Reslizumab Compared with Benralizumab in Patients with Eosinophilic Asthma: A Systematic Literature Review and Network Meta-Analysis

Publication date: Available online 11 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Thomas B. Casale, Maud Pacou, Laura Mesana, Gaelle Farge, Shawn X. Sun, Mario Castro

Background

The interaction of interleukin (IL)-5 with its receptor on eosinophils increases the activation and maintenance of eosinophils; blocking this interaction reduces asthma symptoms in patients with the eosinophilic phenotype. Reslizumab, which binds to IL-5, and benralizumab, which targets the IL-5 receptor α subunit, have not been compared in head-to-head trials.

Objective

To indirectly compare reslizumab with benralizumab in similar patient populations using a network meta-analysis.

Methods

A systematic literature review was conducted and a network meta-analysis was performed on eligible studies using the Markov Chain Monte Carlo simulation method and a Bayesian statistical framework.

Results

Eleven studies were identified, 4 of which evaluated clinically relevant doses and had outcomes at similar time points. To control for population differences, subgroups were selected for the base-case efficacy analysis: a benralizumab subgroup with blood eosinophil levels ≥300 cells/μL (n = 1537) and a reslizumab subgroup in GINA step 4/5 with ≥2 prior exacerbations and ≥400 eosinophils/μL (n = 318). Safety was analyzed in the full population (N = 3462). Reslizumab significantly improved Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ) scores compared with benralizumab Q4W and there were reasonably high posterior probabilities that reslizumab is superior to benralizumab Q4W and Q8W for ACQ score, AQLQ score, FEV₁, and clinical asthma exacerbations.

Conclusions

This indirect comparison suggests reslizumab may be more efficacious than benralizumab in patients with eosinophilic asthma in GINA step 4/5 with elevated blood eosinophil levels (benralizumab, ≥300/μL; reslizumab, ≥400/μL) and ≥2 exacerbations in the previous year.