Administration of benralizumab in a patient with severe asthma admitted to the intensive care unit with COVID-19 pneumonia: case report

Abstract

A patient with severe asthma on benralizumab therapy was admitted to the intensive care unit (ICU) for a coronavirus disease 2019 (COVID-19) infection. At the end of the 8 week benralizumab dosing interval, discussion arose as to whether benralizumab should be administered or if treatment should be discontinued, due to the lack of experience with benralizumab in this situation. Severe broncho-obstruction developed, and the next injection of benralizumab was administered during ICU admission without detrimental symptoms. With this case report, we would like to share our experience with the safe administration of benralizumab during COVID-19 pneumonia, guiding doctors in future decision making.

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

“…The therapy with benralizumab resulted to be well tolerated by this patient who was on mechanical ventilation, but it does not seem to have significantly and/or positively impacted on the COVID-19 clinical course. 28 To conclude, some additional and interesting experiences with benralizumab in the clinical context of drug rash with eosinophilia and systemic symptoms (DRESS) deserve to be mentioned. Schmid-Grendelmeier et al (online publication: October 2020) reported the use of benralizumab in 2 non-asthmatic patients (a 54-year-old woman and a 58-year-old man) who developed DRESS during severe COVID-19, which required the admission to the ICU for acute respiratory distress syndrome.…”

“…The therapy with benralizumab resulted to be well tolerated by this patient who was on mechanical ventilation, but it does not seem to have significantly and/or positively impacted on the COVID-19 clinical course. 28 …”

Coronavirus disease 2019 and severe asthma

“…In addition, Akenroye et al [57] suggested a protective role against asthma exacerbation elicited by SARS-CoV-2 due to antiviral properties and reduction of airways inflammation [64]. The safety of biological administration during COVID-19 is documented in a case report showing that benralizumab injected to an asthmatic patient in mechanical invasion in ICU, led to clinical improvement [65]. In conclusion, biological drugs in COVID-19 patients have a safe profile and their use is recommended by major scientific societies.…”