Comparative real-world effectiveness and safety of benralizumab and two mepolizumab dosing regimens in eosinophilic granulomatosis with polyangiitis: a 24-month prospective single-center cohort study

BackgroundLong-term prospective real-world data on anti–IL-5 and anti–IL-5 receptor biologics in eosinophilic granulomatosis with polyangiitis (EGPA) are limited.MethodsIn this 24-month prospective single-center observational study, 66 adults with EGPA received benralizumab 30 mg (every 4 weeks for the first three doses, then every 8 weeks), mepolizumab 300 mg every 4 weeks or mepolizumab 100 mg every 4 weeks. Remission was defined as BVASv3 = 0 with prednisone ≤5 mg/day.

Glucocorticoid (GC)-free status was defined as no oral GCs. The primary analysis was conducted in patients starting biologics as first-line.

To address confounding by indication, we performed multivariable logistic regression and multinomial propensity score inverse probability weighting (IPTW). Analyses were repeated in an all-lines dataset (81 treatment lines) using generalized estimating equations (GEE) clustered by patient.ResultsClinical outcomes improved over the 24-month follow-up across all regimens.

By 24 months, remission was 73.7% (14/19) with benralizumab, 81.0% (17/21) with mepolizumab 300 mg, and 50.0% (6/12) with mepolizumab 100 mg, without statistically significant differences between regimens.