Introduction

Current definition of Severe Eosinophilic Asthma (SEA) Super-Responders (SR) to biologic treatment does not include patients with other eosinophils-based comorbidities. Whereas Eosinophilic Granulomatosis with Polyangitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases.

Aims and Objectives

To assess SR features in real-life patients with SEA and EGPA treated with Mepolizumab and Benralizumab.

Methods

We enrolled 39 patients with SEA and EGPA eligible to treatment with Mepolizumab or Benralizumab. SR assessment was performed considering OCS cessation, the lack of exacerbations, FEV1 and ACT improvement after a 12-months course of treatment with monoclonal antibodies.

Results

SR showed lower baseline ACT levels (P<0.0001), a marked blood eosinophilia (P=0.04), a higher frequency of severe exacerbations (P=0.001) and higher median OCS administered dose (P=0.03). After biologic treatment, SR significantly reduced exacerbations (P=0.001), OCS use (P<0.0001) and blood eosinophils count (P=0.02), with also a greater ACT improvement compared to non-SR patients (P<0.0001). Definition of SR was consistent only considering a 12-months course of monoclonal antibody, lacking sensitivity in earlier evaluations. 

Conclusions

A consistent part of patients with SEA and EGPA show a super-response after 12 months of treatment with monoclonal antibodies. Despite a worse baseline clinical scenario, SR have greater response to biologic treatment in terms of severe exacerbations reduction, blood eosinophils decrease, symptoms management and OCS administration.