Abstract
Background: Severe eosinophilic asthma decreases lung function and causes worsen symptoms, often forcing recurrent maintenance corticosteroid use. The aim of our real-life study was to evaluate the effectiveness of an add-on treatment with benralizumab in patients with severe eosinophilic asthma, paying particular attention to the impact on their quality of life (QoL). Materials and methods: In this prospective study, 10 outpatients with severe eosinophilic asthma were added-on with benralizumab and followed-up in our severe asthma clinic after 12 and 24 weeks. At each patient visit, pre-bronchodilator FEV1 and inflammatory markers were recorded. Variations in asthma symptoms control and QoL perception was assessed by validated questionnaires. Results: All the subjects experienced a marked reduction of nocturnal and diurnal symptoms over time and were able to stop using OCS, as documented by the improvement in Asthma control test (ACT) and Asthma Control Questionnaire score. Similarly, we recorded a statistically significant increase in patient’s QoL perception in EQ-VAS, EQ-5D-3L and Asthma Quality of Life Questionnaire (AQLQ) assessment (p < 0.05). Simultaneously we recorded a significant reduction in eosinophilic inflammation, an improvement in pre-bronchodilator FEV1. These results appear to be in line with those already obtained in the previous randomized controlled trials (RCTs). Conclusion: Our 24-weeks real life experience supports the effectiveness of an add-on treatment with benralizumab in reducing eosinophilic inflammation and OCS-use, increasing lung function and improving control of nocturnal and diurnal symptoms, as well as restoring severe asthma patients to a better QoL.
Highlights
A high level of eosinophils, present in at least 50% of patients with severe asthma, causes inflammation and hyperresponsiveness of the airways, worsening symptoms and decreasing lung function (Pavord, 2013)
ACQ score reduced from 3.48 ± 0.65 to 2.32 ± 0.57 (12 weeks) (p 0.004) and to 1.42 ± 0.92 (24 weeks) (p < 0.0001), EuroQol-Visual Analogue Scales (EQ-VAS) increased from 44.5 ± 7.7 to 60.5 ± 6.6 (12 weeks) (p 0.002) and to 86.7 ± 7.2 (24 weeks) (p < 0.0001) and BECK Beck Depression Inventory (DI) reduced from 14.6 ± 3.68 to 9.1 ± 1.64 (12 weeks) (p 0.002) and to 3.7 ± 1.8 (24 weeks) (p < 0.0001) (Figures 1A–D)
Our real-life experience supports the effectiveness of benralizumab as an add-on biological treatment in improving nocturnal and diurnal symptom control and mood, as well as restoring patients with severe eosinophilic asthma to an acceptable quality of life (QoL), as highlighted by the increasing in the asthma control test (ACT), Asthma Control Questionnaire (ACQ-6), Asthma Quality of Life Questionnaire (AQLQ), EQ-VAS, EQ-5D3L and Beck Depression Inventory score (Beck DI) score
Summary
A high level of eosinophils, present in at least 50% of patients with severe asthma, causes inflammation and hyperresponsiveness of the airways, worsening symptoms and decreasing lung function (Pavord, 2013). Cumulative dosing from recurrent OCS use in the short term is associated with adverse events (AEs) including osteoporosis, fractures, hyperglycemia, diabetes, cardiovascular disease, anxiety and immunosuppression (Price et al, 2018; Voorham et al, 2019). These adverse effects have a further negative impact on the QoL and can worsen other comorbidities (Voorham et al, 2019). Severe eosinophilic asthma decreases lung function and causes worsen symptoms, often forcing recurrent maintenance corticosteroid use. The aim of our real-life study was to evaluate the effectiveness of an add-on treatment with benralizumab in patients with severe eosinophilic asthma, paying particular attention to the impact on their quality of life (QoL)
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