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Wechsler ME, Nair P, Terrier B, Walz B, Bourdin A, Jayne DRW, Jackson DJ, Roufosse F, Börjesson Sjö L, Fan Y, Jison M, McCrae C, Necander S, Shavit A, Walton C, Merkel PA. Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med 2024; 390:911-921. [PMID: 38393328 DOI: 10.1056/nejmoa2311155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Benralizumab, a monoclonal antibody against the interleukin-5α receptor expressed on eosinophils, may be an option for treating EGPA. METHODS We conducted a multicenter, double-blind, phase 3, randomized, active-controlled noninferiority trial to evaluate the efficacy and safety of benralizumab as compared with mepolizumab. Adults with relapsing or refractory EGPA who were receiving standard care were randomly assigned in a 1:1 ratio to receive benralizumab (30 mg) or mepolizumab (300 mg) subcutaneously every 4 weeks for 52 weeks. The primary end point was remission at weeks 36 and 48 (prespecified noninferiority margin, -25 percentage points). Secondary end points included the accrued duration of remission, time to first relapse, oral glucocorticoid use, eosinophil count, and safety. RESULTS A total of 140 patients underwent randomization (70 assigned to each group). The adjusted percentage of patients with remission at weeks 36 and 48 was 59% in the benralizumab group and 56% in the mepolizumab group (difference, 3 percentage points; 95% confidence interval [CI], -13 to 18; P = 0.73 for superiority), showing noninferiority but not superiority of benralizumab to mepolizumab. The accrued duration of remission and the time to first relapse were similar in the two groups. Complete withdrawal of oral glucocorticoids during weeks 48 through 52 was achieved in 41% of the patients who received benralizumab and 26% of those who received mepolizumab. The mean (±SD) blood eosinophil count at baseline was 306.0±225.0 per microliter in the benralizumab group and 384.9±563.6 per microliter in the mepolizumab group, decreasing to 32.4±40.8 and 71.8±54.4 per microliter, respectively, at week 52. Adverse events were reported in 90% of the patients in the benralizumab group and 96% of those in the mepolizumab group; serious adverse events were reported in 6% and 13%, respectively. CONCLUSIONS Benralizumab was noninferior to mepolizumab for the induction of remission in patients with relapsing or refractory EGPA. (Funded by AstraZeneca; MANDARA ClinicalTrials.gov number, NCT04157348.).
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Affiliation(s)
- Michael E Wechsler
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Parameswaran Nair
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Benjamin Terrier
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Bastian Walz
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Arnaud Bourdin
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - David R W Jayne
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - David J Jackson
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Florence Roufosse
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Lena Börjesson Sjö
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Ying Fan
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Maria Jison
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Christopher McCrae
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Sofia Necander
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Anat Shavit
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Claire Walton
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Peter A Merkel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
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Bettiol A, Urban ML, Padoan R, Groh M, Lopalco G, Egan A, Cottin V, Fraticelli P, Crimi C, Del Giacco S, Losappio L, Moi L, Cinetto F, Caminati M, Novikov P, Berti A, Cameli P, Cathébras P, Coppola A, Durel CA, Folci M, Gullo AL, Lombardi C, Monti S, Parronchi P, Rivera CM, Solans R, Vacca A, Espígol-Frigolé G, Guarnieri G, Bianchi FC, Marchi MR, Tcherakian C, Kahn JE, Iannone F, Venerito V, Desaintjean C, Moroncini G, Nolasco S, Costanzo GAML, Schroeder JW, Ribi C, Tesi M, Gelain E, Mattioli I, Bello F, Jayne D, Prisco D, Vaglio A, Emmi G. Benralizumab for eosinophilic granulomatosis with polyangiitis: a retrospective, multicentre, cohort study. Lancet Rheumatol 2023; 5:e707-e715. [PMID: 38251561 DOI: 10.1016/s2665-9913(23)00243-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Interleukin-5 (IL-5) inhibitors represent novel therapies for eosinophilic granulomatosis with polyangiitis (EGPA). This study assessed the effectiveness and safety of the IL-5 receptor inhibitor benralizumab in a European cohort of patients with EGPA. METHODS This retrospective cohort study included patients with EGPA from 28 European referral centres of the European EGPA Study Group across six countries (Italy, France, UK, Russia, Spain, and Switzerland) who received benralizumab as any line of treatment between Jan 1, 2019, and Sep 30, 2022. We assessed the rates of complete response, defined as no disease activity (Birmingham Vasculitis Activity Score [BVAS] of 0) and a prednisone dose of up to 4 mg/day, in contrast to partial response, defined as a BVAS of 0 and a prednisone dose greater than 4 mg/day. Active disease manifestations, pulmonary function, variation in glucocorticoid dose, and safety outcomes were also assessed over a 12-month follow-up. FINDINGS 121 patients with relapsing-refractory EGPA treated with benralizumab at the dose approved for eosinophilic asthma were included (64 [53%] women and 57 [47%] men; median age at the time of beginning benralizumab treatment 54·1 years [IQR 44·2-62·2]). Complete response was reported in 15 (12·4%, 95% CI 7·1-19·6) of 121 patients at month 3, 25 (28·7%, 19·5-39·4) of 87 patients at month 6, and 32 (46·4%, 34·3-58·8) of 69 patients at month 12; partial response was observed in an additional 43 (35·5%, 27·0-44·8) patients at month 3, 23 (26·4%, 17·6-37·0) at month 6, and 13 (18·8%, 10·4-30·1) at month 12. BVAS dropped from 3·0 (IQR 2·0-8·0) at baseline to 0·0 (0·0-2·0) at months 3 and 6, and to 0·0 (0·0-1·0) at month 12. The proportion of patients with systemic manifestations, active peripheral neurological disease, ear, nose, and throat involvement, and pulmonary involvement decreased, with an improvement in lung function tests. Six patients relapsed after having a complete response. The oral prednisone (or equivalent) dose decreased from 10·0 mg/day (5·0-12·5) at baseline to 5·0 mg/day (3·6-8·5) at month 3 (p<0·01), to 5·0 mg/day (2·5-6·3) at month 6, and to 2·5 mg/day (0·0-5·0) at month 12 (p<0·0001). 19 (16%) of 121 patients had adverse events and 16 (13%) discontinued benralizumab. INTERPRETATION These data suggest that benralizumab could be an effective treatment for EGPA in real-life clinical practice. Further clinical trials are required to confirm the efficacy of benralizumab in patients with a higher baseline disease activity. FUNDING None.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Allyson Egan
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | - Vincent Cottin
- Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; UMR754, National Research Institute for Agriculture, Food and the Environment, University of Lyon, Lyon, France
| | | | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Azienda Ospedaliero Universitaria Policlinico "G Rodolico-San Marco", Catania, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Losappio
- Unit of Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Francesco Cinetto
- Department of Medicine, University of Padova, Padova, Italy; Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, Treviso, Italy
| | - Marco Caminati
- Asthma Centre and Allergy Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Pavel Novikov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alvise Berti
- Rheumatology Unit, Santa Chiara Hospital, APSS Trento and CISMED, University of Trento, Trento, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Angelo Coppola
- Division of Respiratory Medicine, Ospedale San Filippo Neri-ASL Roma 1, Rome, Italy; Saint Camillus International University of Health Sciences, Rome, Italy
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marco Folci
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology, Clinical Immunology and Pneumology, Fondazione Poliambulanza, Brescia, Italy
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Carlos Martinez Rivera
- Department of Pneumology, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - Roser Solans
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angelo Vacca
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna "Guido Baccelli", University of Bari Aldo Moro, Policlinico, Bari, Italy
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Gabriella Guarnieri
- Department of Pneumology, Hospital Cittadella ULSS6 Euganea, Cittadella, Italy
| | | | - Maria Rita Marchi
- Department of Pneumology, Hospital Cittadella ULSS6 Euganea, Cittadella, Italy
| | | | - Jean-Emmanuel Kahn
- National Referral Center for Hypereosinophilic Syndromes, Department of Internal Medicine, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Vincenzo Venerito
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Charlene Desaintjean
- Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Azienda Ospedaliero Universitaria Policlinico "G Rodolico-San Marco", Catania, Italy
| | | | - Jan Walter Schroeder
- Unit of Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Florence, Italy; Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy; Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, VIC, Australia.
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