This finding is largely greater than the average FEV1 improvements recorded during pre-marketing randomized controlled trials.15 Therefore, our observation further confirms that the therapeutic Rabbit polyclonal to LYPD1 responses to anti-asthma biological drugs are strictly individual, being absolutely dependent on the specific endotype of each patient. first dose, and subsequently striking changes were recorded after the second and third doses, including remarkable increases in asthma control test scores and forced expiratory volume in 1?s values, associated with a complete depletion of blood eosinophils and the interruption of oral corticosteroid intake, as well as with the concomitant MK-2048 disappearance of nasal polyps after the second dose. In conclusion, this case study suggests that benralizumab can exert a very rapid and effective therapeutic action in patients with severe eosinophilic asthma and nasal polyposis. Keywords: Severe eosinophilic asthma, interleukin-5 receptor, nasal polyps, benralizumab Introduction According to a recent document jointly elaborated by the European Respiratory Society (ERS) and the American Thoracic Society (ATS), asthma is considered to be severe when its control requires high dosages of ICS/LABA (inhaled corticosteroids/long-acting 2-adrenergic agonists) combinations, eventually integrated by the addition of other drugs (i.e. leukotriene modifiers, tiotropium, theophylline, oral corticosteroids (OCS)), or when the disease remains uncontrolled despite such intense treatments.1 In the latter case, international guidelines recommend an add-on biological therapy consisting of one monoclonal antibody, to be chosen among currently available anti-IgE, anti-interleukin (IL)-5, anti-IL-5 receptor, or anti-IL-4 receptor agents.2 In particular, benralizumab is an eosinophil-depleting humanized IgG1k antibody, whose Fab fragments bind to the subunit of the IL-5 receptor (IL-5R) expressed by eosinophils, basophils, and group 2 innate lymphoid cells (ILC2), thus impeding its interaction with IL-5.3C6 Moreover, through its Fc constant region, benralizumab binds to the FcRIIIa receptor expressed by natural killer (NK) cells, thereby inducing them to release high amounts of pro-apoptotic proteins such as granzyme B and perforin, which implement eosinophil apoptosis triggered by the so-called antibody-dependent cell-mediated cytotoxicity (ADCC).3C5 The pre-marketing randomized clinical trials SIROCCO and CALIMA have previously shown that benralizumab effectively prevents exacerbations of refractory eosinophilic asthma and also improves symptom control and lung function.7,8 Furthermore, the ZONDA study demonstrated that benralizumab can significantly decrease OCS consumption.9 It is also noteworthy that the therapeutic effects of benralizumab appear to be independent of both atopic status and serum IgE levels;10 therefore, benralizumab can be equally effective in the treatment of allergic as well as non-allergic eosinophilic asthma. Less known are the effects of benralizumab on nasal polyps. On the basis of the above-mentioned considerations, we decided to treat with benralizumab a woman with severe allergic eosinophilic asthma and nasal polyps, not eligible to add-on therapy with omalizumab because of her too high serum levels of IgE. In this patient, we evaluated the impact of the first three doses of benralizumab on symptom control, lung function, blood eosinophils, OCS intake, and nasal polyps. Approval by Ethical Committee is not required for this case report. The patient provided written informed consent for the publication of information referring to her disease, reported in this article. Case report During MK-2048 last November, a non-smoker 46-year-old woman referred as outpatient to our Respiratory Unit at Magna Graecia University Hospital located in Catanzaro, Italy. She MK-2048 complained of persistent dyspnoea, wheezing, and cough. These symptoms dated from adolescence and often exacerbated as recurrent asthma attacks. Asthma control test (ACT) score was 11. The patient also suffered from nasal obstruction and hyposmia; indeed, she had undergone two surgical procedures of nasal MK-2048 polypectomy in February 2011 and May 2018, respectively. On chest examination, widespread expiratory wheezes were clearly heard. On 19 November 2018, lung function tests documented a partially reversible severe obstructive ventilatory defect, involving both large and small airways, which was characterized by a deep concavity of the flowCvolume curve (Figure 1). Forced expiratory volume in 1?s (FEV1) was 0.91?L (35% of predicted value), FEV1/FVC (forced vital capacity) ratio was 52.64%, peak expiratory flow (PEF) was 3.33?L/s (52.7% pred.), and the average expiratory flow over the middle half of MK-2048 the FVC manoeuvre (MMEF 75/25) was 0.27?L/s (8.1% pred.). Open in a separate window Figure 1. Baseline flowCvolume curve, characterized by a marked expiratory airflow limitation. Skin prick tests were positive for house dust mite. Serum IgE levels were 2760?IU/mL. Rhinoscopy showed the presence of nasal polyps prolapsing into nasal cavities (Figure 2, left panel). Open in a separate window Figure 2. Rhinoscopic evidence of nasal polyps (left panel), which disappeared after 8?weeks of add-on treatment with benralizumab (right panel). The treatment regimen of our patient included regular therapy with a pressurized metered dose inhaler containing 200/6?g beclomethasone dipropionate/formoterol fumarate dehydrate (two puffs twice daily), 2.5?g tiotropium respimat inhaler (two puffs daily), montelukast 10?mg tablets (one tablet daily), prednisone 25?mg tablets (half tablet daily),.