Asthma Exacerbation Profile on open label treatment with Benralizumab for severe eosinophilic asthma [BenRex]

<bold>Background:</bold> Asthma exacerbations cause major morbidity and their treatment with oral corticosteroids [OCS] can lead to toxicity. In clinical trials, benralizumab, an Interleukin-5 receptor-α blocker, reduced exacerbations by approximately 50%. <bold>Research</bold> showed that exacerbations on mepolizumab are either eosinophilic or infective. Aim of BenRex was to study inflammatory and physiological features of exacerbations while on benralizumab. <bold>Methods:</bold> 15 UK centres participated. Benralizumab was initiated as per NICE/SMC guidance. Subjects were asked to contact the site if they exacerbated and before starting OCS/antibiotics, to have clinical review, spirometry, fractional exhaled nitric oxide (FeNO) and give samples of sputum, urine, nasosorption, gargle and blood. <bold>Results:</bold> Of 157 subjects enrolled, 91 (58%) exacerbated during the 12-18 month follow up. Of 272 exacerbations, 120 visits were on-site before treatment. See participant characteristics with and without an exacerbation in the Table. At exacerbation, median [IQR] for blood eosinophils x109/L was 0 [0,0], sputum eosinophils% was 0 [0,0] and FeNO ppb was 49 [29,92]. Median [IQR] sputum neutrophil% was 66.63[34.00, 84.00] and mean (SD) CRP mg/L was 14.6 (23). <bold>Conclusion:</bold> During exacerbations on benralizumab, eosinophils remain suppressed in the blood and airways, FeNO remains elevated and infective features such as sputum neutrophilia and rise in CRP occur. <fig><object-id>erj;64/suppl_68/PA5356/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

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Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.pa5356
Citations
3
Primary Topic
Asthma and respiratory diseases
Type
article
Field-Weighted Citation Impact
0.98
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article

Asthma Exacerbation Profile on open label treatment with Benralizumab for severe eosinophilic asthma [BenRex]

Thomas Brown, Peer Ameen Shah, Ramesh Kurukulaaratchy, Salman Siddiqui et al.
3 citations
Asthma and respiratory diseases
0.98
article

Asthma Exacerbation Profile on open label treatment with Benralizumab for severe eosinophilic asthma [BenRex]

Thomas Brown, Peer Ameen Shah, Ramesh Kurukulaaratchy, Salman Siddiqui, Steven J. Smith, Liam Gabriel Heaney, Stephen James Fowler, Adel Mansur, Lynsey Gillespie, Wai-Ting Nicola Lee, Hassan Burhan, Ratko Djukanovich, Vijay Mistry, Shoaib Faruqi, D. J. Jackson, James Lordan, Vanessa Brown, Dinesh Saralaya, Kirsty Wetherall, Rekha Chaudhuri, Alex McConnachie, Ian Pavord, James R. Brown, Pujan H. Patel, Jennifer Logan, Christopher E Brightling
article en
3 citations

Abstract

<bold>Background:</bold> Asthma exacerbations cause major morbidity and their treatment with oral corticosteroids [OCS] can lead to toxicity. In clinical trials, benralizumab, an Interleukin-5 receptor-α blocker, reduced exacerbations by approximately 50%. <bold>Research</bold> showed that exacerbations on mepolizumab are either eosinophilic or infective. Aim of BenRex was to study inflammatory and physiological features of exacerbations while on benralizumab. <bold>Methods:</bold> 15 UK centres participated. Benralizumab was initiated as per NICE/SMC guidance. Subjects were asked to contact the site if they exacerbated and before starting OCS/antibiotics, to have clinical review, spirometry, fractional exhaled nitric oxide (FeNO) and give samples of sputum, urine, nasosorption, gargle and blood. <bold>Results:</bold> Of 157 subjects enrolled, 91 (58%) exacerbated during the 12-18 month follow up. Of 272 exacerbations, 120 visits were on-site before treatment. See participant characteristics with and without an exacerbation in the Table. At exacerbation, median [IQR] for blood eosinophils x109/L was 0 [0,0], sputum eosinophils% was 0 [0,0] and FeNO ppb was 49 [29,92]. Median [IQR] sputum neutrophil% was 66.63[34.00, 84.00] and mean (SD) CRP mg/L was 14.6 (23). <bold>Conclusion:</bold> During exacerbations on benralizumab, eosinophils remain suppressed in the blood and airways, FeNO remains elevated and infective features such as sputum neutrophilia and rise in CRP occur. <fig><object-id>erj;64/suppl_68/PA5356/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Queen's University Belfast (GB), University of Liverpool (GB), University of Leicester (GB), Royal Free London NHS Foundation Trust (GB), King's College London (GB), Hull Royal Infirmary (GB), Hammersmith Hospital (GB), Gartnavel General Hospital (GB), Royal Liverpool University Hospital (GB), Harefield Hospital (GB), Queen Alexandra Hospital (GB), University of Manchester (GB), University of Oxford (GB), UK Research and Innovation (GB), Glasgow Life (GB), Royal Brompton Hospital (GB), Heartlands Hospital (GB), NIHR Royal Brompton Cardiovascular Biomedical Research Unit (GB), Science Oxford (GB), Calvary Mater Newcastle Hospital (AU), Southampton City Council (GB), King's College Hospital (GB), Brooklands Hospital (GB), University of Southampton (GB), University of Glasgow (GB), National Patient Safety Foundation (US)
Zero hunger
Openalex Percentile: Top 22%
Asthma and respiratory diseases
0.98
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