POS0326 COMPARATIVE EFFICACY OF MEPOLIZUMAB 100 MG, MEPOLIZUMAB 300 MG AND BENRALIZUMAB 30 MG IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: A MONOCENTRIC RETROSPECTIVE OBSERVATIONAL STUDY
Authors: M. Codirenzi, R. Padoan, L. Iorio, F. Davanzo, E. Fiorin, A. Doria
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Monoclonal antibodies targeting interleukin 5 (IL-5) and IL-5α receptor have proven to be effective in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). <h3>Objectives:</h3> The aim of this study was to compare efficacy of Mepolizumab 300 mg every 4weeks (MEPO300), Mepolizumab 100 mg every 4 weeks (MEPO100) and Benralizumab 30mg every 8 weeks after 3 injections every 4 weeks (BENRA) in EGPA patients. <h3>Methods:</h3> Patients with EGPA who were treated with BENRA, MEPO300, and MEPO100 were retrospectively included in this monocentric observational study. Follow-up data, comprising clinical manifestations, pulmonary function tests, and eosinophil count, were collected. Data were compared between the groups at baseline, 3, 6, and 12 months, as well as at the last follow-up (LFU). Complete remission (CR) was defined as Birmingham Vasculitis Activity Score (BVAS) of 0 and prednisone (PDN) dose of 0 mg/day. Partial remission (PR) was defined as BVAS of 0 and prednisone dose ≥ 5 mg/day. <h3>Results:</h3> 67 patients (52.2% female, median age of 49 [39-58] years, median disease duration of 30 [9-105] months) were included, 33 treated with BENRA, 22 with MEPO300 and 12 with MEPO100. At LFU, CR was observed in 22/33 (66.7%) patients on BENRA, 15/22 on MEPO300 (68.2%) and 4/12 (33.3%) on MEPO100, p=0.091. PR was reported in 7/33 (21.2%) patients on BENRA, 5/22 on MEPO300 (22.7%) and 5/12 (41.7%) on MEPO100, p=0.356. At LFU 11/33 (33.3%) patients on BENRA shifted to another biologic, while 4/22 (18.2%) on MEPO300 and 5/12 (41.7%) on MEPO100 did so, p=0.238. A significant reduction in BVAS was observed in the BENRA (p=0.059) and MEPO300 (p=0.021) groups, but not in the MEPO100 (p=0.323), with no significant differences between treatments at each time-point. A significant decrease in blood eosinophils in all group was observed, with BENRA and MEPO300 being the most effective depleting agents. An improvement in FEV1 values was observed in BENRA patients (p&lt;0.001), but not in MEPO300 (p=0.393) and MEPO100 (p=0.178) groups. No significant change was observed in fractional exhaled nitric oxide (FeNO) in all groups (BENRA p=0.367, MEPO300 p=0.993, MEPO100 p=0.868), but those treated with MEPO100 had the highest values. A significant reduction in PDN dose was observed at LFU in MEPO300 (p=0.013) and MEPO100 (p=0.029) groups, but not in BENRA (p=0.094). Specifically 23/33 (69.7%) patients on BENRA were able to discontinue glucocorticoids, 16/22 (72.7%) on MEPO300, and 5/12 (41.7%) on MEPO100, p=0.150. The tolerability profile was favourable. <h3>Conclusion:</h3> In this real-world monocentric retrospective observational study, BENRA and MEPO300 exhibited a significant steroid-sparing effect, with MEPO300 demonstrating superior drug survival. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>