What is the role of Benralizumab (anti-interleukin-5 receptor alpha subunit monoclonal antibody) in Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Benralizumab is not currently FDA-approved for COPD, but it may be beneficial for specific COPD patient subgroups with elevated blood eosinophil counts (typically ≥300 cells/μL), as it has shown promise in reducing exacerbation rates and improving lung function in these patients. Benralizumab (Fasenra) is a monoclonal antibody that targets the IL-5 receptor, reducing eosinophil counts in the blood and tissues. While primarily approved for severe eosinophilic asthma, recent clinical trials suggest it may benefit COPD patients with elevated blood eosinophil counts. The typical dosing regimen, if used off-label, would be 30 mg administered subcutaneously every 4 weeks for the first three doses, then every 8 weeks thereafter. Patients should be monitored for potential side effects including headache, pharyngitis, and hypersensitivity reactions. Before considering benralizumab for COPD, patients should have optimized standard COPD therapies including bronchodilators, inhaled corticosteroids if appropriate, smoking cessation, and pulmonary rehabilitation, as recommended by guidelines such as those from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society 1. The medication works by depleting eosinophils, which contribute to airway inflammation in some COPD phenotypes, potentially reducing exacerbations and improving symptoms in this specific subset of patients.

Key points to consider when evaluating the use of benralizumab in COPD include:

• The presence of elevated blood eosinophil counts, which may indicate a potential benefit from benralizumab therapy
• The optimization of standard COPD therapies before considering benralizumab
• The potential side effects of benralizumab, including headache, pharyngitis, and hypersensitivity reactions
• The need for careful patient selection and monitoring when using benralizumab off-label for COPD, as recommended by guidelines such as those from the American Thoracic Society and European Respiratory Society 1.

It is essential to weigh the potential benefits of benralizumab against the potential risks and consider the latest evidence, such as the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1, when making treatment decisions for COPD patients.