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Long-Term Effectiveness of Benralizumab in Severe Eosinophilic Asthma: A Systematic Review and Meta-Analysis

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https://doi.org/10.54963/entu.v15i4.1674
Alqathanin, W., Aljaid, H. T., Alharthi, R. A., Alotaibi, M. S., Albugami, R. D., AbuAyfah, H. R., Alosaimi, L. W., Aljuaid, H. M., Abdullah, B., Alshammari, W., Mohammed, R., Mohammed, R., AlAsbi, G., Abdullah, Z., & Zaal, D. (2025). Long-Term Effectiveness of Benralizumab in Severe Eosinophilic Asthma: A Systematic Review and Meta-Analysis. ENT Updates, 15(4), 35–51. https://doi.org/10.54963/entu.v15i4.1674
Volume 15 Issue 4 (2025)
Copyright (c) 2025 Wajan Alqathanin, Hadeel T. Aljaid, Raghad A. Alharthi, Mastora S. Alotaibi, Renad D. Albugami, Hawra R. AbuAyfah, Layan W. Alosaimi, Hams M. Aljuaid, Bader Abdullah, Waleed Alshammari, Rashed Mohammed, Rahaf Mohammed, Ghadah AlAsbi, Zanah Abdullah, Dalia Zaal
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This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors

  • Wajan Alqathanin

    Department of Doctor of Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Hadeel T. Aljaid

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Raghad A. Alharthi

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Mastora S. Alotaibi

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Renad D. Albugami

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Hawra R. AbuAyfah

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Layan W. Alosaimi

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Hams M. Aljuaid

    Department of Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
  • Bader Abdullah

    Department of Pharmaceutical Care, Northern Area Armed Forces Hospital, King Khalid Military City Hospital, Hafer Al-Batin 39745, Saudi Arabia
  • Waleed Alshammari

    Department of Security and Safety, Rafha General Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia
  • Rashed Mohammed

    Department of Patient Experience, Rafha General Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia
  • Rahaf Mohammed

    Department of Pharmacy, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
  • Ghadah AlAsbi

    Department of Medicine, King Khalid University Medical City, Abha 62521, Saudi Arabia
  • Zanah Abdullah

    Department of Medicine, Ministry of Health, Abha 62515, Saudi Arabia
  • Dalia Zaal

    Department of Pharmacy, University of Tabuk, Tabuk 47512, Saudi Arabia

Received: 30 September 2025; Revised: 8 December 2025; Accepted: 20 December 2025; Published: 29 December 2025

Benralizumab is an interleukin-5 receptor α-directed monoclonal antibody that depletes eosinophils via antibody-dependent cell-mediated cytotoxicity. This systematic review and meta-analysis evaluated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA) using evidence from randomized controlled trials, post hoc analyses, and real-world studies. Eight studies comprising 1600 patients were included in this review. Benralizumab significantly reduced the risk of severe exacerbations by 52% (Risk Ratio [RR] = 0.48, 95% confidence interval [CI]: 0.44–0.52) and decreased the maintenance oral corticosteroid (OCS) dose by 11.6 mg/day (95% CI: −13.07 to −10.13). Lung function improved, with a mean increase of 0.22 L in pre-bronchodilator forced expiratory volume in one second (95% CI: 0.18 to 0.26). The asthma control test scores increased by 4.33 points (95% CI: 3.69 to 4.98), surpassing the minimal clinically important difference. These benefits were observed in both randomized controlled trial extensions and real-world studies and were maintained for up to five years, with a favorable safety profile. Subgroup analyses revealed greater improvements in patients with chronic rhinosinusitis with nasal polyps and those receiving maintenance OCS. Benralizumab efficacy was maintained in obese patients, although improvements in lung function were attenuated. These results support the use of benralizumab as a long-term treatment for SEA, particularly in patients with comorbidities or those requiring maintenance OCS. The integration of benralizumab into personalized management plans based on biomarkers and clinical phenotypes can optimize outcomes in SEA.

Keywords:

Benralizumab Severe Eosinophilic Asthma Oral Corticosteroids Exacerbations Type 2 Inflammation

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