From the Guidelines
Benralizumab is not recommended for COPD exacerbations as a first-line treatment, but it may be considered in specific cases of eosinophilic COPD with frequent exacerbations despite optimal standard therapy. The most recent and highest quality study, a clinical practice guideline from the American Academy of Family Physicians 1, does not mention benralizumab as a treatment option for COPD exacerbations. Instead, it recommends standard treatments such as inhaled corticosteroids, long-acting bronchodilators, antibiotics when appropriate, and systemic corticosteroids during acute exacerbations.
Some key points to consider when managing COPD exacerbations include:
- The goal of treatment is to minimize the negative impact of the current exacerbation and prevent subsequent events 1
- Short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation 1
- Systemic corticosteroids improve lung function and oxygenation, and shorten recovery time and hospitalization duration 1
- Antibiotics, when indicated, shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1
In specific cases of eosinophilic COPD, benralizumab may be considered as an off-label use, typically reserved for patients with eosinophilic COPD who continue to have frequent exacerbations despite optimal standard therapy. The typical dosing for benralizumab in its approved indication (severe eosinophilic asthma) is 30 mg subcutaneously every 4 weeks for the first three doses, then every 8 weeks thereafter. However, it is essential to note that the evidence for benralizumab in COPD is limited, and its use should be carefully considered on a case-by-case basis.
The European Respiratory Society/American Thoracic Society guideline 1 also provides recommendations for the management of COPD exacerbations, including the use of oral corticosteroids, antibiotics, and noninvasive mechanical ventilation. However, it does not mention benralizumab as a treatment option.
In summary, while benralizumab may be considered in specific cases of eosinophilic COPD, it is not a recommended treatment for COPD exacerbations as a first-line treatment, and its use should be carefully considered on a case-by-case basis, taking into account the patient's individual needs and medical history.
From the Research
Benralizumab for COPD Exacerbation
- Benralizumab can be used as a treatment for acute eosinophilic exacerbations of COPD, achieving better outcomes than the current standard of care with prednisolone alone 2.
- A post hoc analysis of the GALATHEA and TERRANOVA trials identified a potential responder population in which treatment with benralizumab prevents recurrent COPD exacerbations during 30- and 90-day periods following an initial exacerbation 3.
- However, the GALATHEA and TERRANOVA trials found that add-on benralizumab was not associated with a lower annualized rate of COPD exacerbations than placebo among patients with moderate to very severe COPD 4.
- The effectiveness of benralizumab in treating COPD exacerbations may depend on the presence of eosinophilic inflammation, with patients having high blood eosinophil counts and frequent previous exacerbations being more likely to respond to treatment 2, 3.
- Further research is needed to fully understand the benefits and limitations of benralizumab for COPD exacerbations, including its efficacy and safety in different patient populations and its potential as a targeted therapy for high-risk populations 3, 5.