EFFECTS OF BENRALIZUMAB ON THE MANAGEMENT OF SEVERE ASTHMA

Abstract

SESSION TITLE: Allergy/Airway Abstracts SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 02:30 PM - 03:30 PM PURPOSE: Many patients with eosinophilic severe asthma despite taking medium to high dose inhaled corticosteroids and a second controller medication still have symptoms and exacerbation, and their asthma is not well controlled. Benralizumab is a humanized monoclonal antibody against the interleukin-5 receptor alpha-chain causing eosinophilic depletion. The aim of this systematic review and meta-analysis was to determine the impacts of Benralizumab on the management of eosinophilic severe asthma. METHODS: A comprehensive and systematic review of electronic data bases including PubMed, CENTRAL, CINAHL Plus, EMBASE, IPA, and ClinicalTrials.gov. were performed from the inception of Databases till June 16, 2017. Inclusion criteria were double-blinded, randomized, placebo-controlled, phase 3 clinical trials that measure the impacts of Benralizumab as add-on treatment on eosinophilic severe asthma patients. RESULTS: From1211 reviews articles, finally three articles with a combined 2730 patients were assessed the effects of Benralizumab on annual asthma exacerbation rate and four studies were determined it impacts on Asthma Control Questionnaire (ACQ) scores, Asthma Quality of Life Questionnaire (AQLQ) scores, and prebronchodilator FEV1% values in asthmatic patients with eosinophilia. There was a significant reduction in annual exacerbation rates (rate ratio vs. placebo = 0·62, 95% CI 0·49 to 0·78, p<0·0001) which is more pronounced in patients with elevated blood Eosinophil (rate ratio vs. placebo = 0·54, 95% CI 0·45 to 0·66, p<0·00001). ACQ scores, AQLQ scores, and FEV1% values were significantly improved in patients received Benralizumab in comparison to placebo (Mean Difference: -0.24, 95%CI: -0.32-0.16, p-value: <0.00001); (Mean Difference: 0.23, 95%CI: 0.14,0.32, p-value: <0.00001); (Mean Difference: 0.11, 95% CI 0.08,0.15, p-value: <0.00004) respectively. The adverse event rates were similar in the Benralizumab and placebo groups for many of the adverse events including any adverse events (rate ratio vs. placebo = 0·94, 95% CI 0·88 to 1·00), upper respiratory tract infection (rate ratio vs. placebo = 0·93, 95% CI 0·72 to 1·21), and nasopharyngitis (rate ratio vs. placebo = 0·94, 95% CI 0·78 to 1·13). In addition, only 38 out of 1808 (2·1%) patients discontinued treatment due to an adverse event in the Benralizumab group and 9 out of 922 (1%) in the placebo group. CONCLUSIONS: This systematic review and meta-analysis demonstrate that management of patients with eosinophilic severe asthma with Benralizumab significantly improves in asthma exacerbation rate, asthma control, asthma related quality of life and pre-bronchodilator FEV1 with minimal and acceptable adverse effects. CLINICAL IMPLICATIONS: This study provides evidenced-based recommendations for use of Benralizumab in asthmatic patients with eosinophilia and help direct current treatment guidelines. DISCLOSURES: no disclosure on file for Shabnam Asghari; No relevant relationships by Masoud Mahdavian, source=Web Response