Real-world Outcomes of Benralizumab in EGPA: A 24-Patient Series from a Severe Asthma Clinic in North India

Abstract

ABSTRACT:
INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a small- medium vessel vasculitis that has multisystem involvement. It is mostly seen in severe bronchial asthma patients. Eosinophils play a major pathological role in both the diseases. Targeted monoclonal antibodies have been emerging as a pivotal part of treatment. AIM: To study the clinical, radiological profile of patients of Eosinophilic granulomatosis with Polyangiitis (EGPA) and the response to treatment. Methods: A prospective study conducted in 24 confirmed EGPA patients at a tertiary care center in India. Clinical features, radiological patterns, laboratory markers, lung function parameters, and symptom scores were recorded at baseline and after 3 months of Benralizumab therapy. RESULTS: The mean age of cohort was 57.7 14.4 years, with females 54.2%. Asthma was present in 83.3% patients. 83.3% showed AEC >150 while P-ANCA was positive in 41.7% cases. Ground-glass opacities were the most common hrct chest finding (54.2%). Sinonasal disease occurred in 71%, skin involvement in 50%, and neuropathy in 20.8% cases. After 3 months of Benralizumab, significant improvements were observed across clinical and biomarker domains. Mean AEC decreased from 671 to 288 cells/L (p < 0.001), and mean total IgE declined from 1193 to 558 kU/L (p < 0.001). FEV?% predicted improved from 55% to 71% (p < 0.001). Number of patients with FeNO level <25 ppb increased from 41.7% to 83.3% (p <0.002). The mean ACT improved from 15 to 20 (p <0.001), indicating better symptomatic control. CONCLUSION: Patients with EGPA demonstrated characteristic clinical and radiological patterns, with early diagnosis enabled by 2022 EULAR criteria. Benralizumab produced significant improvements in eosinophilia, lung function, and symptom control within 3 months, supporting its role as an effective targeted therapy. Early recognition and biologic intervention may help prevent long-term organ damage and improve patient outcomes.