Real-world characteristics of “super-responders” to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis

• Published in: ERJ open research Vol. 9; no. 5; p. 419
• Main Authors: Portacci, Andrea, Campisi, Raffaele, Buonamico, Enrico, Nolasco, Santi, Pelaia, Corrado, Crimi, Nunzio, Benfante, Alida, Triggiani, Massimo, Spadaro, Giuseppe, Caiaffa, Maria Filomena, Scioscia, Giulia, Detoraki, Aikaterini, Valenti, Giuseppe, Papia, Francesco, Tomasello, Alessandra, Scichilone, Nicola, Pelaia, Girolamo, Crimi, Claudia, Carpagnano, Giovanna Elisiana
• Format: Journal Article
• Language: English
• Published: European Respiratory Society 01-09-2023
• Subjects: Original s
• ISSN: 2312-0541; 2312-0541
• DOI: 10.1183/23120541.00419-2023

Background The current definition of severe eosinophilic asthma (SEA) super-responders to biologic treatment does not include patients with other eosinophil-based comorbidities. Although eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases. We aim to assess super-responder features in real-life patients with SEA and EGPA treated with mepolizumab and benralizumab. Methods We enrolled 39 patients with SEA and EGPA eligible for treatment with mepolizumab or benralizumab. Super-responder assessment was performed considering oral corticosteroid (OCS) cessation, lack of exacerbations, forced expiratory volume in 1 s and Asthma Control Test (ACT) improvement. Results Super-responders showed worse clinical baseline characteristics than non-super-responder patients, with a greater improvement in severe asthma exacerbations, OCS dose reduction and ACT score increase. Definition of super-responders was consistent only considering a 12-month course of monoclonal antibody, lacking sensitivity in earlier evaluations. Conclusion Mepolizumab and benralizumab are safe and effective in patients with EGPA and SEA, since a consistent proportion of patients show a super-response after 12 months of treatment. Further studies will address specific criteria for super-responder assessment in these patients.