients that are well-controlled on benralizumab have not had their ICS/LABA dose reduced. Further studies are required to understand the optimal monitoring of patients who have ICS dose reduction.