Abstract
Two types of interleukin (IL)-5 antibody biologics, anti-IL-5 antibodies (mepolizumab) and anti-IL-5α receptor antibodies (benralizumab), are indicated for severe asthma. While high-dose mepolizumab is also indicated for EGPA, benralizumab is indicated only for severe asthma. Benralizumab is characterized by antibody-dependent cell-mediated cytotoxicity activity, giving them specific and rapid anti-IL-5α receptor binding abilities and the ability to target a high number of eosinophils in tissues as well as peripheral blood. Recently, reports on the efficacy of benralizumab as a treatment for EGPA have been published, along with reports on some cases that are difficult to treat with existing oral corticosteroids and mepolizumab. Therefore, we focus on the perspective of the efficacy and safety of benralizumab as a treatment for EGPA patients with steroid dependence in this review. A total of 41 patients with EGPA were treated with benralizumab. After the introduction of benralizumab, oral corticosteroids could be reduced to 10 mg/day or less in all cases and to less than 5 mg/day in 80% or more of the cases. Discontinuation of oral corticosteroids was achieved in more than 40% of patients with EGPA. Benralizumab was effective in patients with mepolizumab-refractory EGPA and intractable cardiac and neuropathy complications. Efficient elimination of eosinophils is expected to improve the remission rate of EGPA with benralizumab treatment. Although the total number of patients was small, benralizumab was safe and tolerable in a wide range of age groups, suggesting efficacy in severe cases with EGPA.
Highlights
Eosinophilic granulomatosis with polyangiitis (EGPA) is an intractable disease of unknown etiology, and classical treatment with oral corticosteroids (OCS) and immunosuppressants are the mainstream treatment for EGPA (Furuta et al, 2019)
There are two types of biologics that target IL-5: mepolizumab, an anti-IL-5 Ab, and benralizumab, an anti-IL-5 receptor α Ab. The latter is characterized by the ability to rapidly remove eosinophils in the tissues and blood by antibodydependent cell-mediated cytotoxicity (ADCC) activity mediated by natural killer (NK) cells (Nagase et al, 2020)
We summarize the previous literature published on the efficacy of benralizumab in the treatment of EGPA
Summary
Eosinophilic granulomatosis with polyangiitis (EGPA) is an intractable disease of unknown etiology, and classical treatment with oral corticosteroids (OCS) and immunosuppressants are the mainstream treatment for EGPA (Furuta et al, 2019). Treatments targeting IL-5 improved the remission rate of EGPA and reduced the effective dose of OCS, resulting in many benefits for patients with EGPA. After 24 weeks of treatment (5 injections) with benralizumab, the OCS dose could be reduced from an average of 12.5 to 0 mg, and 3 of the patients were able to discontinue OCS therapy and had a complete depletion of peripheral eosinophils (Padoan et al, 2020).
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