Clinical Report: Real-World Assessment of Benralizumab Versus Mepolizumab in EGPA

Overview

This study evaluates the effectiveness of benralizumab and two dosing strategies of mepolizumab in patients with eosinophilic granulomatosis with polyangiitis (EGPA) over 24 months. Results indicate that both treatment regimens are effective in achieving remission and glucocorticoid-free status, with no significant differences between them.

Background

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare but serious condition characterized by asthma and vasculitis, often requiring long-term glucocorticoid therapy. The introduction of anti–IL-5 and anti–IL-5 receptor biologics offers a promising steroid-sparing approach, particularly for patients with relapsing or refractory disease. Understanding the comparative effectiveness of these biologics is crucial for optimizing treatment strategies.

Data Highlights

Key Findings

• Remission rates at 24 months were 73.7% for benralizumab and 81.0% for mepolizumab 300 mg.
• GC-free status was achieved by 63.2% of patients on benralizumab and 85.7% on mepolizumab 300 mg.
• Eosinophil counts decreased significantly, with near-complete suppression observed in the benralizumab group.
• Improvement in pulmonary function indices was most pronounced in the benralizumab cohort.
• Discontinuations were primarily due to inadequate control of ENT or respiratory symptoms.

Clinical Implications

The findings support the use of both benralizumab and mepolizumab as effective treatment options for EGPA, with significant potential for glucocorticoid sparing. Clinicians should consider individual patient profiles when selecting a biologic therapy, as both options demonstrate similar efficacy.

Conclusion

This study highlights the effectiveness and tolerability of anti–IL-5/IL-5R biologics in EGPA over a 24-month period, reinforcing the need for personalized treatment approaches in this patient population.

Related Resources & Content

1. Nature Medicine, Author Correction, 2026 -- Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial
2. The New Gastroenterologist, 2025 -- Extended Treatment for Eosinophilic Esophagitis Reduces Relapse Risk Without Increased Complications
3. The New Gastroenterologist, 2025 -- Eosinophilic esophagitis: A year in review
4. Clinical Rheumatology, 2021 -- Short-term Outcomes and Progression Predictors of Interstitial Lung Disease in Patients with Rheumatoid Arthritis Treated with Abatacept
5. Nature Reviews Rheumatology, 2023 -- Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis
6. New England Journal of Medicine, 2017 -- Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis
7. Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis
8. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis | New England Journal of Medicine