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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (3) : 340-349
Efficacy and safety of benralizumab in patients with eosinophilic asthma: a meta-analysis of randomized placebo-controlled trials
Ting Liu, Faping Wang, Geng Wang, Hui Mao()
Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Benralizumab is a monoclonal antibody that targets interleukin-5 receptor α to deplete blood eosinophils and improve the clinical outcomes of allergic asthma. We conducted a meta-analysis to evaluate the safety and efficacy of different doses of benralizumab in patients with eosinophilic asthma. All randomized controlled trials involving benralizumab treatment for patients with eosinophilic asthma, which were searched in PubMed, Embase, and the Cochrane Library published until January 2017, as well as the rate of asthmatic exacerbation, pulmonary functionality, asthma control, quality of life scores, and adverse events were included. Randomized-effect models were used in the meta-analysis to calculate the pooled mean difference, relative risks, and 95% confidence intervals. Five studies involving 1951 patients were identified. Compared with the placebo, benralizumab treatment demonstrated significant improvements in the forced expiratory volume in 1?s (FEV1), Asthma Quality of Life Questionnaire scores, decreased asthmatic exacerbation and Asthma Control Questionnaire-6 (ACQ-6) scores. Benralizumab treatment was also not associated with increased adverse events. These findings indicated that benralizumab can be safely used to improve FEV1, enhance patient symptom control and quality of life, and reduce the risk of exacerbations and ACQ-6 scores in patients with eosinophilic asthma. Furthermore, our meta-analysis showed that benralizumab with 30 mg (every eight weeks) dosage can improve the health-related quality of life and appear to be more effective than 30 mg (every four weeks) dosage. Overall, data indicated that the optimal dosing regimen for benralizumab was possibly 30 mg (every eight weeks).

Keywords benralizumab      anti-interleukin-5      monoclonal antibody      eosinophilic asthma      meta-analysis     
Corresponding Authors: Hui Mao   
Just Accepted Date: 06 September 2017   Online First Date: 31 October 2017    Issue Date: 04 May 2018
 Cite this article:   
Ting Liu,Faping Wang,Geng Wang, et al. Efficacy and safety of benralizumab in patients with eosinophilic asthma: a meta-analysis of randomized placebo-controlled trials[J]. Front. Med., 2018, 12(3): 340-349.
Fig.1  Flow chart identifying the studies included in the analysis.
Reference Study design No. of subjects (treatment/placebo) Age (year) Doses of benralizumab used Routine Treatment duration Outcomes Follow-up
Laviolette et al., 2013 [21]a mRCT 4/5 18–65 100 mg Q4W SC 8 weeks Blood, sputum eosinophils; adverse events 20 weeks
Castro et al., 2014 [22]b mRCT 244/80 18–75 2, 20, 100 mg Q8W SC 52 weeks Blood eosinophils; asthma exacerbations; FEV1 52 weeks
Park et al., 2016 [23]b mRCT 60/21 20–75 2, 20, 100 mg Q8W SC 40 weeks Blood eosinophils; asthma exacerbations; FEV1; PEF; ACQ-6 52 weeks
FitzGerald et al., 2016 [24]b mRCT 480/248 12–75 30 mg Q4W or 30 mg Q8W SC 56 weeks Asthma exacerbations; FEV1; ACQ-6; AQLQ 56 weeks
Bleecker et al., 2016 [14]a mRCT 542/267 12–75 30 mg Q4W or 30 mg Q8W SC 48 weeks Asthma exacerbations; FEV1; ACQ-6; AQLQ 48 weeks
Tab.1  Characteristics of the randomized controlled trials included in the meta-analysis
Fig.2  Risk of bias summary of the included studies.
Fig.3  Funnel plot of the five studies that evaluated the effect of benralizumab on FEV1.
Fig.4  Forest plot of the effect of benralizumab treatment on asthma exacerbations versus the placebo. Fixed-effect model. SE, standard error; IV, inverse variance; CI, confidence interval.
Fig.5  Effect of benralizumab treatment versus the placebo on FEV1. SD, standard deviation; IV, inverse variance; CI, confidence interval; Std. Mean Difference, standardized mean difference.
Fig.6  Effect of benralizumab treatment versus the placebo on the ACQ-6 score. SD, standard derivation; IV, inverse variance; CI, confidence interval.
Fig.7  Effect of benralizumab treatment versus the placebo on the AQLQ score. SD, standard derivation; IV, inverse variance; CI, confidence interval.
Fig.8  Forest plot of the effect of benralizumab treatment on adverse events versus the placebo. M-H, Mantel–Haenszel; CI, confidence interval.
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