Systematic Literature Review of Real-world Outcomes of Benralizumab in Eosinophilic Granulomatosis with Polyangiitis.

Background: Several real-world cohorts and numerous case reports investigating benralizumab outcomes in eosinophilic granulomatosis with polyangiitis have been published. These studies complement the limited clinical trial data available by providing early insights on benralizumab use in a broader, real-world population.

Objective: The objective of this systematic literature review (SLR) was to provide an overview of the real-world outcomes of benralizumab in EGPA.

Methods: SLR was conducted to identify articles and abstracts (from January 1, 2017, through January 12, 2024) reporting eosinophilic granulomatosis with polyangiitis and asthma outcomes in patients with eosinophilic granulomatosis with polyangiitis receiving benralizumab.

Results: Thirty-nine studies (seven cohort/32 case reports) were included (N=306/N=41 patients). Mean age ranged from 42 to 56 years; anti-neutrophil cytoplasmic antibody positivity varied from 18% to 59%. Nearly all publications examined benralizumab at the dosage approved for severe eosinophilic asthma. Prior mepolizumab use was reported in 12%-46% of patients. Reasons for switching to benralizumab included lack of (or insufficient) response and persistent symptoms. Remission rates were reported in three cohorts at 12 months (46%-69%) and two cohorts at 24 months (66%-71%). One cohort reported a trend of lower remission rates among patients previously treated with mepolizumab (37% vs. 60%) compared to not (p=0.09). Significant oral corticosteroid-sparing effects were observed, and oral corticosteroid use was completely discontinued in 32%-68% of patients.

Conclusion: In real-world reports, benralizumab was associated with significant oral corticosteroid-sparing effects and clinical remission in a significant proportion of patients with eosinophilic granulomatosis with polyangiitis.