Approved EGPA treatment shows rapid benefits in severe cases
Study: Fasenra eased symptoms in all three patients; larger studies urged
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Fasenra (benralizumab) may provide fast and meaningful benefits for people with severe eosinophilic granulomatosis with polyangiitis (EGPA) who test negative for self-reactive antibodies called ANCAs, according to a small real-world case series.
In all three reported cases, AstraZeneca’s treatment resulted in a fast and complete depletion of eosinophils, immune cells commonly elevated in people with EGPA, eased symptoms, and helped reduce or discontinue standard corticosteroids.
Corticosteroids are a type of anti-inflammatory and immunosuppressive medication commonly used in EGPA, but their long-term use is associated with serious side effects.
“The presented cases provide preliminary real-world observations suggesting that [Fasenra] may be a promising rescue and [corticosteroid-sparing] therapeutic option in selected patients with severe, eosinophilic, ANCA-negative EGPA [resistant] to conventional immunosuppressive therapy,” researchers wrote.
Still, they emphasized that larger studies are needed to confirm these findings.
The cases were described in the study “Benralizumab as a steroid-sparing rescue therapy in ANCA-negative eosinophilic granulomatosis with polyangiitis: real-world experience from three cases and review of the literature,” which was published in Rheumatology International. AstraZeneca was not involved in this study.
Corticosteroids reduced or discontinued in all 3 cases
EGPA is the rarest form of ANCA-associated vasculitis (AAV), a group of autoimmune diseases marked by inflammation and damage to small blood vessels. The abnormal immune attacks that drive AAV are typically associated with self-reactive antibodies called ANCAs.
The rare form is characterized by the formation of immune cell clumps (granulomas) and high blood levels of eosinophils. EGPA commonly affects the lungs and upper airways, leading to asthma-like symptoms. Most patients test negative for ANCAs.
Fasenra is an antibody-based therapy approved for adults with EGPA. In both clinical trials and real-world-studies, it has been shown to reduce eosinophil levels, symptoms, and the need for corticosteroids.
In this study, a team of researchers in Poland — where Fasenra has been reimbursed for EGPA since July 2025 — retrospectively analyzed data from the first EGPA patients treated with Fasenra at their centers.
All three cases had severe, ANCA-negative EGPA marked by an eosinophilic profile (high eosinophil counts) and lung manifestations. In addition to the lungs, the sinuses (air-filled cavities around the nose, eyes, and forehead), skin, and/or the heart were also affected.
Their symptoms were not effectively controlled with corticosteroids or other immunosuppressive treatments. After starting Fasenra, all three patients experienced rapid and sustained depletion of eosinophils, along with a reduction in their main EGPA symptoms.
These responses allowed the early reduction of corticosteroid doses, or their discontinuation, in all cases.
Girl saw improvements in lung function, asthma symptoms
The first case involved an 18-year-old girl with severe respiratory symptoms, chronic sinus disease, skin lesions, and heart involvement. After starting Fasenra, her eosinophils fell to zero within seven days. Her lung function improved, and her asthma and sinus symptoms were reduced.
Her skin lesions did not come back and heart abnormalities observed on MRI scans were resolved. She was able to discontinue corticosteroids.
The second patient, a 68-year-old man with a long history of smoking, experienced severe and recurrent skin lesions, fever, joint pain, and asthma-like symptoms. He had received several diagnoses and treatments over the years.
Within four hours of his first Fasenra dose, he experienced a marked reduction in skin manifestations. Eosinophils were fully depleted and levels of IgE, a type of antibody commonly elevated in people with EGPA, fell by more than half. Glucocorticoids were discontinued.
These observations suggest that [Fasenra] may represent a potentially useful therapeutic option in selected patients with severe, [corticosteroid-dependent], and [treatment-resistant] eosinophilic EGPA; however, conclusions regarding efficacy and safety remain limited by the small retrospective nature of the presented case series.
The third patient was a 47-year-old woman with lung and sinus involvement, as well as severe heart disease. Fasenra led to a complete eosinophil depletion and normalization of inflammatory markers, allowing her corticosteroid dose to be reduced to 5 mg per day. She also reported improved physical performance and reduced sinus symptoms, with sustained remission for about six months.
The researchers suggested that the rapid and profound reduction in eosinophils may be related to how Fasenra works. It binds to interleukin-5 receptor proteins on eosinophils, triggering the cells’ destruction by immune cells, which can lead to near-complete eosinophil depletion within days.
“These observations suggest that [Fasenra] may represent a potentially useful therapeutic option in selected patients with severe, [corticosteroid-dependent], and [treatment-resistant] eosinophilic EGPA; however, conclusions regarding efficacy and safety remain limited by the small retrospective nature of the presented case series,” the team wrote.
The researchers emphasized that larger studies and direct comparisons with Nucala (mepolizumab), another EGPA-approved treatment, are needed to determine the treatment’s optimal role in the disease.
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