Benralizumab May Reduce or Eliminate Oral Corticosteroid Use in Severe Asthma

Patients with asthma who depend on oral corticosteroids (OCS) may be able to reduce the dependence or eliminate the use of OCS altogether with benralizumab, according to study findings presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting held February 26 to March 1, 2021.

Because there is a paucity of evidence guiding OCS withdrawal after starting biologics in patients with severe asthma, the investigators of this study evaluated the potential of benralizumab to help these patients eliminate or reduce OCS to physiologic dosages.

In the single-arm study (ClinicalTrials.gov Identifier: NCT03557307), researchers enrolled 598 patients with asthma who required high-dosage inhaled corticosteroids and long-acting beta-agonists (LABA) for at least 6 months plus OCS, such as 5 mg or higher prednisone or equivalent, for at least 3 months. All patients also had baseline blood eosinophil counts of 150/μL or higher, or 300/μL or higher in the 12 months prior to enrollment. At 4 weeks after the start of benralizumab, patients started an OCS dosage-reduction algorithm that featured rapid down-titration. Personalized reductions were implemented in patients who had adrenal insufficiency (AI).

A total of 62.2% (95% CI, 58.18-66.11) of patients eliminated OCS, while 80.6% (95% CI, 77.20-83.70) either eliminated use or reduced their daily dose to 5 mg or less if AI prevented additional dosage reduction. The median daily dose of OCS was reduced by 100%. The majority of patients achieved a daily OCS dose of 5 mg or less. Reductions in OCS were achieved irrespective of eosinophil counts at baseline.

Up to 25.8% of patients experienced exacerbations during the OCS reduction phase compared with 84.4% of patients in the previous year. Although 60% of patients had either partial AI (33%) or complete AI (27%), this proportion decreased to 38.5% (18.1% and 19.4%, respectively) approximately 2 to 3 months later.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Menzies-Gow A, Gurnell M, Heaney L, et al. Elimination of oral corticosteroids (OCS) with benralizumab treatment in OCS-dependent asthmatics using a rapid, personalized algorithm: the PONENTE trial. Presented at: the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting; February 26-March 1, 2021. Abstract L45.