Background. Among the comorbidities of severe eosinophilic asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts lung function and asthma control in severe patients. We evaluated the effect of the anti-interleukin (IL)-5 receptor antibody, benralizumab, on nasal inflammation and the metabolomic profile of patients with severe eosinophilic asthma and CRSwNP.

Patients and Methods. We enrolled 14 patients who met the criteria for benralizumab prescription. Patients were assessed at baseline (T1), and then after three (T2) and six months (T3). We evaluated: clinical history, Sino-Nasal Outcome Test 22 (SNOT22), Nasal Polyps Score (NPS), Visual Analogue Scale (VAS) for main symptoms of CRSwNP and lung function. We collected samples of nasal lavage (RW) to assess the concentration of cytokines, including IL-2, IL-4, IL-5, eotaxin (CCL11), and metabolites.

Results. A significant reduction in SNOT22 score (T1: 67.86 ±15.84; T3: 53.36 ± 20.30, P<0.001) and in NPS (T1: 4.21 ± 1.19; T3: 2.64 ± 1.34, P<0.001) were observed throughout the study. Forced expiratory volume in 1 second (FEV1) also significantly improved between T1 and T3 (P<0.001). The analysis of RW showed a significant increase in the levels of IL-4 between T1 and T3 (P=0.024). Nuclear Magnetic Resonance based metabolomics of RW showed different metabolite cluster distributions at the three time-points, with more homogeneous results at T2 and T3 in comparison to T1, although no predictive model could reach statistical significance.

Conclusions. Benralizumab might be effective on CRSwNP associated to severe eosinophilic asthma, with an improvement in both SNOT22 and NPS scores.