# Analysis of Selected Serum Cytokines to Evaluate the Early Efficacy of Benralizumab, Dupilumab, and Mepolizumab in Severe Eosinophilic Asthma Treatment

## TL;DR

This study examines how three asthma drugs affect cytokine levels in patients with severe eosinophilic asthma to assess their early treatment efficacy.

## Contribution

The study provides new insights into the distinct immunomodulatory effects of benralizumab, dupilumab, and mepolizumab on serum cytokines in severe asthma.

## Key findings

- Dupilumab significantly reduced CD40L, IL-6, and FeNO levels compared to other drugs.
- Mepolizumab showed the greatest decrease in TNF-α concentration.
- Cytokine changes suggest heterogeneous mechanisms of biologics in asthma treatment.

## Abstract

Background: Severe asthma is a chronic, difficult-to-treat disorder that significantly affects quality of life, and oral glucocorticosteroids are usually required. Many patients suffering from severe asthma exhibit T2 inflammation and may benefit from biological treatment. This study aims to evaluate changes in cytokine concentrations during therapy with benralizumab, dupilumab, and mepolizumab in severe eosinophilic asthma. Materials and Methods: In this prospective, single-center study, 39 patients with severe eosinophilic asthma received treatment with one of the above-mentioned biologics. Parameters, such as the cytokine profile (Human Th9/Th17/Th22 Luminex, Performance Assay 18-plex Fixed Panel, R&D Systems, Minneapolis, MN, USA) and additionally the Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), spirometry (FEV1, FEV/FVC), FeNO, and functional status, were assessed at baseline and after 3–4 months of therapy. Results: The biologic therapies demonstrated diverse effects on inflammatory biomarkers. Dupilumab showed the most pronounced decreases in CD40L, IL-6, and FeNO in comparison to other drugs. In turn, the greatest decrease in TNF-α concentration was observed in the group treated with mepolizumab. Conclusion: Changes in cytokine concentrations highlight the heterogenous immunomodulatory mechanisms of biologics and support personalized strategies based on inflammatory profiles. However, the results should be interpreted with prudence, as the concentrations of cytokines in blood serum fluctuate and the study sample size is small.