Abstract

Background  Chronic rhinosinusitis with nasal polyps (CRSwNP) is a high-prevalence comorbidity in severe eosinophilic asthma (SEA) and could significantly contribute to the loss of asthma control. Since CRSwNP and SEA share a T2-mediated mechanism, the use of some anti-asthma monoclonal antibodies has recently been extended to CRSwNP. While dupilumab and omalizumab are already approved for CRSwNP, mepolizumab and benralizumab are still under investigation.

Aim To evaluate, in a real life setting, benralizumab efficacy on SEA and CRSwNP in patients affected by both pathologies.

Methods We enrolled 18 patients with SEA and CRSwNP. Spirometry, FeNO test, Asthma Control Test (ACT), fiber laryngoscopy with Nasal Polyp Score (NPS), nasal cytology, Sino-Nasal Outcome Test 22 (SNOT 22) were performed at baseline (T0) and at one year after benralizumab initiation (T1). The continuous oral corticosteroid therapy (OCS), the number of year exacerbations and the need for NP surgery were also evaluated. We compared T1 with T0. Statistical significance: p<0.05.

Results At T1 ACT underwent a sensible increase (p < 0.05) and FeNO values (p < 0.05), year exacerbation number (p < 0.05) and mean OCS dosage (p < 0.01) experienced a significative reduction. Regarding CRSwNP, in T1 patients showed a marked reduction of  SNOT-22 (p < 0.01), NPS (p < 0.05), nasal eosinophilia (p < 0.01) and neutrophilia (p < 0.05). Only 1 patient required post benralizumab NP surgery.

Conclusions Our study demonstrates the efficacy of benralizumab not only on SEA but also on clinic, volumetric and cytologic traits of NP, confirming that patients affected by both SEA and CRSwNP may benefit from benralizumab.