Factors influencing lung function changes when inhaled corticosteroid/formoterol is reduced in patients with severe eosinophilic asthma treated with benralizumab

In SHAMAL (NCT04159519), patients (pts) with severe eosinophilic asthma controlled on benralizumab were randomised to maintain or reduce from high-dose inhaled corticosteroid (ICS)/formoterol to medium or low dose or anti-inflammatory reliever (AIR) only over 32 weeks.>90% of pts reduced ICS/formoterol and maintained asthma control.

In pts who reduced (N=92), we analysed (post-hoc) baseline (BL) characteristics and maintenance treatment dose at Week (W) 32, by lung function (LF) decrease (≥ 10% reduction in forced expiratory volume in 1 second [FEV₁] from BL to W48), and correlations in FEV₁ and fractional exhaled nitric oxide (FeNO) at W48.

Significantly more pts with LF decrease (N=26) versus without (N=66), reduced to AIR only by W32 (80.8 vs 53%; p=0.018). There were no significant differences in characteristics between groups at BL ([Fig. 1]). Changes from BL in FEV₁ and fold change in FeNO at W48 were weakly correlated (r_s=–0.28; p=0.008; [Fig. 2]).

BL characteristics were not predictive of LF decrease. Monitoring FEV₁ in pts who reduce ICS/formoterol should be considered.

Fig. 1  

Fig. 2  

Publication History

Article published online:
18 March 2025