Reducing steroid requirements in eosinophilic granulomatosis with polyangiitis by targeting IL-5Ra

Published online: October 14, 2020

Eosinophilic granulomatosis with polyangiitis (EGPA) is a hypereosinophilic disorder associated with asthma, rhinosinusitis, pulmonary infiltrates and vasculitis. Systemic corticosteroids are used to maintain disease remission but result in complications such as osteoporosis and diabetes.  Agents targeting Interleukin (IL)-5 or subunits of its receptor (IL-5Rα) have resulted in reduced eosinophilia and fewer asthma exacerbations. Benralizumab targets IL-5Rα, neutralizing eosinophils and basophils, which are important in eosinophilic disorders such as EGPA.  

Wechsler’s research group (Guntur et al.) recently published a study in The Journal of Allergy and Clinical Immunology: In Practice, evaluating the hypothesis that the monoclonal antibody, benralizumab, that is approved for eosinophilic asthma, would demonstrate safety and efficacy in EGPA as well. A prospective 40-week open label pilot study of benralizumab was performed in patients with EGPA. Systemic oral corticosteroid use, EGPA exacerbations, and adverse events were evaluated.

Benralizumab was well-tolerated and proved to be safe and effective in corticosteroid reduction in EGPA. Significant reduction in systemic corticosteroid use (>50% from baseline) was noted with benralizumab treatment. Half of enrolled subjects were able to achieve a dose of 0 mg prednisone daily. Concurrent reduction of EGPA exacerbations was also noted, despite substantial reduction of corticosteroid use. Unsurprising findings in this study were dramatic reduction in peripheral eosinophils and lack of significant improvement in lung function as measured by forced expiratory volume in 1 second (FEV1). The study drug was well tolerated; the majority of adverse events were not severe and were thought to be unrelated to study drug.

This study by Wechsler’s group finds utility in the use of benralizumab in EGPA, a condition with few currently available effective therapeutic options. Further study in a larger, controlled cohort is necessary to elucidate benralizumab’s effectiveness and long-term benefit in EGPA.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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