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Eur Respir J. 2018 Nov 29;52(5). pii: 1801393. doi: 10.1183/13993003.01393-2018. Print 2018 Nov.

Matching-adjusted indirect comparison of benralizumab versus interleukin-5 inhibitors for the treatment of severe asthma: a systematic review.

Author information

1
Dept of Respiratory Diseases, Montpellier University Hospitals, Arnaud de Villeneuve Hospital, Montpellier, France.
2
INSERM U 1046, University of Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France.
3
Institute of Health Economics, Edmonton, AB, Canada.
4
Dept of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
5
IMAG, CNRS, University of Montpellier, CHU Montpellier, Montpellier, France.
6
AstraZeneca, Gothenburg, Sweden.
7
PAREXEL International Ltd, Chandigarh, India.
8
AstraZeneca, Barcelona, Spain.
9
AstraZeneca, Gaithersburg, MD, USA.

Abstract

Benralizumab is an interleukin-5 receptor α-directed cytolytic monoclonal antibody that directly depletes eosinophils. Its relative efficacy versus other IL-5-targeted treatments for patients with severe, uncontrolled asthma is not yet fully characterised.We performed a matching-adjusted indirect comparison (MAIC) of benralizumab versus mepolizumab and reslizumab. Trials were selected through systematic review and evaluation of trial methods. Benralizumab patient-level data were weighted to match treatment-effect-modifying patient characteristics of comparator trials before indirect efficacy comparisons.After matching adjustment, benralizumab and mepolizumab reduced exacerbations versus placebo by 52% and 49%, respectively (rate ratio [RR] 0.94, 95% CI 0.78-1.13; n=1524) and reduced the rate of exacerbations requiring hospitalisation/emergency department visit by 52% and 52%, respectively (RR 1.00, 95% CI 0.57-1.75; n=1524). Benralizumab and mepolizumab similarly improved pre-bronchodilator forced expiratory volume in 1 s at 32 weeks (difference 0.03 L, 95% CI -0.06-0.12; n=1443). Benralizumab and reslizumab patient populations were too dissimilar to generate a sufficient effective sample size to produce a reliable estimate for MAIC.MAIC is a robust way to indirectly compare treatment efficacies from trials with heterogeneous patient populations. When baseline patient characteristics were matched across asthma trials, benralizumab and mepolizumab yielded similar efficacy.

PMID:
30309978
PMCID:
PMC6277255
DOI:
10.1183/13993003.01393-2018
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflict of interest: A. Bourdin reports personal fees, non-financial support and other support from AstraZeneca, Novartis, Chiesi Pharmaceuticals and Actelion; grants, personal fees and other support from GSK; grants, personal fees, non-financial support and other support from Boehringer Ingelheim; personal fees and other support from Teva and Regeneron; other support from Gilead; and personal fees and non-financial support from Roche, outside the submitted work. Conflict of interest: D. Husereau is a board/advisory committee member for and received financial support from AstraZeneca, and received grants and personal fees for board/advisory committee membership from GSK, outside the submitted work. Conflict of interest: N. Molinari has nothing to disclose. Conflict of interest: S. Golam is an employee of AstraZeneca. Conflict of interest: M.K. Siddiqui is an employee of PARAXEL International, and performed the analysis on behalf of AstraZeneca. Conflict of interest: L. Lindner is an employee of AstraZeneca. Conflict of interest: X. Xu is an employee of AstraZeneca.

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