Mepolizumab versus benralizumab for eosinophilic granulomatosis with polyangiitis (EGPA): A European real-life retrospective comparative study
Irene Mattioli, Maria Letizia Urban, Roberto Padoan, Aladdin J Mohammad, Carlo Salvarani, Chiara Baldini, Alvise Berti, Paolo Cameli, Marco Caminati, P. Cathébras, Fulvia Chieco Bianchi, Francesco Cinetto, Jan Willem Cohen Tervaert, Angelo Coppola, Giulia Costanzo, Vincent Cottin, Claudia Crimi, Stefano Del Giacco, Charlene Desaintjean, Allyson Egan, Georgina Espígol‐Frigolé, Marco Folci, Marco Fornaro, Franco Franceschini, Marcello Govoni, Matthieu Groh, Gabriella Guarnieri, Bernhard Hellmich, Florenzo Iannone, Rachel Jones, Anna Kernder, Alberto Lo Gullo, Carlo Lombardi, Giuseppe Lopalco, Laura Losappio, Maria Rita Marchi, Carlos Martínez‐Rivera, Chiara Marvisi, Matteo Maule, Laura Moi, Sara Monti, Frank Moosig, Gianluca Moroncini, Simone Negrini, Thomas Neumann, Santi Nolasco, Pavel Novikov, Dario Roccatello, Maxime Samson, Jan Walter Schroeder, Benjamin Seeliger, Renato Alberto Sinico, Roser Solans, Colas Tchérakian, Paola Toniati, Elena Treppo, Giorgio Trivioli, Angelo Vacca, David Jayne, Alessandra Bettiol, Augusto Vaglio, Giacomo Emmi, Giacomo Bagni, Edoardo Biancalana, Philippe Bonniaud, Roberto Bortolotti, Linda Borgonovo, Luisa Brussino, Raffaele Campisi, Lorenzo Carriera, Maria C. Cid, Emanuele Chiara, Laura Coladonato, Leda D'Amico, Paolo Delvino, Fabio Fischetti, Michela Gasparotto, Luca Iorio, Claudia Feder, Andrea G. Ledda, Mariapaola Lisi, Danilo Malandrino, Beatrice Maranini, Sergey Moiseev, Silvia Noviello, Miki Palmerini, Tommaso Pianigiani, Beatrice Piazza, Mario Piga, Luca Quartuccio, Jens Rathmann, Francesca Regola, Caterina Ricordi, Riccardo Scarpa, Savino Sciascia, Elena Silvestri, Paola Tomietto, Barbara Trezzi
Abstract
Following the results of the MANDARA trial, this real-life study aimed at comparing the effectiveness and safety profile of mepolizumab versus benralizumab in a European EGPA cohort. We conducted a retrospective observational comparative study including EGPA patients, who received mepolizumab or benralizumab at the asthma dose. Patients were matched 1:1 by sex, age, BVAS and oral corticosteroid (OCS) dosage at the treatment initiation (T0). Complete response (CR) and partial response (PR), disease activity, OCS, pulmonary parameters, eosinophil count, relapses, and safety outcomes were also compared at 3, 6 and 12 months. Patients treated with mepolizumab or benralizumab (n = 88 each) were matched: 57 % were females, median age was 54 years (IQR 45–60), median OCS dose 10 (7.5–12.5) and 10 (7–13) mg/day, median BVAS 4 (2–7) and 3 (2–8), respectively. 45.4 % of patients in the mepolizumab group and 51.1 % in the benralizumab group achieved CR or PR at T3, with CR steadily increasing during follow-up for both treatments. At T12, a higher CR rate was found in the benralizumab group (48.1 % vs 32.4 %, p = 0.005). No differences in BVAS, OCS, and respiratory parameters were observed between groups at the different timepoints. Throughout the follow-up, both treatments reduced eosinophil count, although a deeper reduction was found in the benralizumab group at all timepoints (p < 0.0001). Safety profile was comparable between patient groups. Mepolizumab and benralizumab showed comparable overall effectiveness and safety in EGPA. However, benralizumab achieved a higher CR rate at T12, and a deeper peripheral eosinophil reduction. • The MANDARA trial recently showed that benralizumab is non-inferior to mepolizumab for treating EGPA. • This multicenter retrospective European study found an overall comparable efficacy and safety of mepolizumab and benralizumab. • Benralizumab accounted for a higher complete response at 12 months and a deeper eosinophil depletion. • This real-life study supports anti-IL5 use in EGPA, highlighting differences for personalized therapy.