What is more effective for severe asthma, Benralizumab (Anti-Interleukin-5 Receptor Alpha Monoclonal Antibody) versus Dupilumab (Anti-Interleukin-4 Receptor Alpha Monoclonal Antibody)?

From the Guidelines

Dupilumab is more effective than benralizumab for severe asthma, particularly in patients with type 2 inflammation and comorbidities such as atopic dermatitis or chronic rhinosinusitis with nasal polyps, as it blocks both IL-4 and IL-13 pathways and shows efficacy regardless of baseline eosinophil levels. When considering the treatment options for severe asthma, several factors come into play, including the patient's specific asthma phenotype, comorbidities, and preferences. The evidence from the study 1 suggests that dupilumab has a more favorable profile compared to benralizumab in terms of quality of life, symptoms, and smell, with dupilumab showing superiority over other biologics including benralizumab. Some key points to consider when deciding between these two biologics include:

• The patient's asthma phenotype, with dupilumab being more beneficial for patients with type 2 inflammation
• Comorbidities, such as atopic dermatitis or chronic rhinosinusitis with nasal polyps, which may be more effectively managed with dupilumab
• Administration schedule preference, with benralizumab requiring less frequent dosing
• Insurance coverage, which may vary for these biologics. Both medications have been shown to significantly reduce exacerbations and improve lung function, but the choice between them should be individualized based on the patient's specific needs and circumstances, as supported by the evidence from 1.

From the Research

Comparison of Benralizumab and Dupilumab for Severe Asthma

• The effectiveness of Benralizumab (Anti-Interleukin-5 Receptor Alpha Monoclonal Antibody) and Dupilumab (Anti-Interleukin-4 Receptor Alpha Monoclonal Antibody) for severe asthma has been studied in several research papers 2, 3, 4, 5, 6.
• A study published in the Journal of asthma and allergy found that dupilumab treatment significantly reduced the number of annual exacerbations in patients with severe asthma 2.
• Another study published in Frontiers in pharmacology found that dupilumab improved pulmonary function and reduced local and systemic inflammatory markers with minimal adverse events in patients with moderate to severe asthma 3.
• A Bayesian network meta-analysis published in The Journal of allergy and clinical immunology compared the efficacy of mepolizumab, benralizumab, and dupilumab in individuals with severe eosinophilic asthma, and found that dupilumab was effective in reducing exacerbation rates and improving FEV1 4.
• A retrospective cohort study published in the Asian Pacific journal of allergy and immunology found that anti-IL-5 biologics (including benralizumab) may be more effective than dupilumab in patients with high blood eosinophil counts, while less effective than omalizumab in patients with low eosinophil counts 5.
• A target trial emulation published in The Journal of allergy and clinical immunology found that dupilumab was associated with greater improvements in exacerbation and FEV1 value than omalizumab and mepolizumab in patients with asthma and eosinophil counts of at least 150 cells/μL and IgE levels of 30 to 700 kU/L 6.

Efficacy of Benralizumab and Dupilumab

• The studies suggest that both benralizumab and dupilumab are effective in reducing exacerbation rates and improving lung function in patients with severe asthma 2, 3, 4, 5, 6.
• However, the comparative efficacy of benralizumab and dupilumab is not clearly established, and may depend on the specific patient population and biomarker profiles 4, 5, 6.

Safety and Adverse Events

• The studies found that dupilumab was generally well-tolerated, with minimal adverse events 2, 3.
• However, an increase in blood eosinophils was observed in some patients treated with dupilumab 2, 3.
• The safety profile of benralizumab was not directly compared to dupilumab in the studies, but it is known to have a similar safety profile to other anti-IL-5 biologics 4, 5.