The European Commission has granted approval to Fasenra (benralizumab) for use as an add-on therapy in adult patients suffering from relapsing or treatment-resistant eosinophilic granulomatosis with polyangiitis (EGPA), a rare form of ANCA-associated vasculitis (AAV). This decision marks a significant advancement in the treatment landscape for this challenging condition, offering a new option for patients who have not responded adequately to existing therapies.
The approval is based on data from the Phase 3 MANDARA trial (NCT04157348), which evaluated the efficacy and safety of Fasenra in 140 adults with EGPA. The study compared Fasenra to Nucala (mepolizumab), the only other approved therapy for EGPA, demonstrating that Fasenra was non-inferior in promoting disease remission. Nearly 60% of participants treated with Fasenra in addition to standard treatment achieved disease remission, and 41% were able to discontinue oral glucocorticoids, approximately 1.5 times greater than was seen with Nucala.
Clinical Significance of Fasenra in EGPA Treatment
EGPA is a rare autoimmune disease characterized by inflammation and damage to small blood vessels, often accompanied by elevated eosinophil counts. Patients with EGPA can experience a range of debilitating symptoms, including severe eosinophilic asthma, organ damage, and even death. Current treatment strategies often involve the use of oral corticosteroids, which can lead to serious and long-term side effects.
According to Bernhard Hellmich, MD, chair of the University of Tübingen’s Teaching Hospital and codirector of the Vasculitis Center Tübingen-Kirchhei, the approval of Fasenra provides an important treatment option for people living with EGPA in the EU. "By directly targeting and removing eosinophilic inflammation with [Fasenra], I hope that we will see more patients achieve remission as well as a reduction in the reliance on oral corticosteroids, which can cause serious and long-term side effects," said Hellmich.
Mechanism of Action and Administration
Fasenra is a monoclonal antibody that targets the interleukin-5 receptor alpha (IL-5Rα), a protein expressed on eosinophils. By binding to IL-5Rα, Fasenra inhibits the signaling of interleukin-5 (IL-5), a key cytokine involved in the development, maturation, and survival of eosinophils. This mechanism of action leads to the depletion of eosinophils, thereby reducing eosinophil-mediated inflammation in EGPA patients.
A key advantage of Fasenra is its convenient once-monthly administration via a single 30 mg subcutaneous injection. In contrast, Nucala requires three separate 100 mg subcutaneous injections every four weeks. This reduced injection burden may improve patient adherence and quality of life.
Implications for EGPA Patients
The approval of Fasenra in the EU represents a significant step forward in the management of EGPA. With its proven efficacy in inducing disease remission and reducing the need for oral corticosteroids, Fasenra offers a valuable new treatment option for patients with relapsing or treatment-resistant EGPA. The convenience of a single monthly injection further enhances its appeal, potentially improving treatment adherence and overall outcomes for this vulnerable patient population.
