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Observational Study
. 2025 May:153:103398.
doi: 10.1016/j.jaut.2025.103398. Epub 2025 Mar 26.

Mepolizumab versus benralizumab for eosinophilic granulomatosis with polyangiitis (EGPA): A European real-life retrospective comparative study

Irene Mattioli  1 , Maria Letizia Urban  1 , Roberto Padoan  2 , Aladdin J Mohammad  3 , Carlo Salvarani  4 , Chiara Baldini  5 , Alvise Berti  6 , Paolo Cameli  7 , Marco Caminati  8 , Pascal Cathébras  9 , Fulvia Chieco Bianchi  10 , Francesco Cinetto  11 , Jan Willem Cohen Tervaert  12 , Angelo Coppola  13 , Giulia Costanzo  14 , Vincent Cottin  15 , Claudia Crimi  16 , Stefano Del Giacco  14 , Charlene Desaintjean  15 , Allyson Egan  17 , Georgina Espigol-Frigolé  18 , Marco Folci  19 , Marco Fornaro  20 , Franco Franceschini  21 , Marcello Govoni  22 , Matthieu Groh  23 , Gabriella Guarnieri  10 , Bernhard Hellmich  24 , Florenzo Iannone  20 , Rachel Jones  25 , Anna Kernder  26 , Alberto Lo Gullo  27 , Carlo Lombardi  28 , Giuseppe Lopalco  20 , Laura Losappio  29 , Maria Rita Marchi  30 , Carlos Martinez Rivera  31 , Chiara Marvisi  4 , Matteo Maule  8 , Laura Moi  32 , Sara Monti  33 , Frank Moosig  34 , Gianluca Moroncini  35 , Simone Matteo Negrini  36 , Thomas Neumann  37 , Santi Nolasco  16 , Pavel Novikov  38 , Dario Roccatello  39 , Maxime Samson  40 , Jan Walter Schroeder  29 , Benjamin Seeliger  41 , Renato Alberto Sinico  42 , Roser Solans  43 , Colas Tcherakian  44 , Paola Toniati  21 , Elena Treppo  45 , Giorgio Trivioli  25 , Angelo Vacca  46 , David Jayne  25 , Alessandra Bettiol  47 , Augusto Vaglio  48 , Giacomo Emmi  49 ; European EGPA Study Group
Collaborators, Affiliations
Free article
Observational Study

Mepolizumab versus benralizumab for eosinophilic granulomatosis with polyangiitis (EGPA): A European real-life retrospective comparative study

Irene Mattioli et al. J Autoimmun. 2025 May.
Free article

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ANCA-associated vasculitis; Benralizumab; Biologicals; Eosinophilic granulomatosis with polyangiitis (EGPA); Epidemiology; Interleukin-5; Mepolizumab.

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Conflict of interest statement

Declaration of interests The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David Jayne reports a relationship with GSK that includes: consulting or advisory. Giacomo Emmi reports a relationship with GSK that includes: consulting or advisory. Matthieu Groh reports a relationship with GSK that includes: consulting or advisory. Augusto Vaglio reports a relationship with GSK that includes: consulting or advisory. Roberto Padoan reports a relationship with GSK that includes: consulting or advisory. Vincent Cottin reports a relationship with GSK that includes: consulting or advisory. David Jayne reports a relationship with AstraZeneca that includes: consulting or advisory. Matthieu Groh reports a relationship with AstraZeneca that includes: consulting or advisory. Roberto Padoan reports a relationship with AstraZeneca that includes: consulting or advisory. Augusto Vaglio reports a relationship with AstraZeneca that includes: consulting or advisory. Giacomo Emmi reports a relationship with AstraZeneca that includes: consulting or advisory. Vincent Cottin reports a relationship with AstraZeneca that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Alberto Lo Gullo by National Specialist Hospital Garibaldi, Alessandra Bettiol by University of Florence, Allyson Egan by Tallaght University Hospital, Alvise Berti by University of Trento, Angelo Coppola by Saint Camillus International University of Health and Medical Sciences, Angelo Vacca by University Hospital Polyclinic of Bari, Anna Kernder by Heinrich Heine University Düsseldorf, Carlo Lombardi by Poliambulanza Foundation Hospital Institute, Charlene Desaintjean by Civil Hospices of Lyon, Chiara Baldini by University of Pisa, Chiara Marvisi by University of Modena e Reggio Emilia, Claudia Crimi by G. Rodolico - San Marco” University Hospital, Dario Roccatello by, Pascal Cathébras By CHU, Saint-Etienne, France, Marco Caminati by University of Verona, Verona, Paolo Cameli by University of Siena, Alvise Berti by University of Trento, Chiara Baldini by University of Pisa, Carlo Salvarani by Università di Modena e Reggio Emilia, M Aladdin J. Mohammad by Lund University, Maria Letizia Urban by University of Florence, Irene Mattioli by University of Florence, Giorgio Trivioli by University of Florence, Elena Treppo by University of Udine, Paola Toniati by University of Brescia, Colas Tcherakian by Hôpital Foch, Suresnes, Roser Solans by Autònoma de Barcelona, Renato Alberto Sinico by IRCCS Humanitas Research Hospital Rozzano, Benjamin Seeliger by Hannover Medical School, Maxime Samson by Dijon Bourgogne University Hospital, Dario Roccatello by University of Turin, Pavel Novikov by Sechenov First Moscow State Medical University, Santi Nolasco by University of Catania, Thomas Neumann by Jena University Hospital, Simone Matteo Negrini by AO Ordine Mauriziano Torino, Gianluca Moroncini by Marche University Hospital, Frank Moosig by Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Sara Monti by IRCCS Istituto Auxologico Italiano, Immunorheumatology Research Laboratory, Laura Moi by Centre Hospitalier Universitaire Vaudois, Lausanne, Matteo Maule by University of Verona, Chiara Marvisi by Università di Modena e Reggio Emilia, Carlos Martinez Rivera by Universitat Autònoma de Barcelona, Maria Rita Marchi by Cittadella Hospital, ULSS 6 Euganea, Padua, Laura Losappio by ASST Grande Ospedale Metropolitano Niguarda, Giuseppe Lopalco by University of Bari, Carlo Lombardi by Fondazione Poliambulanza, Brescia, Alberto Lo Gullo by ARNAS Garibaldi, Catania, Anna Kernder by Heinrich-Heine University, Düsseldorf, Rachel Jones by University of Cambridge, Florenzo Iannone by University of Bari, Bernhard Hellmich by University of Tübingen, Gabriella Guarnieri by Azienda Ospedaliero-universitaria di Padova, Marcello Govoni by University of Ferrara, Franco Franceschini by University of Brescia, Marco Fornaro by University of Bari, Marco Folci by Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Georgina Espigol-Frigolé by Hospital Clínic and University of Barcelona and Institut d’Iinvestigacions Biomèdiques August Pi iISunyer (IDIBAPS), Barcelona, Allyson Egan by Tallaght University Hospital, Dublin, Charlene Desaintjean by Hospices Civils de Lyon, Claudia Crimi by University of Catania, Giulia Costanzo by University of Cagliari, Jan Willem Cohen Tervaert by Maastricht University, Francesco Cinetto by University of Padova, Fulvia Chieco Bianchi by Azienda Ospedaliero-universitaria di Padova.

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