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Predicting Clinical Response to Benralizumab Using CT Imaging: Prognostic BenraliScan Study
Arnaud Bourdin1, Marie Felicia Beclin2, Pascal Chanez3
1Department of Respiratory Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; PhyMedExp, Institut National de la Santé et de la Recherche Médicale, CNRS, Montpellier, France; Department of Thoracic Imaging, Department of Radiology, Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
Computed tomography (CT)-derived metrics, specifically PRMSAD and sinus score, show promise in predicting benralizumab response in severe eosinophilic asthma (SEA) patients. These CT measures may aid in personalized treatment strategies for asthma management.
Area of Science:
- Pulmonology and Respiratory Medicine
- Medical Imaging
- Pharmacology
Background:
- Benralizumab is effective for eosinophilic asthma but response varies.
- Baseline computed tomography (CT)-derived metrics were investigated for predicting treatment outcomes.
- Severe eosinophilic asthma (SEA) is characterized by high eosinophil counts (>300/mm³).
Purpose of the Study:
- To determine if baseline CT-derived measures can predict clinical response to benralizumab in SEA patients.
- To assess the prognostic value of CT metrics for exacerbation reduction, lung function, and symptom control at 52 weeks.
- To compare the predictive power of CT metrics against blood eosinophil levels.
Main Methods:
- A prospective, open-label, two-center study involving 59 SEA patients initiating benralizumab.
- Baseline CT scans were analyzed for metrics including PRMSAD, UCSF-mucus plugging, and Lund-Mackay sinus score.
- Primary outcome: ≥50% reduction in exacerbation rates; Secondary outcome: composite clinical score (≥2 of exacerbation reduction, FEV1 increase, ACQ-5 improvement).
Main Results:
- 47 patients completed the study; 42/47 (89%) achieved ≥50% exacerbation reduction.
- 35/47 (74%) patients met the composite secondary outcome.
- PRMSAD (AUC=0.693) and sinus score (AUC=0.714) were significant predictors of response, outperforming blood eosinophil count (AUC=0.630).
Conclusions:
- CT-derived metrics (PRMSAD, sinus score) are associated with benralizumab response in SEA patients.
- These CT measures may serve as valuable biomarkers for predicting treatment success.
- CT phenotyping could enhance precision management of SEA, warranting further validation.
