New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic

Marco Caminati,1,2 Diego Bagnasco,3 Rachele Vaia,2 Gianenrico Senna11Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy; 2Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, Verona, Italy; 3Allergy & Respiratory Di...

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Autores principales:	Caminati M, Bagnasco D, Vaia R, Senna G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Benralizumab efficacy benralizumab safety benralizumab mechanism of action anti IL-5 mAbs severe asthma eosinophilic asthma Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/94f3d5e54f2e44f0bbf5750e6f077a31
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spelling	oai:doaj.org-article:94f3d5e54f2e44f0bbf5750e6f077a312021-12-02T05:57:09ZNew horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic1177-5491https://doaj.org/article/94f3d5e54f2e44f0bbf5750e6f077a312019-05-01T00:00:00Zhttps://www.dovepress.com/new-horizons-for-the-treatment-of-severe-eosinophilic-asthma-benralizu-peer-reviewed-article-BTThttps://doaj.org/toc/1177-5491Marco Caminati,1,2 Diego Bagnasco,3 Rachele Vaia,2 Gianenrico Senna11Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy; 2Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, Verona, Italy; 3Allergy & Respiratory Diseases, DIMI Department of Internal Medicine, University of Genoa, Genoa, ItalyAbstract: In the last decades, the increasing evidence concerning inflammation mechanisms underlying severe eosinophilic asthma has highlighted new potential therapeutic targets and has paved the way to new selective biologic drugs. Understanding the mechanism of action and the clinical outcomes of a particular drug along with the clinical and biological characteristics of the patient population for which that drug was intended may ensure appropriate selection of patients that will respond to that drug. Under this perspective, the present review will focus on the mechanisms of action and clinical evidence of benralizumab as a treatment option for severe eosinophilic asthma, in order to provide a concise overview and a reference for clinical practice. Benralizumab is a fully humanized afucosylated IgG1κ mAb that binds to an epitope on IL-5 Rα, and inhibits IL-5 signaling. Benralizumab also sustains antibody-directed cell-mediated cytotoxicity (ADCC) of eosinophils and basophils and consequently depletes IL-5Rα-expressing cells. As a result, it is responsible for a substantial depletion of blood, tissue, and bone marrow eosinophilia. This unique mechanism of action may account for a more complete and rapid action profile. Randomized clinical trials have demonstrated that benralizumab provides an optimal safety profile, and is able to significantly reduce asthma exacerbations, oral steroid intake, and to improve lung function. Some clinical predictors of enhanced clinical response to benralizumab have also been identified, including: a level of blood eosinophils ≥300 μL−1, oral steroids use, the presence of nasal polyposis, FVC <65% of predicted, and a history of three or more exacerbations per year at baseline. These results can be helpful in identifying the best responder patients to benralizumab. As a step forward, the definition of the responder profile for each of the available biological treatment options will potentially support even more the pathway to precision medicine and the critical matching of the right drug with the right patient.Keywords: benralizumab efficacy, benralizumab safety, benralizumab mechanism of action, anti IL-5 mAbs, severe asthma, eosinophilic asthmaCaminati MBagnasco DVaia RSenna GDove Medical PressarticleBenralizumab efficacybenralizumab safetybenralizumab mechanism of actionanti IL-5 mAbssevere asthmaeosinophilic asthmaMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol Volume 13, Pp 89-95 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Benralizumab efficacy benralizumab safety benralizumab mechanism of action anti IL-5 mAbs severe asthma eosinophilic asthma Medicine (General) R5-920
spellingShingle	Benralizumab efficacy benralizumab safety benralizumab mechanism of action anti IL-5 mAbs severe asthma eosinophilic asthma Medicine (General) R5-920 Caminati M Bagnasco D Vaia R Senna G New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
description	Marco Caminati,1,2 Diego Bagnasco,3 Rachele Vaia,2 Gianenrico Senna11Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy; 2Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, Verona, Italy; 3Allergy & Respiratory Diseases, DIMI Department of Internal Medicine, University of Genoa, Genoa, ItalyAbstract: In the last decades, the increasing evidence concerning inflammation mechanisms underlying severe eosinophilic asthma has highlighted new potential therapeutic targets and has paved the way to new selective biologic drugs. Understanding the mechanism of action and the clinical outcomes of a particular drug along with the clinical and biological characteristics of the patient population for which that drug was intended may ensure appropriate selection of patients that will respond to that drug. Under this perspective, the present review will focus on the mechanisms of action and clinical evidence of benralizumab as a treatment option for severe eosinophilic asthma, in order to provide a concise overview and a reference for clinical practice. Benralizumab is a fully humanized afucosylated IgG1κ mAb that binds to an epitope on IL-5 Rα, and inhibits IL-5 signaling. Benralizumab also sustains antibody-directed cell-mediated cytotoxicity (ADCC) of eosinophils and basophils and consequently depletes IL-5Rα-expressing cells. As a result, it is responsible for a substantial depletion of blood, tissue, and bone marrow eosinophilia. This unique mechanism of action may account for a more complete and rapid action profile. Randomized clinical trials have demonstrated that benralizumab provides an optimal safety profile, and is able to significantly reduce asthma exacerbations, oral steroid intake, and to improve lung function. Some clinical predictors of enhanced clinical response to benralizumab have also been identified, including: a level of blood eosinophils ≥300 μL−1, oral steroids use, the presence of nasal polyposis, FVC <65% of predicted, and a history of three or more exacerbations per year at baseline. These results can be helpful in identifying the best responder patients to benralizumab. As a step forward, the definition of the responder profile for each of the available biological treatment options will potentially support even more the pathway to precision medicine and the critical matching of the right drug with the right patient.Keywords: benralizumab efficacy, benralizumab safety, benralizumab mechanism of action, anti IL-5 mAbs, severe asthma, eosinophilic asthma
format	article
author	Caminati M Bagnasco D Vaia R Senna G
author_facet	Caminati M Bagnasco D Vaia R Senna G
author_sort	Caminati M
title	New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
title_short	New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
title_full	New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
title_fullStr	New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
title_full_unstemmed	New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
title_sort	new horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/94f3d5e54f2e44f0bbf5750e6f077a31
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New horizons for the treatment of severe, eosinophilic asthma: benralizumab, a novel precision biologic

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