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

Andrea Portacci; Raffaele Campisi; Enrico Buonamico; Santi Nolasco; Corrado Pelaia; Nunzio Crimi; Alida Benfante; Massimo Triggiani; Giuseppe Spadaro; Maria Filomena Caiaffa; Giulia Scioscia; Aikaterini Detoraki; Giuseppe Valenti; Francesco Papia; Alessandra Tomasello; Nicola Scichilone; Girolamo Pelaia; Claudia Crimi; Giovanna Elisiana Carpagnano

doi:10.1183/23120541.00419-2023

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

ERJ Open Res. 2023 Oct 30;9(5):00419-2023. doi: 10.1183/23120541.00419-2023. eCollection 2023 Sep.

Authors

Andrea Portacci^{1

2}, Raffaele Campisi^{3

2}, Enrico Buonamico¹, Santi Nolasco^{3

4}, Corrado Pelaia⁵, Nunzio Crimi⁴, Alida Benfante⁶, Massimo Triggiani⁷, Giuseppe Spadaro⁸, Maria Filomena Caiaffa⁹, Giulia Scioscia¹⁰, Aikaterini Detoraki¹¹, Giuseppe Valenti¹², Francesco Papia¹², Alessandra Tomasello⁶, Nicola Scichilone⁶, Girolamo Pelaia⁵, Claudia Crimi^{3

4}, Giovanna Elisiana Carpagnano¹

Affiliations

¹ Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy.
² These authors contributed equally.
³ Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy.
⁴ Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
⁵ Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
⁶ Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
⁷ Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy.
⁸ Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.
⁹ Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy.
¹⁰ Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
¹¹ Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.
¹² Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy.

Abstract

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.