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Real-Life Effectiveness of Benralizumab, Mepolizumab and Omalizumab in Severe Allergic Asthma Associated with Nasal Polyps

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Abstract

Biological therapies are available for the treatment of the severe allergic asthma (SAA) with blood eosinophil count ≥ 0.3 × 109/L. Several of them also showed benefits on nasal polyps (NP), one of the most frequent comorbidities of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking. The aim of this study is to compare the effectiveness of benralizumab, mepolizumab and omalizumab in patients with SAA-NP in real-life settings. A retrospective, observational, multicenter real-life study was realized including patients with SAA-NP treated by benralizumab, mepolizumab or omalizumab for 6 months. We analysed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging and the blood eosinophil count 6 months before and after treatment. Seventy-two patients with SAA-NP were included: 16 treated by benralizumab, 21 by mepolizumab and 35 by omalizumab. After 6 months of treatment, almost all studied parameters were improved (except sinus imaging) with a greater effect of omalizumab on the nasal pruritus (p = 0.001) and more benefits of benralizumab on exacerbations rate, asthma attacks per week and lung function (all p < 0.05). Benralizumab and mepolizumab were more effective to improve the NP endoscopic score and the blood eosinophil count (both p < 0.001). All three biological therapies showed effectiveness by improving asthma and nasal outcomes in patients with SAA-NP. Several differences have been found that should be confirmed by larger comparative studies.

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Abbreviations

ICS:

Inhaled corticosteroids

LABA:

Long-acting β2 receptors agonists

CS:

Systemic corticosteroids

IgE:

Immunoglobulin E

BEC:

Blood eosinophil count

IL-5:

Interleukin 5

IL-5R:

Interleukin 5 receptor

IL-4:

Interleukin 4

NP:

Nasal polyps

SAA:

Severe allergic asthma

ENT:

Ear Nose Throat

SABA:

Short-acting β2 receptors agonists

ACT:

Asthma Control Test

FEV1:

Forced expiratory volume in one second

FVC:

Forced vital capacity

T0:

At baseline

T6:

After 6 months of treatment

CT:

Computed tomography

OR:

Odds ratios

GINA:

Global Initiative for Asthma

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Authors and Affiliations

  1. Department of Pulmonology, University Hospital of Nancy, 9 Rue du Morvan, 54500, Vandoeuvre-Les-Nancy, Nancy, France

    Angelica Tiotiu

  2. Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, Nancy, France

    Angelica Tiotiu & Iulia Ioan

  3. Department of Allergy, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    Paula Mendez-Brea

  4. Lung Function Testing Lab, Children’s University Hospital of Nancy, Nancy, France

    Iulia Ioan

  5. Department of Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    Rodrigo Romero-Fernandez

  6. Department of Pulmonology, Hospital of Colmar, Colmar, France

    Jean Philippe Oster & Thi-cam-tu Hoang

  7. Department of Pulmonology, University Hospital of Besançon, Besançon, France

    Pauline Roux

  8. Department of Pulmonology-Allergology, University Hospital of Strasbourg, Strasbourg, France

    Diana Carolina Ochoa-Gutierrez & Frederic de Blay

  9. Department of Pulmonary Medicine and Intensive Care Unit, University Hospital of Dijon, Dijon, France

    Philippe Bonniaud

  10. LNC UMR866, LipSTIC LabEx Team, Inserm, Dijon, France

    Philippe Bonniaud

  11. Bourgogne Franche-Comté University, Dijon, France

    Philippe Bonniaud

  12. University of Strasbourg, Strasbourg, France

    Frederic de Blay

  13. Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    Francisco-Javier Gonzalez-Barcala

  14. Spanish Biomedical Research Networking Centre-CIBERES, Santiago de Compostela, Spain

    Francisco-Javier Gonzalez-Barcala

  15. Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain

    Francisco-Javier Gonzalez-Barcala

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Correspondence to Angelica Tiotiu.

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Conflict of Interest

Iulia Ioan, Rodrigo Romero-Fernandez, Thi-cam-tu Hoang and Diana Carolina Ochoa-Gutierrez have no conflicts of interest. Angelica Tiotiu reports speaker and consulting fees from ALK, AstraZeneca, GSK, Novartis and Sanofi outside the submitted work. Paula Méndez-Brea Paula reports personal fees from ALK, Allergy Therapeutics, Chiesi, GSK and Stallergenes outside the submitted work. Jean Philippe Oster reports speaker and consulting fees from AstraZeneca, GSK, Novartis and Sanofi outside the submitted work. Pauline Roux reports speaker and consulting fees from AstraZeneca, Chiesi, GSK and Novartis outside the submitted work. Philippe Bonniaud reports speaker and consulting fees from AstraZeneca, Chiesi, GSK, Novartis and Sanofi outside the submitted work. Frederic de Blay reports speaker and consulting fees from ALK, AstraZeneca, Chiesi, GSK, Novartis and Sanofi outside the submitted work. Francisco-Javier Gonzalez-Barcala has received speaker fees, consulting fees or research grants from ALK, AstraZeneca, Bial, Boehringer-Ingelheim, Chiesi, Gebro Pharma, GSK, Laboratorios Esteve, Menarini, Mundipharma, Novartis, Rovi, Roxall, Sanofi, Stallergenes and Teva.

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Tiotiu, A., Mendez-Brea, P., Ioan, I. et al. Real-Life Effectiveness of Benralizumab, Mepolizumab and Omalizumab in Severe Allergic Asthma Associated with Nasal Polyps. Clinic Rev Allerg Immunol 64, 179–192 (2023). https://doi.org/10.1007/s12016-022-08938-w

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