Benralizumab and Mepolizumab 300 mg Show High Remission in EGPA, Benralizumab Achieves Near-Complete Eosinophil Suppression.

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare, severe form of vasculitis characterized by hypereosinophilia and granulomatous inflammation. Current standard-of-care often involves long-term glucocorticoid use, leading to significant side effects. Biologics targeting the interleukin-5 (IL-5) pathway, such as mepolizumab (an anti-IL-5 antibody) and benralizumab (an anti-IL-5 receptor alpha antibody), offer steroid-sparing potential by reducing eosinophil levels. However, long-term prospective real-world data comparing the effectiveness and safety of these agents, especially different dosing regimens, in EGPA patients remain limited, hindering optimal treatment selection. This study addresses that gap.

This 24-month prospective single-center observational study enrolled 66 adults with EGPA. Patients received benralizumab 30 mg (q4w x3, then q8w), mepolizumab 300 mg q4w, or mepolizumab 100 mg q4w. Remission, the primary endpoint, was defined as BVASv3 = 0 with prednisone ≤5 mg/day. GC-free status was also assessed. Primary analysis used multivariable logistic regression and IPTW on first-line patients. An 81-treatment-line dataset was analyzed with GEE for consistency.