Background. The advent of biological therapies has been a turning point in severe eosinophilic asthma (SEA), playing a crucial role in reducing patients' need for steroids and preventing exacerbations. Benralizumab (BZ), an anti-IL-5R agent, showed promising results as SEA add-on therapy. However, data on the long-term effects are lacking. The aim of this study is to assess real-world BZ effectiveness on a 3 year follow up.

Methods. Our retrospective study analyzed data from 11 patients at baseline (T0) and after two (T1) and three (T2) years of treatment with BZ, administered following current indication. We assessed Asthma Control Test (ACT) score, number of exacerbations/year, need for inhaled (ICS) or systemic corticosteroids (OCS), blood eosinophil count and lung function tests.

Results. The population was predominantly women (8, 73%) with a mean age of 61.5 years.At T0, all patients were on high-dose ICS-LABA, with LAMA (82%), anti-LTRA (64%) and/or OCS (45%) as add-on therapy. Despite adherence to therapy, all patients had poor asthma symptom control (mean ACT 16) and 6 (55%) had at least 3 exacerbations/year.At T2, 9 patients (81,8%) reduced ICS to medium/low doses (p=0,008), 5 out of 7 (71,4%) discontinued OCS. A long-lasting improvement in lung function (FEV1, FVC, MEF25-75%) was observed too, as well as rapid eosinophil depletion (p=0,001). Despite treatment step down, 90% of patients had well controlled asthma (ACT>20, p=0,006) with a 50% reduction in exacerbations.

Conclusions. Our findings are consistent with other real-life experiences at 2 years, supporting BZ sustained effectiveness in steroids sparing, reduction in exacerbations, and quality of life improvement.