Mepolizumab Versus Benralizumab for the Treatment of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review and Meta-Analysis

Background: IL-5 inhibitors are effective at inducing remission in EGPA but the comparative benefit of specific drugs has been poorly studied. Methods: A comprehensive search of PubMed and EMBASE was conducted on 10 October 2025 to identify all studies that directly compare mepolizumab with benralizumab in the treatment of EGPA. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 and ROBINS-I V2 tools. Data extraction and statistical analysis were performed using RevMan software to calculate Odds’ Ratios and assess heterogeneity with the I2 statistic. Results: Three studies including a total of 365 participants were analyzed. All patients failed prior treatment, and most patients had a BVAS > 2 and glucocorticoid doses of 10 mg or higher. There was no difference in induction of clinical remission with mepolizumab as compared to benralizumab (OR 0.66 [95% CI 0.43–1.01], I2 = 0%). There was decreased odds of glucocorticoid discontinuation with mepolizumab (OR 0.61 [95% CI: 0.38–0.99], I2 = 0%). There was no difference in achieving glucocorticoid dose less than 5 mg (OR 0.73 [95% CI: 0.18–2.91], I2 = 26%), adverse events (OR 1.26 [95% CI: 0.51–3.12], I2 = 8%), or adverse events requiring discontinuation of therapy (OR 0.62 [95% CI: 0.21–1.85], I2 = 62%). Conclusions: Both benralizumab and mepolizumab effectively induced remission in EGPA. There was a reduced odds of glucocorticoid discontinuation with mepolizumab thus there is a need for prospective head-to-head trials powered to detect a relative glucocorticoid-sparing effect to further assess this finding.