Effect of benralizumab in a patient with uncontrolled severe eosinophilic asthma and comorbid chronic rhinosinusitis with nasal polyps refractory to mepolizumab treatment

Abstract

Severe eosinophilic asthma is associated with a high corticosteroid burden, particularly in patients with comorbid chronic sinusitis/nasal polyps. This case study reports a 33-year-old woman who presented to the severe asthma center with uncontrolled severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Despite maximized asthma treatment, including maintenance oral corticosteroids (OCS) for 7 years, the patient experienced one to two hospitalizations per year, had daily symptoms that substantially impacted her quality of life, and elevated type 2 inflammatory markers (blood eosinophils, 0.72 × 10 9 /L; fractional exhaled nitric oxide, 134 to 300 parts per billion). Her asthma worsened during her first pregnancy, in which she required five hospital admissions despite treatment with maintenance OCS. Mepolizumab treatment was commenced after pregnancy but showed limited efficacy (blood eosinophil levels up to 0.94 × 10 9 /L); treatment was discontinued because of a second pregnancy. The patient's asthma worsened and resulted in four hospitalizations and an increase in monthly OCS dose. Mepolizumab was recommenced after pregnancy, but her asthma remained uncontrolled, symptoms persisted, and one hospitalization and nine OCS courses were required. The patient was switched to benralizumab treatment when it became available. Although her CRSwNP symptoms remained, benralizumab treatment resulted in a marked improvement in asthma control, zero hospitalizations, and suppressed blood eosinophil levels. Notably, the patient was successfully weaned off maintenance OCS after >11 years of treatment. In summary, these findings support the use of benralizumab as a corticosteroid-sparing treatment option in difficult-to-treat severe eosinophilic asthma refractory to mepolizumab treatment.

Benralizumab in Patients with Severe Eosinophilic Asthma: A Multicentre Real-Life Experience

“…Finally, we analysed the subgroup of patients with SEA and CRSwNP, and although no differences were detected within the SNOT-22 score and number of recurrences, we confirmed that benralizumab treatment resulted in a marked improvement in asthma control, suppressed blood eosinophil levels and reduction in the number of exacerbations. Similar findings are reported in a recent case report of Mansur AH [ 23 ]. Another interesting finding observed is the reduction in FeNO; even literature data are still unclear on this.…”

A Case Study Showing Benralizumab’s Effectiveness in Treating Uncontrolled Severe Eosinophilic Asthma that is Resistant to Omalizumab

“…[5] This case report demonstrated the efficacy of bendralizumab treatment in a patient with uncontrolled severe eosinophilic asthma refractory to omalizumab treatment and another study conducted by Adel H. Mansur et al reported the efficacy of bendralizumab treatment in a patient with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps refractory to mepolizumab treatment. [3] In the present study, treatment of uncontrolled severe eosinophilic asthma with bendralizumab appears to be feasible, rapid and safe. A study conducted by Andrea baccelli et al reported that mepolizumab may be beneficial and safe as an add-on biologic in a patient with uncontrolled severe eosinophilic asthma.…”

“…[2] Severe asthma is associated with frequent exacerbations that lead to the excessive use of systemic corticosteroids (SCS) that, with their associated side effects, can be burdensome to the lives of patients. [3] For patients with severe refractory asthma, monoclonal antibodies are a relatively novel therapeutic option that can be added to maintenance therapy. This reduces the requirement for systemic corticosteroid use, improves asthma symptom control, and lowers exacerbations.…”

Updates in biologic therapy for chronic rhinosinusitis with nasal polyps and NSAID‐exacerbated respiratory disease

“…Switching biologicals is an option when adverse reactions are encountered or when response is suboptimal. The literature on switching biologicals in CRSwNP is currently in the form of a few case reports, 51,52 although we may draw from the experience of switching biologicals in asthma. A historical cohort study of over 3500 patients with severe asthma from 11 countries found that the overall rate of discontinuing or switching biologicals was low, at about 10% 53 .…”