Benralizumab reduces asthma exacerbation rates in real-world setting

Treatment with benralizumab significantly reduces exacerbation rates in patients with asthma in a real-world setting, according to the ZEPHYR 2 study presented at AAAAI 2022.

“Benralizumab is an add-on biologic therapy for severe asthma and it has been shown to reduce asthma exacerbation rates and oral corticosteroid (OCS) use in [previous] clinical trials and observational studies,” said Dr Donna Carstens from BioPharmaceuticals Medical, AstraZeneca in Wilmington, Delaware, US.

Using a large insurance claim dataset in the US, the researchers retrospectively analysed 1,292 patients with asthma (primary cohort: mean age, 51.15 years) who were initiated on benralizumab between November 2017 and June 2019 (index date). Two subgroups were also evaluated, including the persistent benralizumab user* (n=708; mean age, 53.36 years) and OCS-dependent** cohorts (n=1,065; mean age, 51.17 years). Participants were assessed at 12 months before and after the index date (pre- and post-index periods, respectively). [AAAAI 2022, abstract 043]

The rates of asthma exacerbations were significantly reduced at post-index vs pre-index period in the primary cohort (-59.0 percent; p<0.001), as well as in the persistent benralizumab (-61.0 percent; p<0.001) and OCS-dependent cohorts (-58.0 percent; p<0.001).

Compared with the pre-index period, the primary cohort also showed significant reductions in asthma exacerbation-related healthcare resource use (HRU) and medical cost for inpatient hospital stays (-58.0 percent and -51.0 percent; p<0.001 for both), emergency department visit (-54.0 percent and -52.0 percent; p<0.001 for both), and outpatient visit (-58.0 percent and -49.0 percent; p<0.001 for both) in the post-index period.

With regard to systemic OCS use with benralizumab, a significant reduction in OCS dependence with benralizumab was observed across all cohorts (-37.0 percent [primary cohort], -39.0 percent [persistent benralizumab cohort], and -42.0 percent [OCS-dependent cohort]; p<0.001 for all) in the post- vs pre-index periods.

Moreover, the rate of any OCS use before and after benralizumab initiation was significantly reduced from pre- to post-index period across all cohorts (from 98.5 percent to 78.7 percent [primary cohort], from 98.4 percent to 76.1 percent [persistent benralizumab cohort], and from 100.0 percent to 82.6 percent [OCS-dependent cohort]; p<0.001 for all).

Other medication use, such as rescue medications (SABAs and SAMAs) and controllers (ICS + LABA combination therapy) and leukotriene modifiers, was also significantly reduced across all cohorts during the post-index period vs the pre-index period.

The median duration of benralizumab treatment was 215, 392, and 215 days in the primary, persistent benralizumab, and OCS-dependent cohorts, respectively.

“In this real-world analysis, patients treated with benralizumab experienced a significant reduction in asthma exacerbations, … [as well as] those with persistent [benralizumab] use and OCS dependence,” said Carstens.

“As the largest real-world evidence study on the impact of benralizumab therapy, our findings strengthen the body of evidence demonstrating the effectiveness of benralizumab in severe eosinophilic asthma,” she added.

*defined as having ≥6 records of benralizumab use