P2745 - Benralizumab for Eosinophilic Esophagitis: A Systematic Review With a Focused Meta-Analysis

Gedion Yilma Amdetsion, MD¹, Chun-wei Pan, MD¹, Hiwot G. Tebeje, MD, MPH², Rena Yadlapati, MD³
1Cook County Health, Chicago, IL; 2Washington University in St. Louis, Saint Louis, MO; 3University of California San Diego, San Diego, CA

Introduction: Eosinophilic esophagitis (EOE) is defined as a chronic, immune/antigen-mediated, esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Usually managed with food avoidance and proton pump inhibitors, refractory cases have prompted investigation into biologics. Interest in benralizumab, given its benefits in other eosinophilic disorders, is rising.

Methods: This systematic review followed PRISMA guidelines. We searched PubMed, Scopus, Cochrane, Embase, and Web of Science from inception to March 23, 2025, for studies on benralizumab in EOE. Human studies without language restrictions were included; RCTs, cohorts, or cross-sectional studies reporting ORs or HRs with 95% CIs were eligible. Case reports, reviews, guidelines, commentaries, and editorials were excluded.

Results: Out of 98 potentially eligible studies, 7 met our criteria; however, only 2 studies were suitable for a focused meta-analysis. The pooled analysis revealed a large, significant reduction in eosinophils (Cohen’s d = -1.45, 95% CI: -2.02 to -0.89, p < 0.001). In contrast, histologic response showed a moderate effect size favoring treatment (Cohen’s d = -0.72, 95% CI: -1.56 to 0.11, p = 0.09). Notably, significant symptom reduction was not consistently observed.

Discussion: Benralizumab is associated with a significant reduction in eosinophil levels in EOE. However, the modest histologic response and the discordance with symptomatic improvement highlight the need for further studies to clarify underlying mechanisms and optimize treatment strategies.


Figure: Fig. 1 Forrest plot: showing the impact of Benerlizumab on eosinophils


Figure: Fig. 1 Forrest plot: showing the impact of Benerlizumab on Histologic grade

Disclosures:
Gedion Yilma Amdetsion indicated no relevant financial relationships.
Chun-wei Pan indicated no relevant financial relationships.
Hiwot Tebeje indicated no relevant financial relationships.
Rena Yadlapati: Braintree – Consultant. Medtronic – Consultant. Phathom Pharmaceuticals – Consultant. Reckitt Benckiser – Consultant. RJSMediagnostix – Advisory Committee/Board Member.

Gedion Yilma Amdetsion, MD¹, Chun-wei Pan, MD¹, Hiwot G. Tebeje, MD, MPH², Rena Yadlapati, MD³. P2745 - Benralizumab for Eosinophilic Esophagitis: A Systematic Review With a Focused Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.