Multicentre, phase 2, double-blind, double-dummy, active placebo-controlled RCT
Treatment
Benralizumab 100 mg subcutaneously once, with or without prednisolone 30 mg daily for 5 days
Control
Prednisolone 30 mg daily for 5 days with placebo injection
Population
158 adults with an acute eosinophilic exacerbation of asthma or COPD and blood eosinophils 300 cells/microlitre or above
Follow-up
90 days
Primary endpoint
Treatment failure at 90 days
Result
Treatment failure occurred in 39 of 53 (74%) with prednisolone alone versus 47 of 105 (45%) in the pooled benralizumab groups — odds ratio 0.26 (95% CI 0.13 to 0.56), p=0.0005. Symptom scores at 28 days also favoured benralizumab.
Secondary endpoints
Symptom visual analogue scores, time to next exacerbation
Benralizumab can be used as a treatment of acute eosinophilic exacerbations and achieves better outcomes than the current standard of care with prednisolone alone. These results offer a new way of treating eosinophilic endotypes of asthma and COPD exacerbations.
The trial authors, in the published abstract
How it has aged
A genuinely different idea: use the biologic to treat the attack rather than to prevent it. Phase 2, 158 patients, and mixing asthma with COPD — this needs replication before it changes practice, but if it holds it displaces a course of steroids that most patients would rather not have.
Publications
Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial
Ramakrishnan S, Russell REK, Mahmood HR, et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial. Lancet Respir Med 2025 Jan;13(1):59-68.
Treatment failure at 90 days fell from 74% to 45%
Better symptom scores at 28 days than prednisolone alone
Phase 2, and enrolled both asthma and COPD exacerbations