Anti-IL-5 therapy for severe asthma – convincing real-world data

A retrospective cohort study of the efficacy of benralizumab treatment in patients with asthma demonstrated a 55% reduction of exacerbations in a real-world setting. Results were consistent with findings from previous randomised controlled trials.

Benralizumab has been approved for eosinophilic asthma patients as add-on medication. Nonetheless, the impact of this agent on asthma exacerbations in a real-world setting has not been studied extensively. Dr Donna Carstens (AstraZeneca, Wilmington, Delaware, USA) presented a retrospective cohort study that included asthma patients from medical and pharmacy claims who started benralizumab between 2017 and 2019 [1]. The index date in this pre-post study was the first day after the drug was taken for the first time. Data from 12 months before this day was compared with the 12 months after the index date. Participants of the primary and secondary cohort were all naïve to biologic treatment and had suffered from at least 2 exacerbations in the pre-index course. The 204 patients of the primary cohort all had ≥2 records of benralizumab, while the secondary or persistent group contained 103 subjects with ≥6 records. Moreover, 114 patients switching from omalizumab and 97 switching from mepolizumab to benralizumab were analysed.

Mean age in the primary cohort was 45.34, 68.6% of patients were female, 77.5% had comorbidity of allergic rhinitis, 45.1% gastroesophageal reflux disease, and 45.6% hypertension. Asthma exacerbation rates were calculated per person-year (PY). The results revealed a 55% reduction of exacerbations (3.25 vs 1.47 per PY) for the benralizumab users in the primary cohort and a reduction of 62% (3.23 vs 1.23 per PY) in the persistent cohort. Both differences were significant with a P<0.001 for pre- and post-index comparisons. Of note, 41.2% and 42.7% respectively under benralizumab in the primary and persistent cohort did not experience any exacerbations during the post-index period.

The outcomes for the switch groups were similar: 54% reduction when changing from omalizumab and a 34% drop in exacerbations with previous mepolizumab. The ameliorations were also consistent with a reduction in cumulative dosage of oral corticosteroids in the post-index period: in the primary cohort, 82% received steroid maintenance pre-index, but only 50% post-index (P<0.001). ”Additionally, rescue medication use, commonly prescribed controllers, and antibiotics also decreased in the post-index period,” Dr Carstens pointed out.

In view of the study design that lacked a control arm, further research confirming the results would be interesting. “In conclusion, patients treated with benralizumab in this real-world analysis experienced a significant reduction in asthma exacerbations consistent with pivotal trials, as well as those who switched from other biologics,” summarised Dr Carstens.

1. Carstens D, et al. Real-World Effectiveness of Benralizumab on Asthma Exacerbations: Results from the ZEPHYR 1 Study. Session TP015: Updates in Adherence and treatment of lung disease. ATS 2021 International Conference, 14-19 May.

 



Posted on 17 May, 20213 August, 2021