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Benralizumab Effect on Severe Nasal Polyps: A Randomized Placebo Controlled Trial
  • Jody Tversky,
  • Andrew P. Lane,
  • Antoine Azar
Jody Tversky
Johns Hopkins University
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Andrew P. Lane
Johns Hopkins Univ
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Antoine Azar
Johns Hopkins University
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Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) can be a severe and debilitating disease associated with significant morbidity, complete anosmia, sinus pressure, and asthma exacerbations. Eosinophils play a role in the majority (85%) of patients. Benralizumab, an afucosylated monoclonal antibody directed against the IL-5 receptor has powerful apoptotic effects on eosinophils. Objective: We sought to investigate the therapeutic benefit of inhibiting the IL-5 receptor using benralizumab to treat severe nasal polyposis. Methods: Twenty-four patients (n = 24) with severe NP (grade 5 or more out of 8) with elevated eosinophils and a history of previous polypectomy were randomized in a double-blind fashion to receive 30mg benralizumab SC or placebo. Endoscopic NP score was assessed at baseline and at treatment week 20. CT scan, SNOT-22 survey, and UPSIT smell test score changes were also evaluated from baseline. Results: Compared to baseline, 8 out 12 patients receiving benralizumab had a significantly improved NP score versus 4 out of 12 placebo. 5 of 12 benralizumab treated patients had improvements in all major outcomes (polyp score, CT, SNOT-22 and smell test) versus 2 out of 12 placebo. The ratio of blood eosinophil count to allergen skin test positivity correlated with polyp reduction. Conclusion: Compared to baseline, benralizumab achieved a statistically significant reduction in polyp size by endoscopy and CT scan and was associated with both less symptoms and improved sensation of smell for most patients (10 of 12).

Peer review status:UNDER REVIEW

11 Sep 2020Submitted to Allergy
12 Sep 2020Assigned to Editor
12 Sep 2020Submission Checks Completed
14 Sep 2020Reviewer(s) Assigned