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

Recommended Dosage of Fasenra (Benralizumab) for EGPA

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

Dosing Regimen and Administration

• Unlike the dosing schedule for asthma (which follows a Q4W for first 3 doses, then Q8W thereafter), EGPA requires consistent Q4W dosing
• Administration should be subcutaneous into the thigh, abdomen, or upper arm 1
• Fasenra is intended for use under healthcare provider guidance, with monitoring after administration recommended 1

Patient Selection for Fasenra in EGPA

• Fasenra can be considered for EGPA patients who:
  • Have disease refractory to mepolizumab therapy 2
  • Present with predominant respiratory manifestations 2
  • Are glucocorticoid-dependent 2

Clinical Evidence and Efficacy

• Recent evidence from the MANDARA trial (2024) demonstrated that benralizumab 30 mg Q4W was noninferior to mepolizumab 300 mg Q4W for inducing remission in relapsing or refractory EGPA 3
• In this trial, 59% of patients in the benralizumab group achieved remission at weeks 36 and 48, compared to 56% in the mepolizumab group 3
• Benralizumab allowed complete withdrawal of oral glucocorticoids in 41% of patients, compared to 26% with mepolizumab 3

Treatment Strategy in EGPA Management

• For remission induction in new-onset, active EGPA:

  • Glucocorticoids are the initial therapy for all patients 4
  • In severe disease (with unfavorable prognostic factors), cyclophosphamide or rituximab should be added 4
  • In non-severe disease, glucocorticoids alone are recommended initially 4

• For remission maintenance:

  • In severe EGPA: rituximab, mepolizumab, or traditional DMARDs in combination with glucocorticoids 4
  • In non-severe EGPA: glucocorticoids alone or with mepolizumab 4
  • Benralizumab represents an alternative option, particularly for patients with refractory disease 2

Monitoring and Response Assessment

• Monitor disease activity using validated tools (e.g., Birmingham Vasculitis Activity Score) 2
• Track blood eosinophil counts, which typically decrease significantly with treatment 3
• Evaluate glucocorticoid reduction capability 2
• Clinical response is expected within 3-6 months of initiation 2

Safety Considerations

• Benralizumab appears to have a favorable safety profile in EGPA patients 3
• In comparative studies, serious adverse events were reported in 6% of benralizumab-treated patients versus 13% with mepolizumab 3
• Caution is warranted in patients with histological evidence of vasculitis and/or ANCA positivity, as vasculitis flares have been reported in this subgroup 5

Important Clinical Pearls

• Prior mepolizumab failure may predict lower response rates to benralizumab 5
• Benralizumab may be more effective for controlling respiratory and ENT manifestations than systemic vasculitic features 5
• The goal of therapy should be to reduce glucocorticoid dose to ≤4 mg/day of prednisone or equivalent 2