Effect of benralizumab on asthma exacerbation rates in patients with severe asthma: Systematic review and meta-analysis

BACKGROUND: Severe asthma patients require high-dose inhaled corticosteroids (ICS) plus a second controller medication to control their disease or remain inadequately controlled despite this. Benralizumab is a humanized, monoclonal antibody that targets the interleukin-5 receptor alpha-chain causing depletion of eosinophils. The aim of this meta-analysis was to determine whether Benralizumab reduces annual asthma exacerbation rates in patients with severe asthma. METHODS: A comprehensive search of electronic databases was performed to include published articles databases until June 16, 2017. Inclusion criteria were randomized, double-blind, placebo-controlled, phase 3 clinical trials that measured annual asthma exacerbation rates, and used Benralizumab as add-on treatment for severe asthmatic patients. The primary outcome was reduction in annual exacerbation rates. Outcomes were reported as rate ratios versus placebo. FINDINGS: From 1211 reviews articles, three articles with a combined 2730 patients were included in the meta-analysis. There was a significant reduction in annual exacerbation rates (rate ratio vs. placebo = 0.62, 95% CI 0.49 to 0.78, p < 0.0001), which is more pronounced in patients with elevated blood Eosinophil (rate ratio vs. placebo = 0.54, 95% CI 0.45 to 0.66, p < 0.00001). INTERPRETATION: Benralizumab significantly reduces annual exacerbation rates in severe asthma patients as an add-on treatment with minimal adverse events.