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Meta-Analysis
. 2025 Jul 22:16:1587158.
doi: 10.3389/fimmu.2025.1587158. eCollection 2025.

Anti-IL5/IL-5 receptor therapies for eosinophilic granulomatosis with polyangiitis: an updated Systematic Review

Matteo Lazzeroni  1   2 , Valeria Longoni  3 , Paolo Schiavo  2 , Emanuele Bizzi  4 , Antonio Brucato  5 , Giulia Gramellini  6 , Marco Borin  6 , Alberto Dragonetti  6 , Michele Gaffuri  7 , Mario Lentini  8 , Antonino Maniaci  9 , Angela Mauro  10 , Antonio Gidaro  11 , Jan Schroeder  12 , Pasquale Capaccio  1   2
Affiliations
Meta-Analysis

Anti-IL5/IL-5 receptor therapies for eosinophilic granulomatosis with polyangiitis: an updated Systematic Review

Matteo Lazzeroni et al. Front Immunol. .

Abstract

Introduction: Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare necrotizing vasculitis characterized by eosinophilic inflammation that was traditionally treated with corticosteroids associated with other immunosuppressants. Over the last years different biological therapies targeting IL-5/IL-5 receptor have become available and have been employed to tackle this challenging condition. Aim of the present study is to synthesis the evidence on the clinical presentation of this disease and on the efficacy of the newly available therapeutic strategies.

Methods: In June 2024 PubMed, Embase and the Cochrane library were searched for studies reporting on EGPA patients being treated by means of different anti IL-5 or anti eosinophils biological therapies. Risk of bias was assessed through the ROBINS-I and RoB2 tools according to study design. Proportion meta-analysis was employed to synthetize data on EGPA clinical manifestations, while data on treatment outcomes was analyzed descriptively due to the high heterogeneity.

Results: The present systematic review included 25 studies on a total of 1131 patients. Asthma was present in 99.2% of the patients, Sinonasal involvement in 87.0% and ANCA positivity in 22.8%. The explored treatments consisted in Benralizumab 30 mg every 4 weeks, Mepolizumab 100 mg or 300 mg every 4 weeks and Reslizumab 3mg/Kg every 4 weeks. All the anti-IL-5/IL-5 receptor molecules proved efficacious in remission control and corticosteroid tapering.

Conclusion: The available data strongly suggests integrating anti IL-5/IL-5 receptor therapies into EGPA treatment strategies, to enhance patients' outcomes and reduce the long term side effects of prolonged corticosteroid therapy.

Keywords: EGPA; IL5; benralizumab; eosinophil; mepolizumab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
PRISMA flowchart of the study selection process for the present systematic review and meta-analysis.
Figure 2
Figure 2
Forest plot reporting on the overall prevalence of asthma among the included patients.
Figure 3
Figure 3
Forest plot reporting on the overall prevalence of sinonasal involvement among the included patients.
Figure 4
Figure 4
Forest plot reporting on the overall prevalence of neuropathy among the included patients.
Figure 5
Figure 5
Forest plot reporting on the overall prevalence of cardiac involvement among the included patients.
Figure 6
Figure 6
Forest plot reporting on the overall prevalence of cutaneous involvement among the included patients.
Figure 7
Figure 7
Forest plot reporting on the overall prevalence of renal involvement among the included patients.
Figure 8
Figure 8
Forest plot reporting on the overall prevalence of ANCA positivity among the included patients.
See this image and copyright information in PMC

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