Perspectives on the Efficacy of Benralizumab for Treatment of Eosinophilic Granulomatosis With Polyangiitis

Abstract

Two types of interleukin (IL)-5 antibody biologics, anti-IL-5 antibodies (mepolizumab) and anti-IL-5α receptor antibodies (benralizumab), are indicated for severe asthma. While high-dose mepolizumab is also indicated for EGPA, benralizumab is indicated only for severe asthma. Benralizumab is characterized by antibody-dependent cell-mediated cytotoxicity activity, giving them specific and rapid anti-IL-5α receptor binding abilities and the ability to target a high number of eosinophils in tissues as well as peripheral blood. Recently, reports on the efficacy of benralizumab as a treatment for EGPA have been published, along with reports on some cases that are difficult to treat with existing oral corticosteroids and mepolizumab. Therefore, we focus on the perspective of the efficacy and safety of benralizumab as a treatment for EGPA patients with steroid dependence in this review. A total of 41 patients with EGPA were treated with benralizumab. After the introduction of benralizumab, oral corticosteroids could be reduced to 10 mg/day or less in all cases and to less than 5 mg/day in 80% or more of the cases. Discontinuation of oral corticosteroids was achieved in more than 40% of patients with EGPA. Benralizumab was effective in patients with mepolizumab-refractory EGPA and intractable cardiac and neuropathy complications. Efficient elimination of eosinophils is expected to improve the remission rate of EGPA with benralizumab treatment. Although the total number of patients was small, benralizumab was safe and tolerable in a wide range of age groups, suggesting efficacy in severe cases with EGPA.

Long-term Safety and Efficacy of Benralizumab for Eosinophilic Granulomatosis with Polyangiitis Complicated with Severe Neuropathy

“…Although the efficacy of benralizumab for mepolizumabrefractory EGPA has been reported previously (2,(15)(16)(17), the long-term efficacy of benralizumab on EGPA and its complications has not been reported (18). Since EGPA is an intractable disease that is prone to recurrence, it is important to elucidate the long-term safety and efficacy of biologics.…”

Effective treatment with mepolizumab in a patient with severe eosinophilic granulomatosis with polyangiitis complicated with small intestine perforation

“…Recently, benralizumab, an anti-IL-5α receptor antibody, has been reported to be effective in cases of severe EGPA. It led to remission in combination with GS [ 19 ]. Prevention of infectious diseases is also important in EGPA, but EGPA requires long-term administration of steroids and immunosuppressants.…”

Biologics for eosinophilic granulomatosis with polyangiitis

“…Concerning benralizumab, for which RCTs are ongoing, a recent review of the literature by Koga et al [39] collected all published case reports and case series of benralizumab-treated EGPA patients. Data from 41 patients suggest that benralizumab was effective as a steroid-sparing agent, leading to oral GC discontinuation in more than 40% of patients.…”