Benralizumab for eosinophilic granulomatosis with polyangiitis.
(2023) Annals of the rheumatic diseases — Vol. 82, n° 12, p. 1580-1586 (2023)
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Cottu, Adrien 
Groh, Matthieu
- Abstract
- BACKGROUND: Benralizumab is effective in the treatment of eosinophilic asthma and is being investigated for the treatment of other eosinophil-associated diseases. Reports on the use of benralizumab for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) are limited to case reports and small case series. METHODS: We conducted a multicentre, retrospective study including EGPA patients treated with off-label benralizumab. The primary endpoint was the rate of complete response defined as no disease activity (Birmingham Vasculitis Activity Score=0) and a prednisone dose ≤4 mg/day. Partial response was defined as no disease activity and a prednisone dose ≥4 mg/day. RESULTS: Sixty-eight patients were included, including 31 (46%) who had previously received mepolizumab. The use of benralizumab was warranted by uncontrolled asthma in 54 (81%), persistent ear, nose and throat (ENT) manifestations in 27 (40%) and persistent glucocorticoids (GCs) use in 48 (74%) patients. Median (IQR) follow-up after starting benralizumab was 23 (9-34) months. Thirty-three patients (49%) achieved a complete response, 24 (36%) achieved a partial response and 10 (15%) did not respond. Among the 57 patients who initially responded, 10 (18%) eventually required further line treatments. GCs were discontinued in 23 patients (38%). Prior mepolizumab use was associated with a higher rate of primary failure (26.7% vs 5.4%, p=0.034) and less frequent GCs discontinuation (14.8% vs 55.9%, p=0.001). Vasculitis flares occurred in 7 patients (11%) and were associated with histological evidence of vasculitis and/or antineutrophil cytoplasmic antibodies positivity at benralizumab initiation (p=0.004). CONCLUSIONS: Benralizumab appears to be an effective treatment for refractory asthma or ENT manifestations in EGPA and allows GC-sparing. However, its efficacy was lower after prior failure of mepolizumab.
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Citations
Cottu, A., Groh, M., Desaintjean, C., Marchand-Adam, S., Guillevin, L., Puechal, X., Beaumesnil, S., Lazaro, E., Samson, M., Taille, C., Durel, C.-A., Diot, E., Nicolas, S., Guilleminault, L., Ebbo, M., Cathebras, P., Dupin, C., Yildiz, H., Belfeki, N., et al. (2023). Benralizumab for eosinophilic granulomatosis with polyangiitis. Annals of the rheumatic diseases, 82(12), 1580-1586. https://doi.org/10.1136/ard-2023-224624 (Original work published 2023)