Effectiveness and Safety of Mepolizumab in Combination with Corticosteroids in Patients with Eosinophilic Granulomatosis with Polyangiitis

Abstract

Objectives: Mepolizumab (MPZ), an anti-interleukin-5 antibody, is effective for treating eosinophilic granulomatosis with polyangiitis (EGPA). However, its effectiveness has not been adequately evaluated in real-world clinical practice. In this study, we assessed the effectiveness and safety of 300 mg MPZ for relapsing/refractory EGPA resistant to corticosteroids (CS) for 1 year in real-world settings. Methods: We administered MPZ (300 mg) to 16 patients with relapsing/refractory EGPA resistant to CS (with-MPZ). We also retrospectively collected data from the same patients for 12 months before administering MPZ (without-MPZ). The primary endpoint was the 12-month remission rate after MPZ administration, and the secondary endpoints were the Birmingham vasculitis activity score (BVAS), vasculitis damage index (VDI), eosinophil count, changes in concomitant CS doses/concomitant immunosuppressant use, MPZ retention rate, and incidence of adverse events. The clinical course was compared between Without-MPZ and With MPZ.Results: The 12-month remission rate after initiating MPZ was 75%. No change was observed in BVAS, eosinophil count, or concomitant CS dose in the without-MPZ, whereas all these parameters were significantly decreased in the with-MPZ. The number of patients on concomitant immunosuppressants also decreased in the with-MPZ. VDI did not increase in both groups. The MPZ retention rate was 100%, and only three patients (18.8%) had infections.Conclusion: This study demonstrated that MPZ is effective and safe for EGPA, furthermore, compared to Without-MPZ, MPZ improves disease activity and possesses a higher remission rate and CS sparing effect.

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

“…In this study, there was no significant difference in the improvement of neurological (sensory or motor) involvement between the groups. We had previously reported that the serum IL-5 levels of relapsing/refractory EGPA, even in the maintenance phase, were significantly higher than of healthy controls [7]. Namely, there is a possibility that sustained increase in IL-5 levels contributes to chronic organ involvement or treatment (CS) resistance.…”

“…In 2018, MPZ was approved for coverage by the national health insurance system in Japan for the treatment of EGPA resistant to currently available therapies. 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].…”

Effectiveness of Low-Dose Mepolizumab in the Treatment of Eosinophilic Granulomatosis with Polyangiitis (EGPA): A Real-Life Experience

“…After approval of mepolizumab in the treatment of EGPA, the steroid-sparing effect of mepolizumab at a dose of 300 mg/month was demonstrated in other studies [15,16]. However, later it was shown that mepolizumab was able to reduce the steroid dose at a dose of 100 mg/ month.…”

Safety and Effectiveness of Mepolizumab Therapy in Remission Induction Therapy for Eosinophilic Granulomatosis with Polyangiitis: A Retrospective Study

“…VDI scores did not signi cantly increase in either group, and the degree of changes did not signi cantly differ between the two groups. Although concomitant CS doses signi cantly decreased at and after month 1 in both groups, the rates of decrease in CS doses at and after month 3 were signi cantly higher in the MPZ group.Conclusions: This study suggested that the use of MPZ as remission induction therapy for severe EGPA might be safe and effective for controlling disease activity and reducing CS doses.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].…”

“…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].…”