Early add‐on administration of mepolizumab and intravenous immunoglobulin effective in treating eosinophilic granulomatosis with polyangiitis

Abstract

Treatment of eosinophilic granulomatosis with polyangiitis (EGPA) remains a challenge because currently available therapies, corticosteroids and immunomodulators, do not always control symptoms and are often associated with significant morbidity and relapse. Mepolizumab has been demonstrated to be an effective add-on therapy with steroid-sparing effect in cases of relapsing or refractory EGPA. Intravenous immunoglobulin (IVIG) therapy is effective against mononeuritis multiplex or heart failure in patients with EGPA who do not respond to corticosteroid-cyclophosphamide treatment. We present two cases of EGPA in which earlier add-on administration of adjunct mepolizumab and IVIG led to significant improvement in EGPA symptoms and prevention of flareup of the disease. We suggested that earlier add-on combination administration of IVIG and mepolizumab might be a useful adjunct treatment to induce clinical remission of EGPA and improve the rate of remission, decrease relapse rate, and allow for reduced glucocorticoid use without any serious adverse drug effects.

Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study

“…We have previously reported the safety and effectiveness of MPZ in maintenance therapy in relapsing and refractory EGPA in clinical settings [7]. MPZ is an effective agent for maintenance therapy; moreover, since MPZ has been used as remission induction therapy for steroid-resistant EGPA, it has started to attract increased attention [8][9][10][11]. In the present study, we assessed the safety and effectiveness of MPZ at a dose of 300 mg/ month in combination with high-dose CS as remission induction therapy for EGPA in real-world clinical settings.…”

Clinical Significance of MPO-ANCA in Eosinophilic Granulomatosis With Polyangiitis: Experience From a Longitudinal Chinese Cohort

“…The high-dose IVIG might be effective for patients with heart failure or peripheral neuropathy not responsive to standard immunosuppressive therapy (40)(41)(42). A recent study suggested that earlier add-on combination administration of IVIG and mepolizumab might be efficient adjunct treatment to induce clinical remission and decrease relapse risk for patients with EGPA (43).…”

From DREAM to REALITI‐A and beyond: Mepolizumab for the treatment of eosinophil‐driven diseases

“…112 , 135 , 136 , 137 However, there are significant risks associated with long‐term use of OCS 138 ; therefore, early initiation of targeted biologic treatment is essential to reduce OCS use, 44 , 64 , 82 , 101 and achieve the best results for patients. This is especially true for patients with EGPA 139 or HES, 140 since serious, irreparable damage, and remodeling may develop during the disease course. 141 This is also true for patients with severe asthma, as eosinophil‐driven changes to the airways are associated with reduced lung function.…”