Inconsistent results have been reported regarding IL-5 blockade treatment in 
asthma. There were no direct between-treatment comparisons. Only differences 
between each drug and placebo were studied. We identified all RCTs with anti-IL5 
treatments for patients with asthma over the 1990-September 2015 period. RCTs 
were searched on Medline, Cochrane and Embase. At least 50 patients were 
enrolled in each study. Outcomes considered were exacerbation rate reduction, 
FEV1 changes, ACQ-5 improvement, adverse events and serious adverse events. A 
global meta-analysis was first conducted followed by an indirect comparison of 
each IL-5-targeting drug: benralizumab, reslizumab and mepolizumab. Further 
eosinophilic subgroup analysis and sensitivity analysis were also conducted in 
case of heterogeneity. Ten trials involving 3421 patients were eligible for 
meta-analysis. IL-5 blockade significantly reduced annual exacerbation rates vs. 
placebo by 40% [29-50] (P < 0.01, I2 = 0.61). ACQ-5 was significantly improved 
vs. placebo but below the recognized MCID level (-0.31 [-0.41, -0.21], P < 0.01, 
I2 = 0.11). FEV1 changes from baseline were improved vs. placebo by 0.09 L 
[0.05-0.12] (P < 0.01, I2 = 0.28). The subgroup analysis identified a slight 
additional improvement in mean treatment effects in eosinophilic (> 300 mm3 /L) 
patients with severe asthma. Similar patterns and rates of adverse events and 
severe adverse events were reported with the three drugs. The data 
interpretations were not affected by the sensitivity analysis. IL-5 blockade 
appears to be a relevant treatment strategy to improve severe asthma management, 
particularly for eosinophilic patients. No clear superiority appeared between 
the drugs when appropriate doses were compared.