CT Metrics Predict Benralizumab Response in Severe Asthma

Managing severe eosinophilic asthma remains a clinical challenge, as a significant subset of patients continues to experience frequent exacerbations despite high-dose conventional therapy. Benralizumab, a monoclonal antibody targeting the interleukin-5 receptor alpha subunit, has demonstrated efficacy in the MIRACLE trial by reducing annualized exacerbation rates by 74% (rate ratio 0.26; 95% CI 0.19 to 0.36; p < 0.0001) in patients with baseline blood eosinophil counts of at least 300 cells per microliter [1, 2, 3]. However, achieving clinical remission (a composite endpoint requiring the absence of exacerbations, no maintenance oral corticosteroid use, and stable lung function) remains possible for only a minority of patients [4]. While blood eosinophil counts are the standard biomarker for initiating biologics, they do not always correlate with improvements in airflow obstruction or patient-reported outcomes [5, 6]. Recent advances in quantitative computed tomography (a digital imaging technique that uses specialized software to measure airway wall thickness and air trapping) suggest that specific remodeling patterns may offer deeper insights into disease phenotyping [7]. A new study evaluates whether these imaging metrics can provide a more precise prognostic roadmap for clinicians prescribing benralizumab, potentially allowing physicians to identify which patients are most likely to achieve comprehensive symptom control.