Research Summary

Benralizumab for Acute Eosinophilic Exacerbations of Asthma, COPD

Edited by:
Anthony Calabro, MA

Key Highlights

  • Benralizumab reduced 90-day treatment failures compared with prednisolone alone.
  • Symptom burden at 28 days improved significantly with benralizumab.
  • Prednisolone-treated groups experienced hyperglycemia and sinusitis; benralizumab was well tolerated.
  • Results support a precision-medicine approach for acute eosinophilic exacerbations.

A randomized clinical trial published in The Lancet Respiratory Medicine found that a single subcutaneous dose of benralizumab improved outcomes for patients experiencing an eosinophilic exacerbation of asthma or chronic obstructive pulmonary disease (COPD). The findings suggest that targeting inflammatory endotypes may outperform standard prednisolone therapy in this clinical setting.

The acute exacerbations treated with BenRAlizumab (ABRA) trial enrolled adults presenting to urgent care and emergency departments across 2 UK hospital networks. Eligible participants had asthma or COPD and a blood eosinophil count of at least 300 cells/µL at the time of exacerbation. Patients were randomized to prednisolone alone, benralizumab alone, or benralizumab plus prednisolone. Both participants and research personnel were blinded to treatment allocation. Co-primary outcomes were treatment failure within 90 days and total VAS symptom score at day 28.

Study Findings

Among 158 randomized participants, treatment failure occurred in 74% of those receiving prednisolone alone and in 45% of those in the pooled benralizumab groups (OR, 0.26; 95% CI, 0.13-0.56; P = .0005). Symptom scores at day 28 also favored benralizumab, with a mean improvement of 49 mm on the VAS scale (95% CI, 14-84; P = .0065).

Benralizumab prolonged time to first treatment failure (HR, 0.39; 95% CI, 0.25-0.61; P = .0003), with a number needed to treat of 4. Patient-reported outcomes generally improved more with benralizumab, although lung-function gains were similar across treatment arms. Adverse events were common but nonfatal; hyperglycemia and sinusitis occurred only in prednisolone-treated patients.

Clinical Implications

According to the study authors, these findings suggest that benralizumab may offer an effective acute treatment option for eosinophilic exacerbations of asthma or COPD and could reduce reliance on systemic glucocorticoids, which pose cumulative risks.

The authors also noted several limitations. Only a minority of patients were recruited from emergency departments, limiting insight into the drug’s performance in the most severe exacerbations. The study was not powered to assess asthma and COPD separately, and investigators evaluated only benralizumab, leaving uncertainty about whether other biologics would show similar benefit.

Expert Commentary

“In patients with an eosinophilic exacerbation of asthma or COPD, a single subcutaneous injection of benralizumab, with or without a short course of systemic glucocorticoids (oral prednisolone) reduced treatment failures, prolonged time to first event, and improved respiratory symptoms and disease-specific health quality compared with standard care with oral corticosteroids following an exacerbation,” the researchers concluded.

Reference
Ramakrishnan S, Russell REK, Mahmood HR, et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial. Lancet Respir Med. 2025;13(1):59-68. doi:10.1016/S2213-2600(24)00299-6