The Phase 3 MANDARA trial was specifically designed to compare the efficacy of Fasenra (benralizumab) with Nucala (mepolizumab) in the management of EGPA. The study encompassed 140 adult patients with difficulty in treating EGPA who were receiving oral corticosteroids, evaluating the ability of Fasenra to reduce steroid usage while maintaining disease remission.

What is Granulomatosis with Polyangiitis (EGPA)

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a complex condition that challenges patients and healthcare professionals. EGPA is an autoimmune disease that predominantly affects the blood vessels, leading to inflammation and systemic symptoms. 

Patients have a very high eosinophils count, and around half of them have severe (eosinophilic) asthma. The complexity of the disease necessitates the use of steroids, which, while effective, come with numerous side effects; thus, better treatment options are needed.

 Key Points:

1. Fasenra (benralizumab) and Nucala (mepolizumab) were similarly effective at inducing remission in eosinophilic granulomatosis with polyangiitis (EGPA). Still, more people on Fasenra could stop using oral corticosteroids (OCS) with fewer monthly injections.
2. It is the first trial to demonstrate that most patients can achieve remission from EGPA through treatments and eosinophil-targeting biologics.
3. Eliminating oral glucocorticoids in EGPA treatment is now achievable using eosinophil-focused therapies, though further research is necessary.

Fasenra vs. Nucala

In this trial, Fasenra matched Nucala in inducing disease remission and enabled more patients to reduce their steroid intake. Importantly, Fasenra was administered less frequently, suggesting an improved treatment regimen with potentially fewer side effects and greater patient convenience.

“The results from this trial are an important step forward for the EGPA community, as this is the first trial to demonstrate that remission from EGPA with an eosinophil-targeting biologic is achievable for the majority of patients,” Sharon Barr, executive vice president of BioPharmaceuticals R&D at AstraZeneca.

Patient Implications

This shift in treatment paradigm holds profound implications for those afflicted by EGPA. Minimising steroid usage can substantially reduce the risk of adverse effects, thereby improving the overall quality of life. 

The MANDARA trial marks a significant step forward in seeking optimal EGPA treatment. By offering a viable alternative that not only mitigates disease symptoms but also reduces steroid dependency, Fasenra could transform care and increase understanding for people with inflammatory conditions like EGPA.

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