ABSTRACT
Introduction: The use of biological therapy in eosinophilic and atopic asthma has grown exponentially over the last 14years. Treatment was initially hospital-based, but the COVID-19 pandemic has accelerated the implementation of patient homecare self-administration (HSA) of biologics. Aim(s): To assess the stability of patients transfered on HSA by comparing data from biologic initiation to HSA discharge and annual review. Result(s): This report includes 56 patients who attended for annual review between April and December 2021 (60% female, mean age 54 [SD13.4]) for Benralizumab (42.9%), Mepolizumab (35.7%) and Omalizumab (21.4%). The time on biologic when commencing HSA was 19 (IQR 21.8) months, with an annual review 12 (IQR 8.3) months later. Previously obtained improvements in asthma control, lung function, eosinophil suppression and oral corticosteroid use, were maintained in 53(95%) of the patients (Table 1). HSA was stopped in 3(5%) patients due to deterioration in asthma control. Conclusion(s): The vast majority of patients recieving HSA of biologics maintained previous improvements across asthma outcomes, thereby strongly supporting the use of HSA in the correctly identified patient, consequently optimising service capacity. Appropriate monitoring arrangements are still needed to promptly identify any deterioration. (Table Presented).
ABSTRACT
Introduction: Benralizumab and mepolizumab are subcutaneous monoclonal antibodies licensed for the treatment of severe eosinophilic asthma. Benralizumab acts by blocking the anti-IL5 a receptor whilst mepolizumab binds to IL-5 inhibiting it binding to eosinophils. There is currently an absence of head-to-head data but trial outcomes have found a similar reduction in exacerbation frequency. Aim: To compare clinical outcomes of patients receiving benralizumab or mepolizumab at 6 and 12 months of treatment. Method: A retrospective review of 50 mepolizumab and 50 benralizumab patients was carried out. The mepolizumab group reviewed had started treatment immediately prior to introduction of benralizumab to ensure a similar patient population. Measurements at baseline, 6 months and 12 months of treatment were compared for the following: daily oral cortico-steroid dose (OCS);asthma control scores;blood and sputum eosinophils;FeNO. We also examined adherence to inhaled corticosteroid (ICS) at baseline. Results: Statistically significant differences were seen in FeNO, ACQ scores, blood and sputum eosinophils at 6 and 12 months (table). Blood eosinophils were undetectable in 75% (n=33) of patients on benralizumab and 2% (n=1) on mepolizumab at 6 months, and at 12 months 77% (n=10) and 8% (n=2) respectively. Likewise sputum eosinophils were (Table presented) undetectable at 12 months in 83% (n=5) on benralizumab and 16% (n=2) in mepolizumab. Mean (SD) adherence to ICS in patients initiating benralizumab was 88 (11)% versus 80 (3)% in mepolizumab (p<0.001). Lung function and FeNO measurements were not available at 12 months due to COVID-19 restrictions. Conclusion: There was a higher proportion of patients on benralizumab achieving complete suppression of blood and sputum eosinophils at six and 12 months compared to those on mepolizumab. Asthma control scores after treatment were also superior with benralizumab compared to mepolizumab. Despite higher levels of adherence in the benralizumab group these patients had a higher FeNO after treatment.
ABSTRACT
Background: Anti-IL-5 monoclonal antibodies reduce systemic corticosteroid use, exacerbation rate, and airway inflammation in severe asthma. Different effectors of the eosinophil IL-5 pathway are targeted, but algorithms to choose the most appropriate biologic for each patient are still being refined. Our team regularly monitors severe asthma patients' airway inflammation using sputum eosinophils. Aims: To investigate clinical outcomes of patients that switched to benralizumab after non-response to mepolizumab associated with persistent sputum eosinophilia. Methods: We prospectively monitored sputum cell counts of patients starting MDT-approved benralizumab after: • failing to respond to mepolizumab, • and whose positive sputum eosinophils remained above the threshold of 3%. Additional clinical parameters were recorded including corticosteroid dose, ACQ, AQLQ, and blood eosinophils. Lung function testing was severely impacted by the COVID pandemic. Results: Fifty-one of 183 (27.9%) mepolizumab patients to date have been identified as candidates for a switch of therapy with residual positive sputum eosinophils, of which 44 have received their first doses of benralizumab and 16 have completed 6 months of treatment with available sputum eosinophil results. After 6 months on benralizumab therapy, clinically and statistically significant improvements in ACQ and mAQLQ were observed compared to baseline. (Table presented) All but two patients had negative sputum eosinophils (< 3%) compared to levels on mepolizumab (Table). Both also had elevated blood eosinophils: one patient was sampled during an exacerbation, the other is being investigated for parasitic infestation due to frequent foreign travels. At baseline 81% of patients were taking maintenance oral corticosteroids compared to 44% at 6 months (NS). Conclusions: More than a quarter of patients failed to respond to mepolizumab and displayed persistent airway eosinophilia. Of these, 88% achieved negative airway inflammation on benralizumab with significant clinical improvement (ACQ, AQLQ) and clinically (though not statistically on this small sample size) significant fall of OCS. Benralizumab appears to prove effective at reducing inflammation at tissue level in patients previously unable to achieve this on a different anti-IL-5 therapy. As more patients progress through their treatment, repeat monitoring at 12 months will establish if this benefit is maintained and is associated with long term steroid dose reduction, and exacerbation rate.