Work

Functional respiratory imaging reveals early structural and functional airway responses to benralizumab in severe eosinophilic asthma

Year: 2026

Type: article

Abstract: BACKGROUND: Benralizumab improves outcomes in severe eosinophilic asthma (SEA). We aimed to evaluate early effects of benralizumab on airway pathophysiology using functional respiratory imaging (FRI). METHODS: In this prospective, single-arm study, 20 adults with SEA underwent CT at baseline, 4 and 12 weeks. Coprimary endpoints were changes in specific airway volume (siVaw) and resistance (siRaw) at functional residual capacity (FRC) and total lung capacity (TLC) at 12 weeks. Imaging outcomes included mucus score/volume and air-trapping. RESULTS: At week 12, siVaw increased at FRC by 0.16 mL/L (27%; 95% CI 0.01% to 0.31%; p = 0.02) and at TLC by 0.14 mL/L (14%; 95% CI 0.03% to 0.25%; p = 0.02); siRaw at TLC decreased by -0.41 kPa·s/L (-24%; 95% CI -0.80% to -0.01%; p = 0.04). siRaw at FRC increased (2.99 kPa·s/L; 95% CI -4.57 to 10.54; p=0.42), with a significant relative change (293%; p=0.03) that lost significance after excluding outliers. siVaw at FRC increased early (week 4: 0.19 mL/L; 33%; 95% CI 0.03% to 0.34%; p = 0.01). At week 12, the mucus score decreased by 0.41 (95% CI -0.67 to -0.14; p<0.01), and air-trapping by 5.5% (95% CI -8.8 to -2.1; p < 0.01). Changes in siVaw and mucus correlated with improvements in forced expiratory volume in 1 s (r = 0.66 and -0.77; both p<0.01) and Saint George's Respiratory Questionnaire (mucus: r = 0.45; p = 0.05). CONCLUSIONS: Benralizumab treatment in SEA was associated with early improvements in airway volume, resistance, mucus and air-trapping, correlating with better lung function and quality of life. These findings support FRI to monitor early treatment effects. TRIAL REGISTRATION NUMBER: NL-OMON26915.

Source: BMJ Open Respiratory Research

DOI: 10.1136/bmjresp-2025-003845

Authors: Lennart Conemans, Qichen Deng, Sami O Simons, Frits M E Franssen, Martijn A Spruit, Bita Hajian

Institutions: Maastricht University Medical Centre, Maastricht University, Ciro

Language: English

Topic: Asthma and respiratory diseases

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,085