Effect of Benralizumab in Patients With Severe Eosinophilic Asthma and Chronic Rhinosinusitis With Nasal Polyps: A Case Series

Abstract

Objective To analyze the effect of benralizumab in severe eosinophilic asthma (SA) and chronic rhinosinusitis with polyps (CRSwP). Methods Retrospective review of patients with both SA and CRSwP that were treated with benralizumab. Asthma controlled test (ACT), pulmonary function metrics (FEV1), Meltzer endoscopic polyp scores, SNOT-22 scores, were collected before and after at least 4 months of benralizumab therapy. Results 23 patients were included. The mean age at the time of enrollment into benralizumab therapy was 50.47 ± 17.3 years and majority (65.2%, n = 15) were males. Pulmonary Effects: In comparison to baseline ACT, scores at four months showed significant improvement (p = 0.03). In those with pre and post spirometry measurements, mean FEV1 showed significant increase following benralizumab therapy (p = 0.04) with a mean increase of 547 mL ± 597 mL following therapy. Sinonasal Effects: 78.5% of subjects on benralizumab had a significant improvement in sinonasal symptoms (p = 0.009) based on their SNOT-22 scores. Additionally, there was an improvement in endoscopic polyp scores, although not statistically significant, following benralizumab therapy (p = 0.2) with 54.5% patients showing improvement. Conclusion Usage of benralizumab in patients with SA and CRSwNP can lead to significantly improved asthma control, lung function, and sinonasal quality of life. Additionally, in this patient population, there was a subset of patients that showed a significant reduction in polyp burden.

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

“…Results from the OSTRO (benralizumab) and SYNAPSE (mepolizumab) Phase 3 trials in CRSwNP have demonstrated improvements in nasal polyp score and nasal blockage/obstruction following biologic treatment [ 29 , 30 ]. These findings are supported by studies that found a reduction in nasal polyp size, symptoms, and/or quality of life in the overlap population of patients with severe eosinophilic asthma and CRSwNP treated with benralizumab [ [31] , [32] , [33] ]. Furthermore, a randomized, double-blind, placebo-controlled study showed that mepolizumab treatment led to a reduced need for surgery in patients with severe nasal polyps receiving topical corticosteroids [ 34 ].…”

Real-Life Experience of Monoclonal Antibody Treatments in Chronic Rhinosinusitis with Nasal Polyposis

“…Therefore, we had to accept a smaller benralizumab group with only 6 cases in this group. Although other studies showed a significant decrease in the SNOT-22 score and endoscopic polyp score, the small group size in our study made it nearly impossible to see a real trend of treatment success [15, 16]. We were also unable to include dupilumab, which also appears to be a very promising biological compound in the treatment of CRSwNP [17].…”

Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

“…Monoclonal antibodies have been demonstrated to be very useful in the management of chronic eosinophilic diseases such as asthma and atopic dermatitis; the experience in these fields encouraged researchers to investigate efficacy of these drugs in CRSwNP. Proof-of-concept studies [35][36][37][38][39][40] were performed mainly in patients with severe asthma and nasal polyps, generating promising results and building upon successful phase 3 studies 41 . The pathophysiology of CRSwNP includes eosinophilia, T-helper cell 2 cytokines and IgE formation, and for this reason three main strategies may be undertaken with monoclonal antibodies: anti-IL-4/IL-13 signaling (dupilumab), anti-IL-5 pathways (mepolizumab, benralizumab) and anti-IgE antibodies (omalizumab).…”

“…The Phase III studies, SIROCCO and CALIMA57,58 , demonstrated the efficacy and safety of benralizumab in significantly reducing annualised exacerbations rates, improving lung function and disease control vs placebo as add-on therapy to high-dosage ICS/LABA in patients with SEA and blood eosinophil counts ≥ 300 cells/ microliter. A growing body of evidence suggests that benralizumab may exert a rapid and effective therapeutic action in patients with SEA and concomitant relapsing nasal polyposis39 . Canonica et al59 presented the results of a sub-study of ANDHI phase III-b trial at EAACI congress in 2020, involving 153 patients with SEA and CRSwNP as ter 24 weeks.…”