What does this research mean for the field?

Benralizumab confers durable clinical benefits, including sustained exacerbation reduction, oral corticosteroid independence, and improved lung function, with an excellent safety profile in severe eosinophilic asthma beyond three years. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to evaluate the long-term effects and safety of benralizumab in patients with severe eosinophilic asthma over three years.

May 20, 2026

B32-27 Long-Term Remission and Sustained Efficacy of Benralizumab in Severe Eosinophilic Asthma: A Contemporary Systematic Review of Real-World Evidence Beyond Three Years

Puntos clave

The aim is to evaluate the long-term effects and safety of benralizumab in patients with severe eosinophilic asthma over three years.
Reviewed six longitudinal and retrospective cohort studies per PRISMA 2020 guidelines.
Included studies had at least 36 months of follow-up evaluating outcomes of benralizumab.
Outcomes extracted included clinical remission, exacerbation rates, lung function, and safety.
Benralizumab achieved sustained reductions in exacerbations (≈85-95%) and significant improvements in FEV₁ (+350-450 mL).
Composite clinical remission occurred in 70-90% of patients, with a trend from partial to complete remission over time.
Treatment-related adverse events were infrequent (1-2%), primarily mild, with no serious complications observed.

Resumen

Abstract Background Severe eosinophilic asthma (SEA) represents a chronic, treatment-refractory phenotype driven by persistent type-2 inflammation. While short-term efficacy of anti-IL-5 receptor therapy with benralizumab is well established, data on sustained remission, long-term safety, and potential disease modification beyond three years remain limited Methods Following PRISMA 2020 guidelines, six real-world longitudinal and retrospective cohort studies published between 2022 and 2025 were reviewed to evaluate ≥3-year outcomes of benralizumab in SEA. Studies with at least 36 months of follow-up were included. Extracted outcomes included clinical remission, annualized exacerbation rates (AER), lung function (FEV₁), oral corticosteroid (OCS) sparing, safety, and predictors of sustained response. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Given heterogeneity in outcome definitions, potential for meta-analysis was evaluated qualitatively. Clinical remission was most commonly defined as OCS independence, absence of exacerbations, and an ACT ≥20 maintained for ≥12 months. Results Of 267 screened titles and abstracts, six studies were included, encompassing 507 patients (mean age 56.4 years; 43% male). Benralizumab demonstrated durable efficacy, with sustained reductions in exacerbations (≈85-95%), significant improvements in FEV₁ (+350-450 mL), and marked OCS withdrawal or dose reduction (90%) over up to four years. Composite clinical remission was achieved in 70-90% of patients, with a progressive transition from partial to complete remission over time. Baseline predictors of long-term response included comorbid nasal polyposis, OCS dependence, preserved baseline FEV₁, and higher blood basophil counts. Persistent eosinophil depletion was universally maintained without evidence of increased infection risk or immunologic compromise. Treatment-related adverse events were infrequent (1-2%), mostly mild bronchitis or vagal hypotension, with no signal for serious infections, malignancy, or autoimmune events. Conclusions Long-term real-world evidence indicates that benralizumab confers durable clinical benefit in SEA, achieving sustained exacerbation reduction, steroid independence, and stable or improved lung function beyond three years, with an excellent safety profile. Although persistent eosinophil depletion may mitigate airway remodeling, definitive evidence of disease modification remains unproven. Standardized remission criteria and prospective studies with structural and biomarker endpoints are warranted to validate long-term durability and elucidate potential disease-modifying effects. This abstract is funded by: None

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