Effectiveness of Benralizumab in Reducing Asthma and COPD Exacerbations in Patients with Severe Asthma and Concomitant COPD: Real-World Evidence from the ZEPHYR-5 Study

Purpose: This real-world evidence study sought to evaluate the effectiveness of benralizumab on reducing both asthma and COPD exacerbations among patients with a diagnosis of asthma and concomitant COPD. Patients and Methods: This study was a non-interventional, single-arm, retrospective database analysis of the MORE 2 Registry ® and the 100% Medicare Fee-for-Service (FFS) claims databases from 2017– 2022. Inclusion criteria were as follows: 1) prescription claim for benralizumab and ≥ 1 refill within 90 days (earliest claim=index date), 2) 12 months of database enrollment preceding (baseline) and following (follow-up) the index date, 3) medical claims with diagnoses of asthma and COPD during the baseline period, and 4) presence of ≥ 2 asthma exacerbations during the baseline period. Percent change in the annual rates of both asthma and COPD exacerbations were assessed from the baseline to follow-up, with paired t-tests used to examine statistically significant differences. Subgroup analyses were also conducted among the subset of patients with blood eosinophil levels, and by payer type. Results: A total of 2894 patients with asthma and concomitant COPD were included. Following initiation of benralizumab, the mean (SD) number of total asthma exacerbations decreased by 39.2% (from 4.0 (2.2) to 2.4 (2.4) exacerbations/year; p < 0.001), while COPD exacerbations decreased by 45.6% (from 3.6 (2.5) to 1.9 (2.2) exacerbations/year; p < 0.001). The proportion of patients receiving systemic corticosteroids decreased by 11.4% from 100% to 88.6% ( p < 0.001). Subgroup analyses revealed that patients with the highest eosinophil levels (≥ 300 eosinophils/μL) experienced the greatest reductions in asthma exacerbations (42.7%) and COPD exacerbations (50.8%; all p < 0.001). Conclusion: This study provides real-world evidence supporting the effectiveness of benralizumab in reducing both asthma and COPD exacerbations and decreasing reliance on corticosteroids, particularly among those with elevated eosinophil levels. Keywords: benralizumab, COPD, asthma, exacerbations, biologics, blood eosinophils