Abstract

Background: Mepolizumab and benralizumab, which are humanized monoclonal antibodies targeting the interleukin (IL)-5 and IL-5 receptor respectively, showed oral glucocorticoid-sparing effects in patients with relapsing or refractory eosinophilic granulomatosis with polyangiitis (EGPA).

Objective: We assessed the efficacy and safety of mepolizumab and benralizumab in patients with EGPA in real-life settings.

Methods: We conducted a retrospective analysis of patients with EGPA and refractory asthma, who received mepolizumab 100 or 300 mg/4 weeks or benralizumab 30 mg/8 weeks, in addition to oral glucocorticoids. They were followed every 6±3 months. Assessments included clinical manifestations, pulmonary function tests and biological markers. The primary efficacy outcome was the proportion of patients who had reduced a daily prednisone dosage to 4 mg or less at 6 months.

Results: Twenty-two patients were included. At 6±3 months, 10% of patients had reached the primary endpoint. The mean prednisone daily dosage decreased from 13.9 mg at baseline to 10.6 mg at 6±3 months (p=0.028) and 5.9 mg at 12±3 months (p= 0.002). 8 patients discontinued glucocorticoid therapy whereas an increase or no change in dose was observed for 33 % of patients. The eosinophil count significatively decreased from 537 to 91 cells per cubic centimeter at 12±3months. No significant change was observed on FEV1 which was at 2.4 L. Asthma exacerbations decreased from 0.56 to 0.2 per 6 months. Tolerability was unremarkable.

Conclusion: Mepolizumab and benralizumab had a significant sparing effect of glucocorticoids and a generally positive effect on post-EGPA asthma, without improvement in FEV1.