What is the recommended dose of Fasenra (benralizumab) for Eosinophilic Granulomatosis with Polyangiitis (EGPA)?

Fasenra (Benralizumab) Dosing for EGPA

The recommended dosage of Fasenra (benralizumab) for Eosinophilic Granulomatosis with Polyangiitis (EGPA) is 30 mg administered subcutaneously once every 4 weeks. 1

Administration Details

• Fasenra is administered as a subcutaneous injection into the thigh, abdomen, or upper arm 1
• Unlike the dosing schedule for asthma (which transitions to every 8 weeks after the first 3 doses), EGPA treatment maintains the every-4-week schedule continuously 1
• Administration should be performed under healthcare provider guidance with monitoring after administration due to potential hypersensitivity reactions 1

Evidence Supporting Use in EGPA

Benralizumab has demonstrated efficacy in EGPA treatment, particularly in:

• Patients with refractory disease who have failed mepolizumab therapy 2
• Those with predominant respiratory manifestations 2
• Patients requiring glucocorticoid reduction 2

Comparative Efficacy

Recent high-quality evidence from the MANDARA trial (2024) demonstrated that:

• Benralizumab 30 mg every 4 weeks was noninferior to mepolizumab 300 mg every 4 weeks for inducing remission in EGPA 3
• Complete withdrawal of oral glucocorticoids was achieved in 41% of benralizumab patients versus 26% of mepolizumab patients 3
• Benralizumab produced greater reductions in blood eosinophil counts compared to mepolizumab 3
• Safety profiles were comparable, with fewer serious adverse events in the benralizumab group (6% vs 13%) 3

Treatment Considerations

• Benralizumab should be considered particularly for patients with:

  • EGPA refractory to mepolizumab therapy 2, 4
  • Predominant respiratory manifestations 2
  • Glucocorticoid dependence 2, 5

• Prior mepolizumab failure may be associated with:

  • Higher rates of primary failure with benralizumab (26.7% vs 5.4%) 4
  • Less frequent glucocorticoid discontinuation (14.8% vs 55.9%) 4

Monitoring Recommendations

• Assess disease activity using validated tools (e.g., Birmingham Vasculitis Activity Score) 2
• Monitor blood eosinophil counts 2
• Evaluate glucocorticoid reduction capability 2
• Watch for potential vasculitis flares, which occur in approximately 11% of patients 4

Important Caveats

• Vasculitis flares during benralizumab treatment are associated with histological evidence of vasculitis and/or ANCA positivity 4
• While benralizumab is effective for respiratory manifestations, its efficacy for systemic vasculitis manifestations may be more variable 2, 4
• Treatment response should be expected within 3-6 months of initiation 2
• The goal should be to reduce glucocorticoid dose to ≤4 mg/day of prednisone or equivalent 2

Benralizumab represents a valuable treatment option for EGPA, with strong evidence supporting its use at the 30 mg every 4 weeks dosage, particularly for patients with predominant respiratory manifestations or those requiring glucocorticoid reduction.