Eosinophil Depletion with Benralizumab for Eosinophilic Esophagitis.
Humans
Eosinophilic Esophagitis
/ drug therapy
Antibodies, Monoclonal, Humanized
/ therapeutic use
Male
Double-Blind Method
Eosinophils
Female
Adolescent
Middle Aged
Adult
Child
Young Adult
Aged
Deglutition Disorders
/ etiology
Leukocyte Count
Interleukin-5 Receptor alpha Subunit
/ antagonists & inhibitors
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
27 Jun 2024
27 Jun 2024
Historique:
medline:
26
6
2024
pubmed:
26
6
2024
entrez:
26
6
2024
Statut:
ppublish
Résumé
Benralizumab is an eosinophil-depleting anti-interleukin-5 receptor α monoclonal antibody. The efficacy and safety of benralizumab in patients with eosinophilic esophagitis are unclear. In a phase 3, multicenter, double-blind, randomized, placebo-controlled trial, we assigned patients 12 to 65 years of age with symptomatic and histologically active eosinophilic esophagitis in a 1:1 ratio to receive subcutaneous benralizumab (30 mg) or placebo every 4 weeks. The two primary efficacy end points were histologic response (≤6 eosinophils per high-power field) and the change from baseline in the score on the Dysphagia Symptom Questionnaire (DSQ; range, 0 to 84, with higher scores indicating more frequent or severe dysphagia) at week 24. A total of 211 patients underwent randomization: 104 were assigned to receive benralizumab, and 107 were assigned to receive placebo. At week 24, more patients had a histologic response with benralizumab than with placebo (87.4% vs. 6.5%; difference, 80.8 percentage points; 95% confidence interval [CI], 72.9 to 88.8; P<0.001). However, the change from baseline in the DSQ score did not differ significantly between the two groups (difference in least-squares means, 3.0 points; 95% CI, -1.4 to 7.4; P = 0.18). There was no substantial between-group difference in the change from baseline in the Eosinophilic Esophagitis Endoscopic Reference Score, which reflects endoscopic abnormalities. Adverse events were reported in 64.1% of the patients in the benralizumab group and in 61.7% of those in the placebo group. No patients discontinued the trial because of adverse events. In this trial involving patients 12 to 65 years of age with eosinophilic esophagitis, a histologic response (≤6 eosinophils per high-power field) occurred in significantly more patients in the benralizumab group than in the placebo group. However, treatment with benralizumab did not result in fewer or less severe dysphagia symptoms than placebo. (Funded by AstraZeneca; MESSINA ClinicalTrials.gov number, NCT04543409.).
Sections du résumé
BACKGROUND
BACKGROUND
Benralizumab is an eosinophil-depleting anti-interleukin-5 receptor α monoclonal antibody. The efficacy and safety of benralizumab in patients with eosinophilic esophagitis are unclear.
METHODS
METHODS
In a phase 3, multicenter, double-blind, randomized, placebo-controlled trial, we assigned patients 12 to 65 years of age with symptomatic and histologically active eosinophilic esophagitis in a 1:1 ratio to receive subcutaneous benralizumab (30 mg) or placebo every 4 weeks. The two primary efficacy end points were histologic response (≤6 eosinophils per high-power field) and the change from baseline in the score on the Dysphagia Symptom Questionnaire (DSQ; range, 0 to 84, with higher scores indicating more frequent or severe dysphagia) at week 24.
RESULTS
RESULTS
A total of 211 patients underwent randomization: 104 were assigned to receive benralizumab, and 107 were assigned to receive placebo. At week 24, more patients had a histologic response with benralizumab than with placebo (87.4% vs. 6.5%; difference, 80.8 percentage points; 95% confidence interval [CI], 72.9 to 88.8; P<0.001). However, the change from baseline in the DSQ score did not differ significantly between the two groups (difference in least-squares means, 3.0 points; 95% CI, -1.4 to 7.4; P = 0.18). There was no substantial between-group difference in the change from baseline in the Eosinophilic Esophagitis Endoscopic Reference Score, which reflects endoscopic abnormalities. Adverse events were reported in 64.1% of the patients in the benralizumab group and in 61.7% of those in the placebo group. No patients discontinued the trial because of adverse events.
CONCLUSIONS
CONCLUSIONS
In this trial involving patients 12 to 65 years of age with eosinophilic esophagitis, a histologic response (≤6 eosinophils per high-power field) occurred in significantly more patients in the benralizumab group than in the placebo group. However, treatment with benralizumab did not result in fewer or less severe dysphagia symptoms than placebo. (Funded by AstraZeneca; MESSINA ClinicalTrials.gov number, NCT04543409.).
Identifiants
pubmed: 38924732
doi: 10.1056/NEJMoa2313318
doi:
Substances chimiques
benralizumab
71492GE1FX
Antibodies, Monoclonal, Humanized
0
Interleukin-5 Receptor alpha Subunit
0
Banques de données
ClinicalTrials.gov
['NCT04543409']
Types de publication
Journal Article
Randomized Controlled Trial
Multicenter Study
Clinical Trial, Phase III
Langues
eng
Sous-ensembles de citation
IM
Pagination
2252-2263Investigateurs
Fabio Almerigogna
(F)
Ignacio Antepara Ercoreca
(I)
Ana María Alonso Llamazares
(AM)
Laurent Alric
(L)
Dhandapani Ashok
(D)
Kevin Bax
(K)
Lindsey McLeish
(L)
María Basagaña Torrentó
(M)
Amir Ben Tov
(A)
Adi Anafy
(A)
Dmitry S Bordin
(DS)
Elen R Valitova
(ER)
Albert J Bredenoord
(AJ)
M Laura Haasnoot
(ML)
Aaltje Lei
(A)
Marco Caminati
(M)
Mirna Chehade
(M)
Constanza Ciriza de Los Ríos
(C)
Steven Clayton
(S)
Anca Mihaela Safta
(AM)
Prerana Williamson
(P)
Elżbieta Czkwianianc
(E)
Wit Danilkiewicz
(W)
Nicola De Bortoli
(N)
Santino Marchi
(S)
Evan Dellon
(E)
Anjan Dhar
(A)
Rafael Firszt
(R)
Natalia Filipof
(N)
Ronald Fogel
(R)
Yasuhiro Fujiwara
(Y)
Beata Gawdis-Wojnarska
(B)
Maciej Gonciarz
(M)
Nirmala Gonsalves
(N)
Frédéric Gottrand
(F)
Matthieu Antoine
(M)
Ian M Gralnek
(IM)
Matthieu Groh
(M)
Catherine Nizou
(C)
Mar Guilarte Clavero
(M)
Laura Company-Sapiña
(L)
Ingrid Johana Gil
(IJ)
Paula Galván-Blasco
(P)
Thirumazhisai Gunasekaran
(T)
Jamal Hayat
(J)
Samantha Baillie
(S)
Attah Ocholi
(A)
Abigail Seward
(A)
Enrico Heffler
(E)
Alessandro Repici
(A)
Gaia Pellegatta
(G)
Francesca Racca
(F)
Navneet Hundal
(N)
Norihisa Ishimura
(N)
Eiko Okimoto
(E)
Anand S Jain
(AS)
Halley Fowler
(H)
Maria Janiak
(M)
Jayaprakash Kamath
(J)
Showkat Hossain
(S)
Sergey Kashin
(S)
Jun Kato
(J)
Sibylle Koletzko
(S)
Hannes Leon
(H)
Tobias Schwerd
(T)
Bartosz Korczowski
(B)
Michał Korczowski
(M)
Natalya Krasnopeeva
(N)
Santhosh Kumar
(S)
Guillaume Lefevre
(G)
Jaroslaw Leszczyszyn
(J)
John Leung
(J)
Evan Cunningham
(E)
Joel Liem
(J)
Lindsay Douglas
(L)
Tracey Bondy
(T)
Delina Copland
(D)
Amanda Vieira
(A)
Maxime Luu
(M)
Kristle Lee Lynch
(KL)
Jonathan Matz
(J)
François Mion
(F)
Sabine Roman
(S)
Ziva Mrevlje-Roman
(Z)
Zdenka Cipinova
(Z)
Rosa Muñoz-Cano
(R)
Gemma Lopez
(G)
Jason Ohayon
(J)
Sibgha Rehman
(S)
Vaidehi Bhatt
(V)
Gurnoor Walia
(G)
Robert Pesek
(R)
Erin Thomas
(E)
Safin Attwal
(S)
Kathryn Peterson
(K)
Amy Holman
(A)
Mohammed Mannan
(M)
Anupama Ravi
(A)
Imad Absah
(I)
Puanani Hopson
(P)
Yehuda Ringel
(Y)
Marc Rothenberg
(M)
Kara Kliewer
(K)
Cristin Murray Petzold
(C)
Vincent Mukkada
(V)
Phil Putnam
(P)
Scott Bolton
(S)
Justin Schwartz
(J)
Pablo Abonia
(P)
Erinn Kellner
(E)
Ashley Devonshire
(A)
Frederick Ruthardt
(F)
Cecilio Santander Vaquero
(C)
Sergio Casabona Francés
(S)
Teresa Pérez Fernandez
(T)
Verónica Martin Domínguez
(V)
Pedro Majano Rodriguez
(P)
Francisca Molina Jiménez
(F)
Jennifer Fernandez Pacheco
(J)
Ellen Sher
(E)
Gary Gross
(G)
Jacqueline Ross
(J)
Ulyana Trytko
(U)
Peter Siersema
(P)
Dareen Siri
(D)
María Luisa Somoza Álvarez
(ML)
Kathrin Sprinzl
(K)
Anna Stanziola
(A)
Miguel Stein
(M)
Robert Szalewski
(R)
Vinay Mehta
(V)
Alexander Trukhmanov
(A)
Vladimir Ivashkin
(V)
Tatiana Lapina
(T)
Toshio Uraoka
(T)
Christoph Schlag
(C)
Simon Weidlich
(S)
Jörg Ulrich
(J)
Bas Weusten
(B)
Phillip Woodland
(P)
William Yang
(W)
Patrizia Zentilin
(P)
Manuele Furnari
(M)
Elisabetta Giuliana
(E)
Giorgia Bodini
(G)
Elisa Marabotto
(E)
Frank Zerbib
(F)
Noam Zevit
(N)
Maciej Żymła
(M)
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