Rigor Reviewed

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Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial.

Name: Adcurare Rigor Record — Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial.
Item: Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial.
Rating: 96
Author: Adcurare

Ogbogu PU, Roufosse F, Akuthota P, Kuna P, Groh M, Reiter A, Yokota A, Siddiqui SH, Mutsaers PGNJ, Li B, Khoury P, Bahadori LM, Bednarczyk A, Bouma G, Brooks LG, Ferreira J, Grindebacke H, Ho CN, Jain P, Palmer RL, Jison ML, Klion AD, NATRON study group

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Adcurare Rigor Review — 3.25★ (Adequate), 0 critical, 6 high issues for “Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial.”

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Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 6, 2026

Adcurare Rigor Review

Rigor Reviewed

3.25 / 5

Adequate — real issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×3−1.5★
ReportingKey resources partially met−0.25★

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

Problems surfaced2 types

Key resources under-identified (antibodies, cell lines, RRIDs)
Internal contradictions in the reported numbers

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The paper reports a well-designed phase 3 RCT with strong methodology in most dimensions. Two dimensions (key_resources and statistical_analysis) have minor reporting gaps: the SAS version is missing, model assumptions are not verified, and Table 1 race counts inexplicably sum below the group total. These gaps are fixable and do not undermine the core findings.

Three independent AI models scored all eight dimensions on the full text; a copyedit pass and verification components (statistics, citation, reproducibility, integrity, claim audit) provided supplementary checks. All three reviewers agreed on most dimensions; the synthesis weighted specific verifiable evidence (e.g., missing assumption check, missing race data) above general impressions.

12 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 13 tests: 13 consistent, 0 inconsistent, 13 via agent-written checks.

3 integrity concerns flagged (0 high).

Reporting

Eight Dimensions7 pass · 1 warn

The introduction cites prior studies on HES epidemiology, the limited efficacy and toxicity of corticosteroids/immunosuppressants, the phase 3 mepolizumab trial, and the phase 2 benralizumab study. It provides a logical rationale that IL-5 receptor blockade may benefit patients who do not respond to mepolizumab. The strengths and weaknesses of existing therapies are discussed (e.g., 'treatment responses vary' and 'some patients do not achieve a clinical response'). The study's objectives and hypothesis follow logically from the cited evidence.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper clearly establishes the scientific premise: HES is a rare, heterogeneous disease with limited treatment options beyond corticosteroids; mepolizumab (anti-IL-5) has variable responses, and benralizumab (anti-IL-5 receptor α) offers a more direct eosinophil-depleting approach, supported by prior phase 2 data. Limitations of prior therapies are acknowledged.

Evidence

direct quote[Introduction, paragraph 4]

“Results from two clinical trials demonstrated that mepolizumab... reduced disease flares compared to placebo and had corticosteroid-sparing effects... However, treatment responses vary.”

direct quote[Introduction, paragraph 6]

“The central role of eosinophilic inflammation... suggests that a more direct eosinophil-depleting approach may also be beneficial.”

direct quote[Introduction, paragraph 3]

“Treatment for patients with nonmyeloid HES typically involves the use of corticosteroids and/or immunosuppressive or cytotoxic therapies, which can reduce inflammation and control symptoms but often lead to adverse effects and may still result in suboptimal disease control.”

PASSReviewer 2· 95% conf

The paper firmly establishes the scientific premise by citing prior research on HES, mepolizumab, and benralizumab, providing a logical rationale for the study, and addressing limitations of existing therapies.

Evidence

direct quote[Main, paragraph 3]

“While the approval of mepolizumab for HES has improved clinical outcomes, treatment responses vary. Some patients do not achieve a clinical response, or respond only partially to mepolizumab, highlighting the need for alternative therapies.”

direct quote[Main, paragraph 5]

“The central role of eosinophilic inflammation… suggests that a more direct eosinophil-depleting approach may also be beneficial.”

direct quote[Main, paragraph 7]

“In a phase 2 study of patients with symptomatic, treatment-refractory FIP1L1::PDGFRA-negative HES, 90% of patients achieved a ≥50% reduction in absolute eosinophil counts…”

PASSReviewer 3· 95% conf

The paper clearly establishes the scientific foundation by citing prior research on HES and benralizumab, providing a logical rationale, and acknowledging limitations of existing therapies.

Evidence

direct quote[Introduction, paragraph 1-4]

“Hypereosinophilic syndrome (HES) is defined by the presence of hypereosinophilia and evidence of eosinophil-mediated clinical manifestations.”

direct quote[Introduction, paragraph 5]

“The central role of eosinophilic inflammation and eosinophil-mediated end organ damage in the pathophysiology of HES, as well as the efficacy of IL-5 inhibition with mepolizumab, suggests that a more direct eosinophil-depleting approach may also be beneficial.”

direct quote[Introduction, paragraph 3]

Randomization was computer-generated centrally using a permuted block design with fixed block size 4, stratified by geographic region and HES flare status at screening. Patients were randomized 1:1 to benralizumab 30 mg SC Q4W or matching placebo. Blinding was maintained for patients, sponsor, site staff, and investigators; unblinded personnel were explicitly listed. The sample size assumption (38 events, 80% power, HR 0.389) is reported. Inclusion and exclusion criteria are exhaustive (age ≥12, HES diagnosis, confirmed eosinophilia, recent flares; exclusions include FIP1L1::PDGFRA, life-threatening HES, etc.). The primary analysis set is the full analysis set (ITT). A sensitivity analysis for background therapy changes and subgroup analyses are pre-specified. An OCS-responsiveness assessment at screening ensured safety.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The study design is robust: a randomized, double-blind, placebo-controlled phase 3 trial with centralized computer-generated random allocation using permuted blocks (size 4) stratified by region and flare status. Blinding is clearly described (patients, site staff, investigators, and sponsor). A power analysis is provided, and detailed inclusion/exclusion criteria are listed. The primary analysis follows intention-to-treat principles.

Evidence

direct quote[Methods, Randomization and masking]

“The randomization sequence was computer-generated centrally using a permuted block design with a fixed block size of 4 and stratified by geographic region (North America, Europe, Asia and rest of the world) and HES flare status at screening.”

direct quote[Methods, Randomization and masking]

“Patients, sponsor, site staff and investigators were blinded to treatment allocation and to patients’ blood and biopsy leukocyte counts during the double-blind treatment period and up to week 4 of the OLE.”

direct quote[Methods, Statistical analysis]

PASSReviewer 2· 95% conf

The study design is robust with proper randomization, blinding, pre-specified inclusion/exclusion criteria, and a sample size calculation. All applicable sub-criteria for this human RCT are adequately reported.

Evidence

direct quote[Methods, Randomization and masking]

“The randomization sequence was computer-generated centrally using a permuted block design with a fixed block size of 4 and stratified by geographic region… and HES flare status at screening.”

direct quote[Methods, Randomization and masking]

“Patients, sponsor, site staff and investigators were blinded to treatment allocation and to patients’ blood and biopsy leukocyte counts during the double-blind treatment period.”

direct quote[Methods, Statistical analysis]

PASSReviewer 3· 95% conf

The study design is robust: randomization, blinding, power analysis, and inclusion/exclusion criteria are all adequately reported, meeting applicable standards for a phase 3 RCT.

Evidence

direct quote[Methods, Randomization and masking]

“All patients were centrally assigned to a randomized study treatment using Interactive Web Response Systems (IWRS)/Interactive Voice Response Systems (IVRS).”

direct quote[Methods, Statistical analysis]

“It was estimated that approximately 38 first HES flare events during the double-blind period were required to detect a statistically significant difference between treatment groups at the two-sided 5% significance level with approximately 80% power if the true treatment effect is an HR of 0.389 (equivalent to 30% of patients receiving benralizumab experiencing an event by the end of the double-blind period versus 60% of patients receiving placebo).”

direct quote[Methods, Study design]

“Patients were ≥12 years of age, had a diagnosis of HES (defined as history of persistent eosinophilia (>1,500 cells μl −1 ) without secondary cause on two examinations (≥1 month apart) and evidence of end-organ manifestations attributable to eosinophilia)... Exclusion criteria were the presence of an FIP1L1::PDGFRA fusion tyrosine kinase gene rearrangement...”

Table 1 provides detailed baseline demographics: age (median 51 years, range 14-87), sex (61.7% female, 38.3% male), race, region, time since diagnosis, eosinophil counts, HES subtypes, organ involvement, and background therapy. Age, sex, and race are reported. Sex is justified because both sexes are enrolled; no single-sex justification is needed. Health status is reflected in disease characteristics and organ involvement.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 80% conf

Age, sex, health status, and demographics are well-reported in a comprehensive baseline table. However, body weight is not reported, which is a minor omission for a drug trial with fixed dosing. Both sexes were enrolled (62% female), so sex justification is not applicable.

Evidence

direct quote[Results, Baseline demographics, Table 1]

“Overall, 62% (82/133) of patients were female, 38% (51/133) were male.”

direct quote[Results, Baseline demographics, Table 1]

“Median (range) age was 51.0 (14.0–87.0) years.”

absence[Table 1]

Weight is not reported in baseline characteristics.

PASSReviewer 2· 95% conf

Demographic and clinical characteristics are thoroughly reported, including age, sex, race, HES subtypes, organ involvement, and baseline therapy. All applicable sub-criteria are adequately covered.

Evidence

direct quote[Table 1]

“Female 43 (64.2%)… Male 24 (35.8%)… Median (range) age 49.0 (14.0–87.0)”

paraphrase[Table 1]

“Table 1 lists HES subtypes (idiopathic, lymphocytic, single-organ, EGPA/HES overlap), organ involvement (pulmonary, dermatologic, GI, etc.), and background systemic OCS doses.”

PASSReviewer 3· 95% conf

Sex, age, and detailed demographics are reported in Table 1, and health status is characterized through inclusion criteria and baseline characteristics.

Evidence

direct quote[Table 1]

“Sex: Female 43 (64.2%) [benralizumab], 39 (59.1%) [placebo]. Age (years): Median (range) 51.0 (14.0–87.0).”

direct quote[Table 1]

“Race: White 42 (72.4%)... Asian 10 (17.2%)... HES subtypes: I-HES 49 (73.1%)...”

direct quote[Table 1 and Results]

“Median (range) time since diagnosis was 1.9 (0.1–32.3) years... Around three-quarters of patients (76.7%, 102/133) were receiving background systemic OCS at enrollment.”

The Methods state that the protocol, amendments, and relevant documents were reviewed and approved by the Independent Ethics Committees/Institutional Review Boards listed in the Supplementary Information. 'All patients provided written informed consent.' The trial also includes an independent safety monitoring board. Regulatory compliance with Declaration of Helsinki and ICH GCP is stated. The paper does not explicitly name the IRB in the main text but refers to the Supplementary Information for the list, which is adequate.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval and informed consent are clearly described. The protocol was approved by Independent Ethics Committees/Institutional Review Boards (listed in the Supplementary Information). All patients provided written informed consent. The trial was conducted in accordance with the Declaration of Helsinki and ICH Good Clinical Practice guidelines.

Evidence

direct quote[Methods, Study design]

“The protocol, protocol amendments and any other relevant documents were reviewed and approved by the Independent Ethics Committees/Institutional Review Boards listed in the Supplementary Information.”

direct quote[Methods, Study design]

“All patients provided written informed consent.”

direct quote[Methods, Study design]

“The trial was conducted in accordance with the ethical principles of the Declaration of Helsinki and is consistent with the International Council for Harmonisation Good Clinical Practice guidelines.”

PASSReviewer 2· 90% conf

Ethical approvals, informed consent, and regulatory compliance are adequately reported. The IRB/ethics committee approval is documented with reference to a list in the Supplementary Information.

Evidence

direct quote[Methods, Study design]

“All patients provided written informed consent.”

direct quote[Methods, Study design]

PASSReviewer 3· 90% conf

Ethical approvals are stated: the study was conducted under Declaration of Helsinki and ICH GCP, approved by independent ethics committees/IRBs, and written informed consent was obtained from all participants.

Evidence

direct quote[Methods, Study design]

“The protocol, protocol amendments and any other relevant documents were reviewed and approved by the Independent Ethics Committees/Institutional Review Boards listed in the [referenced].”

direct quote[Methods, Study design]

“All patients provided written informed consent.”

direct quote[Methods, Study design]

Benralizumab is identified as a humanized afucosylated monoclonal antibody binding to the IL-5 receptor α subunit; the formulation is '30 mg (accessorized prefilled syringe)' administered subcutaneously every 4 weeks; manufacturer is AstraZeneca. For the software criterion, the paper states 'All data analyses were performed with SAS System (SAS Institute Inc.) software' but no version number is provided, making it reported_but_inadequate. All other resource sub-criteria (antibodies, cell lines, mycoplasma, organisms) are not applicable for a clinical trial using a biologic drug as an investigational product.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

The investigational product (benralizumab 30 mg prefilled syringe) is adequately identified with manufacturer, strength, dose, and regimen. However, the statistical software (SAS) is identified without a version number, which is a minor omission. No other biological or chemical resources (e.g., antibodies, cell lines) are applicable for this clinical trial.

Evidence

direct quote[Methods, Procedures]

“Patients were randomly assigned 1:1 into the 24-week double-blind period where they received benralizumab 30 mg (accessorized prefilled syringe) subcutaneously every 4 weeks or a matching placebo.”

direct quote[Methods, Statistical analysis]

“All data analyses were performed with SAS System (SAS Institute Inc.) software.”

WARNReviewer 2· 80% conf

The investigational product (benralizumab) is adequately identified, but the statistical software (SAS) is not reported with a version number, leading to a warn.

Evidence

direct quote[Methods, Procedures]

“Patients were randomly assigned 1:1 into the 24-week double-blind period where they received benralizumab 30 mg (accessorized prefilled syringe) subcutaneously every 4 weeks”

direct quote[Methods, Statistical analysis]

“All data analyses were performed with SAS System (SAS Institute Inc.) software.”

WARNReviewer 3· 85% conf

The investigational product (benralizumab) is adequately identified with dose and regimen, but the software used (SAS) is reported without a version number, which is a minor reporting gap.

Evidence

direct quote[Methods, Procedures]

direct quote[Methods, Statistical analysis]

“All data analyses were performed with SAS System (SAS Institute Inc.) software.”

All statistical tests are named (log-rank, Cox, logistic, negative binomial, MMRM). Exact p-values are reported (e.g., 0.0024, 0.0033, <0.0001). Effect sizes with 95% CIs are provided. Software is reported as SAS without version. Data presentation includes Kaplan-Meier curves, forest plots, and tables with per-group n. Assumptions are addressed through pre-specified models. Mathematical plausibility checks show no errors. One of 7 sub-criteria is inadequate, which is insufficient to downgrade from pass to warn.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedINADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 80% conf

Statistical tests are well-named, exact p-values are reported (with some as p < 0.0001), effect sizes and 95% CIs are provided, and data presentation follows clinical trial conventions (KM curves, forest plots, CONSORT diagram). However, model assumptions (e.g., proportional hazards for Cox model) are not explicitly verified, software version is missing, and the race counts in Table 1 do not sum to the group totals (missing race data not explained), which affects mathematical plausibility.

Evidence

direct quote[Results, Primary endpoint]

“HR 0.35, 95% CI 0.18 to 0.69, P = 0.0024)”

absence[Methods, Statistical analysis]

Model assumptions are not explicitly verified.

paraphrase[Table 1]

“In the benralizumab column, race categories sum to 58 patients, not 67; similarly for placebo 57 of 66. Missing race data is not explained.”

PASSReviewer 2· 90% conf

Statistical methods are well described with named tests, exact p-values, effect sizes and confidence intervals, and adequate data presentation. The only minor shortfall is the lack of a software version number.

Evidence

direct quote[Methods, Statistical analysis]

“Time-to-event endpoints were analyzed using a stratified log-rank test, adjusted for region. HRs and 95% CIs were estimated using a Cox proportional hazards model”

direct quote[Table 2]

“HR 0.35 (0.18 to 0.69) P=0.0024”

paraphrase[Table 2]

“Table 2 reports HR, OR, RR, and LS mean differences with 95% confidence intervals for all primary and secondary endpoints.”

PASSReviewer 3· 90% conf

All key statistical practices are reported: tests named, exact p-values and effect sizes with CIs provided, software identified (though version missing), data presentation is adequate for a clinical trial, and no arithmetic errors detected.

Evidence

direct quote[Methods, Statistical analysis and Table 2]

“Time-to-event endpoints were analyzed using a stratified log-rank test... HRs and 95% CIs were estimated using a Cox proportional hazards model.”

direct quote[Results, Table 2]

“HR 0.35 (0.18 to 0.69) P = 0.0024”

direct quote[Figure 2, Figure 3]

“Kaplan-Meier curves with number at risk shown.”

The data availability statement names AstraZeneca's data sharing policy and provides URLs for the Vivli platform, including a member page. This constitutes a concrete access route with conditions. For a clinical trial with identifiable patient data, managed access via a platform is the norm. No depositable non-identifiable datasets (e.g., sequencing) are mentioned, so repository_deposit and accession_numbers are not applicable. Custom analysis code was not shared; however, this is standard for SAS-based analyses in industry trials.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

A detailed data availability statement is provided, directing to AstraZeneca's data sharing policy and Vivli platform for requesting access to individual patient data. This managed-access route is appropriate for a pharma-sponsored trial. No code sharing or public repository deposit is applicable for this clinical trial with standard SAS analysis.

Evidence

direct quote[Data availability section]

“Data underlying the findings described in this Article can be requested in accordance with AstraZeneca’s data sharing policy available via AstraZeneca at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure . Data for studies directly listed on Vivli are available via Vivli at https://www.vivli.org .”

absence[Entire paper]

No code sharing statement is provided.

PASSReviewer 2· 95% conf

A data availability statement is provided that describes a concrete route for requesting data via the Vivli platform, which is adequate for a clinical trial with patient-level data. Code sharing and repository deposit are not applicable.

Evidence

direct quote[Data availability]

“Data underlying the findings described in this Article can be requested in accordance with AstraZeneca’s data sharing policy available via AstraZeneca at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Data for studies directly listed on Vivli are available via Vivli at https://www.vivli.org.”

WARNReviewer 3· 85% conf

A data availability statement is provided with a concrete access route via Vivli and AstraZeneca's data sharing policy, but no direct dataset identifier or repository DOI is given, and code for the statistical analyses is not shared.

Evidence

direct quote[Data availability section]

“Data underlying the findings described in this Article can be requested in accordance with AstraZeneca’s data sharing policy... Data for studies directly listed on Vivli are available via Vivli at https://www.vivli.org .”

absence[Entire paper]

No custom code shared.

Methods include full study design, eligibility criteria, randomization and blinding procedures, intervention details, outcome definitions, and statistical analysis plan. Trial registration number is provided. The paper references a Nature Portfolio Reporting Summary. All primary, key secondary, and additional secondary endpoints are reported; the SF-36 MCS result at week 24 (P = 0.0852) is reported as non-significant. Limitations are discussed in the Discussion section (small sample size, limited subgroup analysis, shorter disease duration, exclusion of life-threatening HES, 24-week double-blind period). Conclusions state 'benralizumab demonstrated efficacy and safety in the treatment of HES' and acknowledge the need for long-term data. Funding (AstraZeneca) and detailed competing interests are provided.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The manuscript is comprehensively reported: methods are detailed, the trial is registered (NCT04191304), a reporting summary (Nature Portfolio) is referenced, all pre-specified outcomes are reported (including non-significant results), limitations are discussed, conclusions are proportional to the evidence, and funding sources and competing interests are disclosed.

Evidence

direct quote[Abstract, Methods]

“ClinicalTrials.gov identifier: NCT04191304.”

direct quote[Table 2]

“Change from baseline in SF-36v2 MCS at week 24... LS means difference 2.60 (–0.4 to 5.6) | 0.0852”

direct quote[Discussion]

“First, the sample size was small owing to the rarity of the disease. Unfortunately, this limited the ability to draw conclusions on efficacy on the basis of subgroups...”

PASSReviewer 2· 95% conf

The manuscript is transparent: methods are detailed, the trial is registered, limitations are discussed, all pre-specified outcomes are reported (including non-significant results), conclusions are proportional, and funding/COI are disclosed.

Evidence

direct quote[Abstract]

“ClinicalTrials.gov identifier: NCT04191304”

direct quote[Discussion]

“First, the sample size was small owing to the rarity of the disease. Unfortunately, this limited the ability to draw conclusions on efficacy on the basis of subgroups… NATRON excluded patients with life-threatening HES… the double-blind period of the study was limited to 24 weeks.”

direct quote[Acknowledgements and Competing interests]

“The study is sponsored and funded by AstraZeneca (Södertälje, Sweden).”

PASSReviewer 3· 95% conf

The manuscript reports all key elements: detailed methods, clinical trial registration, a reporting summary (Nature Portfolio), all outcomes reported including non-significant ones, limitations discussed, conclusions proportional, and funding/COI disclosed.

Evidence

direct quote[Abstract and Methods]

“ClinicalTrials.gov identifier: NCT04191304 (http://clinicaltrials.gov/ct2/show/NCT04191304).”

direct quote[Methods, Reporting summary]

“Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.”

direct quote[Discussion, paragraph 6]

“First, the sample size was small owing to the rarity of the disease... NATRON excluded patients with life-threatening HES... the double-blind period of the study was limited to 24 weeks.”

5 copyedit issues flagged: mostly typo, consistency.

Checked 29 references: 0 verified — 29 not checked.

Reproducibility

6 data/code links checked; 6 live.

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

Adcurare Rigor Action ItemsFinal pass before journal submission

Ready after moderate revision. The manuscript is strong but, before submission, the authors must (1) add SAS version, (2) test and report proportional hazards assumptions, (3) explain the missing race data in Table 1 and the missing SF-36v2 data point for one placebo patient, and (4) fix the three copyedit typos. These are straightforward corrections that will eliminate the warns and produce a clean submission.

1.
HIGHstatistics
Test the proportional hazards assumption for the Cox model (e.g., using Schoenfeld residuals) and report the result in the Methods (Statistical analysis) section.
This is a standard assumption for time-to-event analysis; its absence is a reporting gap that a reviewer may flag.
2.
HIGHreporting
Add a footnote to Table 1 explaining why race counts sum to 58 (benralizumab) and 57 (placebo) instead of the group Ns (67 and 66); clarify whether race data were missing for 9 and 9 patients respectively.
Missing race data without explanation is an inconsistency that undermines baseline table integrity and was flagged by both a reviewer and the copyedit pass.
3.
HIGHreporting
Explain in Table 1 or Results why the SF-36v2 baseline data are reported for n=65 in placebo instead of n=66; add a footnote if one patient had missing data.
The table shows 65 placebo patients for SF-36v2 but the group total is 66; unexplained missing data raises questions about data completeness.
4.
HIGHrigor
Add the version number of SAS (e.g., 'SAS System version 9.4') in the Methods (Statistical analysis) section.
All three reviewers noted the missing version; this minor addition meets reproducibility standards and resolves the key_resources warn.
5.
HIGHcopyedit
Correct the typo 'avialable' to 'available' in the Data availability section (appears multiple times).
This typographical error is flagged by the copyedit pass and is a simple fix.
6.
HIGHcopyedit
Correct the typo 'Universtié' to 'Université' in author 5's affiliation.
This error in the author list is a copyedit issue that should be fixed before submission.
7.
MEDIUMreporting
Consider reporting body weight as a baseline demographic variable in Table 1, as it is often collected in clinical trials and may be relevant for pharmacokinetic analyses.
One reviewer noted weight is absent; while not critical for this fixed-dose trial, adding it would improve thoroughness.
8.
MEDIUMstatistics
Pre-specify and report the verification of model assumptions for the negative binomial model (e.g., overdispersion) and the mixed model (e.g., covariance structure) in the Methods (Statistical analysis).
Adding a brief note on assumption checks for secondary models would strengthen the statistical reporting.
9.
MEDIUMdata code
Include a statement about code availability in the Data availability section (e.g., 'The statistical analysis code is available from the corresponding author upon reasonable request'), even if only standard SAS procedures were used.
One reviewer flagged the absence of a code-sharing statement; adding this optional statement improves transparency without obligating public release.
10.
MEDIUMdata code
If possible, provide a study-specific persistent identifier (e.g., a DOI) for the dataset as part of the data availability statement, or note the study ID for the Vivli platform.
One reviewer noted the lack of a direct dataset identifier; while the current URL is acceptable, a DOI would improve discoverability.
11.
MEDIUMreporting
Consider listing the names and protocol numbers of the ethics committees/IRBs in the main text or as a supplementary table, rather than only referencing the Supplementary Information.
Two reviewers suggested this for maximal transparency; it is a simple enhancement.
12.
LOWreporting
Explicitly state that the study follows CONSORT guidelines and consider including a completed CONSORT checklist as supplementary material.
One reviewer recommended this; while not required, it aligns with best reporting practices.

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Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial.

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DOI

10.1038/s41591-026-04315-8

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