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Chest · 2026

Switching from mepolizumab to benralizumab in eosinophilic granulomatosis with polyangiitis (EGPA).

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Cottu Adrien, Mattioli Irene, Groh Matthieu, Puéchal Xavier, Egan Allyson, Padoan Roberto, Brussino Luisa, Schroeder Jan, Taillé Camille, Samson Maxime, Cathébras Pascal, Cinetto Francesco, Yildiz Halil, Pugnet Gregory, Chauvin Pierre, Jouneau Stéphane, Diot Elisabeth, Nicolas Sarah, Lifermann François, Martellosio Jean-Philippe, Guilleminault Laurent, Nguyen Yann, De Moreuil Claire, Guilpain Philippe, Cottin Vincent, Moroni Luca, Delvino Paolo, Franceschini Franco, Conticini Edoardo, Crimi Claudia, Moroncini Gianluca, Bond Milena, Moi Laura, Jayne David, Vaglio Augusto, Tcherakian Colas, Emmi Giacomo, Terrier Benjamin, European EGPA study group (EESG) and the French Vasculitis Study Group (FVSG)

Аннотация

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is an ANCA-associated vasculitis characterized by eosinophilic asthma and ENT involvement. Both mepolizumab and benralizumab have demonstrated efficacy in EGPA and are now considered front-line options. In patients who do not respond to mepolizumab, benralizumab may be a valuable alternative owing to its enhanced depletion of eosinophils. We assessed the efficacy for and safety of switching from mepolizumab to benralizumab in EGPA.

RESEARCH QUESTION: Is benralizumab effective and safe in EGPA patients after mepolizumab failure, given its enhanced depletion of eosinophil?

STUDY DESIGN AND METHODS: We conducted a retrospective European multicenter study including 68 adult EGPA patients who received benralizumab after mepolizumab failure. Complete (CR) and partial (PR) response were defined as BVAS=0, with prednisone ≤4 mg/day and > 4 mg/day, respectively.

RESULTS: Median benralizumab follow-up period was 28 [20-39] months. CR and PR were achieved in 32% and 25% of patients, and maintained at last follow-up in 19% and 16%. Median time to CR was 6 [4-12] months. Forced expiratory volume in one second improved from 73% to 79%, and 38% of patients discontinued glucocorticoids. Vasculitis flares occurred in six patients. Primary mepolizumab failure was associated with lower CR rates (OR 0.19, 95% CI 0.06-0.60). Benralizumab was discontinued in 18% due to persistent respiratory symptoms. Adverse events occurred in five patients, including two severe SARS-CoV-2 infections.

INTERPRETATION: In EGPA patients with persistent respiratory manifestations after mepolizumab failure, switching to benralizumab could represent a valuable option, improving lung function and reducing glucocorticoid use. Further prospective studies are needed to optimize sequencing and patient selection.