Background: Anti IL-5 biologics reduce exacerbation rate and steroid exposure in severe eosinophilic asthma but it is not known whether these benefits are seen after switching from a previously ineffective biologic with or without persistent sputum eosinophilia.

Aim: To assess real life response to benralizumab in biologic-naïve patients, or having failed mepolizumab, with or without persistent airway eosinophilia (SpEo+ or SpEo-).

Methods: Patients were assessed after 1 year on benralizumab. Outcomes were compared across the 3 cohorts (steroid requirements, exacerbation rates, blood & sputum eosinophils, asthma control, quality of life).

Results: Of 116 patients 58 were biologics-naïve, and 58 had suboptimal mepolizumab response, 47 SpEo+ and 11 SpEo-. Successful reduction in steroid use and/or exacerbation rate after 1yr on benralizumab was observed in 84% patients.

There was no statistical difference in other outcomes between the three cohorts (Table).

Conclusion: Our real-life observations support trial data on clinical benefits after 1 year on benralizumab. It confirms that prior anti-IL5 treatment does not affect IL-5r response, even in patients who had failed to reduce airway inflammation on mepolizumab.