ICS use trajectories in severe asthma patients on benralizumab: real-life data from 3-years follow-up

Background: Inhaled steroids dose reduction is a relevant goal in severe asthma management. Research question: We aimed to investigate ICS use trajectories and their clinical impact in severe asthma patients on benralizumab over 36 months. Study design and methods: We conducted a retrospective real-life observational study including clinical and inflammatory parameters. Patients were stratified according to ICS dose trends over time: “stable” (same dose at ≥80 % of visits), “decreasing” (≥50 % of visits with lower ICS dose vs baseline), and “increasing” (≥50 % of visits with higher ICS dose vs baseline). Results: 92 patients were included. Post-bronchodilation FEV1 significantly increased over 36 months, while pre-bronchodilation FEV1 remained stable. An overall statistically significant improvement was observed also for ACT, ACQ, AQLQ and annual exacerbation rate. The probability of decreasing ICS dose was 19.0 % at 12 months and 37.4 % at 36 months. In the decreasing group (30 % of the cohort), baseline blood eosinophil count (BEC) was higher than in the stable group, and BEC suppression over time was greater. The decreasing group was also less frequently treated with OCS at baseline. At 24 months, the stable group showed a greater reduction in OCS use compared to the decreasing group. Across all groups, OCS use dropped from 89.8 % to 4.9 % at 36 months. Interpretation: The findings suggest that ICS tapering is feasible and safe in selected patients under benralizumab therapy. Conclusions: To the best of our knowledge, this is the first real-life study specifically supporting the ICS-sparing effect of benralizumab over a 36-month period.