Efficacy and safety of biologics for eosinophilic granulomatosis with polyangiitis: a network meta-analysis

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis affecting small-to-medium size vessels, characterized by eosinophil infiltration and extravascular granulomas in multiple organs. Biologics have emerged as promising therapeutic options for EGPA management, and this network meta-analysis aimed to comprehensively compare their efficacy and safety profiles.

A systematic literature search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, and Clinicaltrial.gov (inception-15 October 2025) for studies of biologics in adult EGPA patients. Network meta-analysis with a random-effects model was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome (remission rate), secondary outcomes (oral corticosteroid [OCS] dose and relapse rate), and adverse events (AEs) were compared.

Seventeen articles involving 1150 participants and 4 biologics (mepolizumab, benralizumab, rituximab, and omalizumab) were included. Compared to conventional therapy/placebo, benralizumab (OR = 6.18, 95% CI: 1.98-19.31) and mepolizumab (300 mg: OR = 5.83, 95% CI: 2.00-17.02; 100 mg: OR = 3.70, 95% CI: 1.26-10.92) were associated with the phase 3 Mepolizumab in Relapsing or Refractory EGPA (MIRRA)-defined remission of EGPA patients. Benralizumab and mepolizumab (300 mg) also exhibited favorable performance in reducing OCS dosage, and preventing asthma relapse or vasculitis relapse. Notably, the overall and serious AE rates of biologics were comparable to conventional therapy or placebo.

Benralizumab and mepolizumab were potentially associated with clinical remission and OCS usage reduction for EGPA patients, with safety profiles similar to placebo.