Effectiveness of benralizumab in severe eosinophilic asthma: Distinct sub-phenotypes of response identified by cluster analysis

Nicola Scichilone, Alida Benfante, Claudia Crimi, Raffaele Campisi, Giuseppe Valenti, Giulia Scioscia, Nunziata Ribecco, Angela Maria D’Uggento, Corrado Pelaia, Maria Filomena Caiaffa, Maria D'Amato, Simona Pellegrino, Domenico Ciotta, Giovanna Elisiana Carpagnano, Danilo Di Bona, Luigi Macchia, Alessandro Vatrella, Maria Filomena Caiaffa, Girolamo Pelaia, Giuseppe SpadaroNunzio Crimi, Cecilia Calabrese

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: Benralizumab is effective in severe eosinophilic asthma (SEA), but suboptimal responses are observed in some patients. Although several factors have been associated with benralizumab response, no cluster analysis has yet been undertaken to identify different responsiveness sub-phenotypes. Objective: To identify SEA sub-phenotypes with differential responsiveness to benralizumab. Methods: One hundred and five patients diagnosed with SEA who had completed 6 months of benralizumab treatment were included in a hierarchical cluster analysis based on a set of clinical variables that can be easily collected in routine practice (age, age at disease onset, disease length, allergen sensitization status, blood eosinophil count, IgE levels, FEV1% predicted, nasal polyposis, bronchiectasis). Results: Four clusters were identified: Clusters 2 and 3 included patients with high levels of both IgE and eosinophils (type-2 biomarkers high), whereas Clusters 1 and 4 included patients with only one type-2 biomarker at a high level: IgE in Cluster 1 and eosinophils in Cluster 4. Clusters 2 and 3 (both type-2 biomarkers high) showed the highest response rate to benralizumab in terms of elimination of exacerbations (79% and 80% respectively) compared to Clusters 1 and 4 (52% and 60% respectively). When super-response (the absence of exacerbation without oral corticosteroid use) was assessed, Cluster 2, including patients with more preserved lung function than the other clusters, but comparable exacerbation rate, oral corticosteroid use and symptom severity, was the most responsive cluster (87.5% of patients). Conclusions: Our cluster analysis identified benralizumab differential response sub-phenotypes in SEA, with the potential of improving disease treatment and precision management.
Original languageEnglish
Pages (from-to)312-323
Number of pages12
JournalClinical and Experimental Allergy
Publication statusPublished - 2022

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology


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