BENRALIZUMAB INJ,SOLN
Clinical Criteria Summary
Exclusion Criteria
- Acute exacerbation of asthma or status asthmaticus
- Concurrent use with other biologics for asthma
- Currently undergoing bronchial thermoplasty
- Untreated parasitic (helminth) infection (treat before starting benralizumab)
- Inclusion Criteria (All must be met)
- Provider is a VA or VA Community Care asthma specialist (pulmonologist, allergist, immunologist) or designated expert
- Diagnosis of asthma with an eosinophilic phenotype
- Blood eosinophil count > 150 cells/microliter obtained prior to treatment (does not apply if switching from another interleukin modifying drug for asthma)
- Receiving high-dose inhaled corticosteroid (or maximally tolerated dose) AND at least 3 months of a long-acting beta agonist and/or other controller medication such as tiotropium if appropriate, with or without an oral corticosteroid
- Adherent to asthma medications as evidenced by a review of prescription refill history
- Patient has demonstrated correct inhaler technique (documented in chart)
- Additional Inclusion Criteria (At least one must be met)
- Two or more asthma exacerbations requiring systemic corticosteroids OR one or more hospitalizations in the prior year
- Requires maintenance with oral corticosteroids
- Inadequate symptom control (e.g., short-acting beta-agonist use > 2 days/week, nighttime awakening due to asthma > once/week, limitation of normal activity, Asthma Control Test <19)
Other Justification
- Patient with non-severe active eosinophilic granulomatosis with polyangiitis (EGPA) to induce remission, prevent relapse and to minimize exposure to glucocorticoids and prescribed by a specialty provider experienced in managing EGPA