Evaluating the efficacy and safety of benralizumab in eosinophilic granulomatosis with polyangiitis: a review of clinical trials versus real-world evidence

Abstract

Benralizumab, an afucosylated monoclonal antibody against the IL-5 receptor α, has the ability to eliminate eosinophils from tissues and blood through antibody-dependent cell-mediated cytotoxicity (ADCC) driven by natural killer (NK) cells. This study aims to evaluate the efficacy and safety of benralizumab in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA), compare outcomes from clinical trials with real-world evidence, and analyze its potential to address the limitations of traditional therapies in improving patient quality of life. Studies have shown that benralizumab is as effective as mepolizumab in inducing remission. However, it has other advantages, such as better tolerability, reduced need for oral corticosteroids, and fewer EGPA exacerbations. It has also been shown to be a potential therapy for severe/refractory eosinophilic gastroenteritis in patients with eosinophilic asthma and even in non-responder patients receiving mepolizumab. The safety of benralizumab is another key advantage over other alternatives, making it a more reliable option for treating EGPA. The effectiveness of benralizumab was less pronounced in cases where mepolizumab had already failed. This highlights the importance of closely monitoring patients and adopting a comprehensive treatment approach to ensure optimal outcomes. However, further investigations in a larger population are still needed to determine the long-term benefit of benralizumab, its effectiveness as monotherapy, a deeper understanding of the mechanism of action, and optimal dosing for better outcomes.