The following is a summary of “Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis,” published in the February 2024 issue of Rheumatology by Wechsler et al.

Researchers started a retrospective study to investigate if Benralizumab, a monoclonal antibody targeting the interleukin-5α receptor on eosinophils, could be a viable treatment option for Eosinophilic granulomatosis with polyangiitis (EGPA).

They conducted a double-blind phase 3 trial comparing benralizumab with mepolizumab for EGPA. Adults with relapsing or refractory EGPA were randomized 1:1 to receive benralizumab (30 mg) or mepolizumab (300 mg) every 4 weeks for 52 weeks. The primary goal was remission at weeks 36 and 48, with a -25 percentage point noninferiority margin. Other goals included remission duration, time to relapse, glucocorticoid use, eosinophil count, and safety.

The results showed 140 patients, 70 in each group). The adjusted percentage of patients achieving remissiat weeks 36 and 48 was 59% for benralizumab and 56% for mepolizumab (difference, 3 percentage points; 95% CI, –13 to 18; P=0.73 for superiority), indicating noninferiority but not the superiority of benralizumab over mepolizumab. The duration of remission and time to first relapse were comparable between the groups. Complete withdrawal of oral glucocorticoids during weeks 48 through 52 was observed in 41% of benralizumab recipients and 26% of mepolizumab recipients. Mean (±SD) baseline blood eosinophil counts were 306.0±225.0 per microliter for benralizumab and 384.9±563.6 per microliter for mepolizumab, reducing to 32.4±40.8 and 71.8±54.4 per microliter, respectively, by week 52. Adverse events: 90% for benralizumab and 96% for mepolizumab recipients; serious adverse events: 6% and 13%, respectively.

Investigators concluded that benralizumab was as effective as mepolizumab in achieving remission for patients with relapsing or refractory EGPA.

Source: nejm.org/doi/full/10.1056/NEJMoa2311155