A single injection of the biologic drug benralizumab appears to significantly outperform standard corticosteroid therapy in treating acute eosinophilic exacerbations of asthma and COPD. That’s according to the findings of the British study, “Treating Eosinophilic Exacerbations of Asthma and COPD With Benralizumab (ABRA): A Double-Blind, Double-Dummy, Active Placebo-Controlled Randomized Trial.” The study was published in The Lancet Respiratory Medicine.
The findings suggest a potential shift in frontline care for a patient population at high risk of relapse, hospitalization and long‑term harm from steroid use, the authors noted. The multicenter, double‑blind, randomized ABRA trial was conducted at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust. Researchers evaluated 158 adults experiencing an acute eosinophilic exacerbation — defined as blood eosinophils equal or greater to 300 cells/µL — between May 2021 and February 2024.
Participants were assigned to one of three treatment arms: prednisolone alone, benralizumab alone or a combination of the two drugs. The two groups receiving some form of benralizumab were pooled for primary analysis due to the drug’s prolonged mechanism of action.
The results were striking:
- Treatment failures at 90 days occurred in 74% of those receiving prednisolone alone, compared with 45% in the pooled benralizumab group.
- Patients receiving benralizumab also reported significantly better symptom scores at 28 days.
Researchers noted that the outcomes reflect improvements in both clinical stability and patient‑reported well-being — two priorities identified by the trial’s patient advocacy partners.
Eosinophilic inflammation is a distinct biological subtype of asthma and COPD flare‑ups. Patients in this group face high relapse rates and are often treated with repeated courses of systemic corticosteroids, which carry serious long‑term risks including hyperglycemia, infection and increased mortality. The study suggests benralizumab — which rapidly depletes eosinophils — may offer a safer and more effective alternative.
Additionally, researchers called attention to the limitations of existing standard-of-care strategies, based on the unexpectedly high failure rate in the prednisolone alone group. They underscored the idea that biologic therapy targeted to a patient’s inflammatory endotype represents a major step forward in precision medicine for respiratory disease.
Benralizumab was well tolerated across the cohort, with no reported fatal adverse events. Side effects linked to prednisolone, such as hyperglycemia and sinus infections, were not seen in patients who received benralizumab alone.
Most trial participants were treated in urgent care clinics rather than hospital settings, reinforcing the feasibility of biologic intervention early during an exacerbation. Only one in eight patients was enrolled directly from an emergency department. Researchers emphasized the urgent need to improve outcomes not only for hospitalized patients but also for those deteriorating at home — groups with significant mortality risk.
The study’s authors noted the cumulative harms of steroid therapy in asthma and COPD and said the findings support a future where systemic glucocorticoids are used far less frequently.
Although the study’s results are promising, the authors acknowledge that the study was not powered to separately evaluate asthma versus COPD outcomes and that hospital‑level efficacy requires further study. They also called for further research into other biologics with similarly rapid mechanisms of action.
