Benralizumab Therapy

Approved Indications and Dosing

The American College of Rheumatology recommends benralizumab for adult patients with Eosinophilic Granulomatosis with Polyangiitis (EGPA), particularly for those with refractory asthma/ENT disease without systemic manifestations despite high-dose glucocorticoids and optimized inhaled therapy, at a dose of 30 mg subcutaneously every 4 weeks for the first 3 doses, then every 8 weeks thereafter 1

Benralizumab may be effective in treating Eosinophilic Esophagitis (EoE) and Hypereosinophilic Disorders, with cases reported of complete resolution of dysphagia symptoms and histological evidence of deep remission in patients with both eosinophilic asthma and EoE, and a phase-2 study showing significant lowering of eosinophil count in both serum and tissue, with 74% of patients having sustained response at 48 weeks 2, 3
The European Respiratory Society recommends benralizumab as an option for managing treatment-dependent Allergic Bronchopulmonary Aspergillosis (ABPA) 4
Benralizumab may be a potential candidate for managing Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) based on its efficacy in eosinophilic asthma 5, 6, 7

The European Respiratory Society recommends therapeutic drug monitoring when using benralizumab 4
For patients with EGPA, benralizumab can be considered when disease is refractory to mepolizumab therapy, according to the American College of Rheumatology 1, 8

For patients with severe eosinophilic asthma or hypereosinophilic syndrome who have responded well to benralizumab treatment, maintenance therapy should continue indefinitely to prevent rapid disease relapse and loss of therapeutic benefit 9

The mechanism of action of benralizumab, near-complete eosinophil depletion via IL-5 receptor alpha blockade, requires ongoing treatment to maintain therapeutic effect, similar to the principle seen in eosinophilic esophagitis treated with topical steroids where histological relapse rates are extremely high after withdrawal, with only 4.4% of patients maintaining remission on placebo versus 73.5-75% on continued treatment 9