Beyond eosinophil depletion: long-term clinical trajectory and durability of response to benralizumab in patients with severe eosinophilic asthma and CRSwNP: an 18-month real-world study (the BANDOR study)
12 affiliations
- 1Internal Medicine, Vita-Salute San Raffaele University
- 2Pneumology Unit, Azienda Socio Sanitaria Territoriale (ASST) Rhodense
- 3Servizio di Allergologia, Casa di Cura Beato Palazzolo
- 4Internal Medicine, Ospedale Luigi Sacco, Aziende Socio Sanitarie Territoriali (ASST) Fatebenefratelli-Sacco
- 5Allergology and Clinical Immunology, Luigi Sacco Hospital, University Hospital and Academic Centre
- 6Allergology and Immunology Unit, ASST GOM Niguarda
- 7Allergy, Immunology and Rheumatology, Tor Vergata University Hospital
- 8Department of Internal Medicine, Ospedale San Pietro
- 9Center for Molecular Cardiology, University of Zurich
- 10Farmacia Marsico, Acquaviva delle Fonti
- 11Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, ASST Fatebenefratelli-Sacco
- 12Department of Internal Medicine, Ospedale Fatebenefratelli e Oftalmico
Abstract
Background: The management of patients with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps requires therapies capable of inducing stable remission. While benralizumab is an established treatment for severe asthma, randomized controlled trials in nasal polyposis have failed to reach primary clinical endpoints or showed inconsistent results. Consequently, there is a lack of evidence regarding its performance in clinical practice. The primary objective of this study was to evaluate the kinetics of response across different symptom domains and to identify predictors of clinical improvement in a Real-World setting in patients affected by severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps.
Methods: This retrospective observational study analyzed a cohort of patients with a United Airways Disease phenotype treated with benralizumab for a continuous period of 18 months. We mapped the longitudinal trajectory of specific SNOT 22 subdomains and lung function. Patients were stratified into early and late responders based on the timing of clinical improvement to identify baseline predictors of rapid versus gradual response.
Results: Analysis revealed that SNOT 22 subdomains exhibit distinct recovery patterns. Nasal and physical symptoms showed a significant improvement within the first months of therapy despite the limited success reported in previous clinical trials. In contrast, functional and emotional domains required a longer period of treatment to reach a stable plateau. Early responders were characterized by a significantly higher baseline eosinophil count (median 885 vs 530 cells per microliter) and greater bronchial obstruction at baseline compared to late responders. Functional stability in FEV1 and a reduction in oral corticosteroid use were maintained throughout the observation.
Conclusions: The BANDOR study demonstrates that benralizumab can induce durable clinical remission in a specific subset of patients who maintain treatment adherence. The speed of response is domain specific, with physical symptoms improving before emotional and functional ones. A high initial eosinophilic burden is the primary determinant of a rapid response. These findings suggest that while randomized trials showed limited efficacy, Real-World data identifies a high disease burden phenotype that derives significant long term benefit from receptor targeted eosinophil depletion.
Related
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BibTeX
@article{bizzi2026beyond,
title = {{Beyond eosinophil depletion: long-term clinical trajectory and durability of response to benralizumab in patients with severe eosinophilic asthma and CRSwNP: an 18-month real-world study (the BANDOR study)}},
author = {Emanuele Bizzi and Alessandro Maria Marra and Giuseppina Manzotti and Antonio Gidaro and Valeria Ortolani and Enrico Iemoli and Linda Borgonovo and Chiara Asperti and Stella Modica and Elisabetta Greco and Sara Rotunno and Mona-Rita Yacoub and Stefano Ministrini and Francesco Bini and Cristiano Germinario and Angela Mauro and Francesco Paciullo and Sarah Damanti and Francesca Casarin and Martina Sculco and Patrizia Rovere Querini},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1950211},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1950211/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond eosinophil depletion: long-term clinical trajectory and durability of response to benralizumab in patients with severe eosinophilic asthma and CRSwNP: an 18-month real-world study (the BANDOR study)
AU - Emanuele Bizzi
AU - Alessandro Maria Marra
AU - Giuseppina Manzotti
AU - Antonio Gidaro
AU - Valeria Ortolani
AU - Enrico Iemoli
AU - Linda Borgonovo
AU - Chiara Asperti
AU - Stella Modica
AU - Elisabetta Greco
AU - Sara Rotunno
AU - Mona-Rita Yacoub
AU - Stefano Ministrini
AU - Francesco Bini
AU - Cristiano Germinario
AU - Angela Mauro
AU - Francesco Paciullo
AU - Sarah Damanti
AU - Francesca Casarin
AU - Martina Sculco
AU - Patrizia Rovere Querini
PY - 2026
DA - 2026/10/19
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1950211
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1950211/full
AB - Background: The management of patients with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps requires therapies capable of inducing stable remission. While benralizumab is an established treatment for severe asthma, randomized controlled trials in nasal polyposis have failed to reach primary clinical endpoints or showed inconsistent results. Consequently, there is a lack of evidence regarding its performance in clinical practice. The primary objective of this study was to evaluate the kinetics of response across different symptom domains and to identify predictors of clinical improvement in a Real-World setting in patients affected by severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps. Methods: This retrospective observational study analyzed a cohort of patients with a United Airways Disease phenotype treated with benralizumab for a continuous period of 18 months. We mapped the longitudinal trajectory of specific SNOT 22 subdomains and lung function. Patients were stratified into early and late responders based on the timing of clinical improvement to identify baseline predictors of rapid versus gradual response. Results: Analysis revealed that SNOT 22 subdomains exhibit distinct recovery patterns. Nasal and physical symptoms showed a significant improvement within the first months of therapy despite the limited success reported in previous clinical trials. In contrast, functional and emotional domains required a longer period of treatment to reach a stable plateau. Early responders were characterized by a significantly higher baseline eosinophil count (median 885 vs 530 cells per microliter) and greater bronchial obstruction at baseline compared to late responders. Functional stability in FEV1 and a reduction in oral corticosteroid use were maintained throughout the observation. Conclusions: The BANDOR study demonstrates that benralizumab can induce durable clinical remission in a specific subset of patients who maintain treatment adherence. The speed of response is domain specific, with physical symptoms improving before emotional and functional ones. A high initial eosinophilic burden is the primary determinant of a rapid response. These findings suggest that while randomized trials showed limited efficacy, Real-World data identifies a high disease burden phenotype that derives significant long term benefit from receptor targeted eosinophil depletion.
SN - 1664-3224
ER -