S925 Benralizumab for Eosinophilic Esophagitis: A Systematic Review With a Focused Meta-Analysis

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; randomized controlled trials, cohorts, or cross-sectional studies reporting odds ratios or hazard ratios with 95% confidence intervals (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. Conclusion: 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.