Efficacy and safety of benralizumab in patients with eosinophilic asthma： a meta-analysis of randomized placebo-controlled trials

Benralizumab is a monoclonal antibody that targets interleukin-5 receptor α to deplete blood eosinophils and improve the clinical outcomes of allergic asthma. We conducted a meta-analysis to evaluate the safety and efficacy of different doses of benralizumab in patients with eosinophilic asthma. All randomized controlled trials involving benralizumab treatment for patients with eosinophilic asthma, which were searched in PubMed, Embase, and the Cochrane Library published until January 2017, as well as the rate of asthmatic exacerbation, pulmonary functionality, asthma control, quality of life scores, and adverse events were included. Randomized-effect models were used in the meta-analysis to calculate the pooled mean difference, relative risks, and 95% confidence intervals. Five studies involving 1951 patients were identified. Compared with the placebo, benralizumab treatment demonstrated significant improvements in the forced expiratory volume in 1 s （FEV1）, Asthma Quality of Life Questionnaire scores, decreased asthmatic exacerbation and Asthma Control Questionnaire-6 （ACQ-6） scores. Benralizumab treatment was also not associated with increased adverse events. These findings indicated that benralizumab can be safely used to improve FEV1, enhance patient symptom control and quality of life, and reduce the risk of exacerbations and ACQ-6 scores in patients with eosinophilic asthma. Furthermore, our meta-analysis showed that benralizumab with 30 mg （every eight weeks） dosage can improve the health-related quality of life and appear to be more effective than 30 mg （every four weeks） dosage. Overall, data indicated that the optimal dosing regimen for benralizumab was possibly 30 mg （every eight weeks）.

Histological remission of eosinophilic esophagitis under asthma therapy with IL-5 receptor monoclonal antibody:A case report

BACKGROUND Benralizumab is a monoclonal antibody targeting the IL-5 receptor used in the treatment of asthma.The use of benralizumab in other conditions is only emerging and could represent a therapeutic option for other eosinophil-associated diseases.Here,we report the case of a patient suffering from eosinophilic esophagitis and asthma who achieved histological remission of eosinophilic esophagitis(EoE)under benralizumab treatment for his asthma.CASE SUMMARY Our patient was a 56-year-old white male with a history of eosinophilic esophagitis and severe asthma.After years of usual treatments,including topical steroids,biological treatment with mepolizumab,and standard asthma treatment,only poor control of both conditions was obtained.A control gastroscopy after the initiation of benralizumab showed complete histological remission of his EoE.CONCLUSION Our case shows the effects of therapy with a novel agent not yet approved for this condition but for other diseases,with histological resolution of EoE after treatment.Complete clinical remission was not observed,which exemplifies the complex nature of EoE,its associated psychosomatic burden,and the chronification of the disease.Nevertheless,monoclonal antibodies targeting the Th2 response and,in our case,an IL5 receptor antagonist,achieved complete histological remission,which was not the case with an antibody against IL-5,which was also initiated to treat asthma.

Specific regulator of eosinophil apoptosis： Siglec-8 new hope for bronchial asthma treatment

Objective It is known that Siglec-8 is selectively expressed on human eosinophils at a high level and mediates eosinophil apoptosis when crosslinked with its antibody. The aim of our review is to elucidate the molecular and biological characteristic of Siglec-8 and then discuss the function and possible mechanisms of Siglec-8 in eosinophils. Thereby, we will expand our understanding to the regulation of eosinophil apoptosis, and provide important clues to the treatment of asthma and other hyper-eosinophilic diseases. Data sources Most articles were identified by searching of PubMed online resources using the key term Siglecs. Study selection Mainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected. Results Siglec-8 is selectively expressed on human eosinophil and can specifically induce eosinophil apoptosis. Conclusion The restricted expression of Siglec-8 on human eosinophil and the rapid progress in understanding its role as cell signaling and activation of death receptors have made it an attractive target for treatment of asthma and other hyper-eosinophilic diseases.

Role of Combining Spreading Moxibustion and Point Injection in Reducing ECP and LPO Levels and Improving Lung Function

Objective: To observe the effect of combining spreading moxibustion and point injection on serum eosinophil cationic protein(ECP), lipid peroxidase(LPO) and cellular immunity in patients with cough-variant asthma. Methods: A total of 150 cases who met the inclusion criteria were randomized into three groups, 50 in each group. Spreading moxibustion and point injection were employed in the observation group, spreading moxibustion alone in the spreading moxibustion group and point injection alone in the point injection group. Then the therapeutic efficacies were evaluated after one course of treatment. Results: The recovery rate and total effective rate were 50.0% and 98.0% respectively in the observation group, versus 18.0% and 86.0% in the spreading moxibustion group and 14.0% and 82.0% in the point injection group, showing a statistically significant difference(P < 0.01). Before treatment, there were no inter-group statistically significant differences in levels of ECP, LPO, CD3+,CD4+, CD4+/CD8+ and CD8+, forced vital capacity(FCV), forced expiratory volume 1(FEV1), and peak expiratory flow(PEF)(P>0.05). After treatment, the ECP and LPO levels in the observation group were more significantly reduced than those in the other two groups, showing statistically significant difference(P<0.01); the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly elevated but CD8+ was significantly reduced, showing statistically significant differences compared with those in the other two groups(P<0.01); and the lung function indexes(FVC, FEV1 and PEF) in the observation group were more significantly elevated than those in the other two groups(P<0.05). Conclusion: Combining spreading moxibustion and point injection could remarkably reduce the contents of ECP and LPO in patients with cough-variant asthma, improve cellular immunity, increase the contents of CD3+, CD4+ and CD4+/CD8+, reduce the content of CD8+ and improve the lung function.