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

Abstract

<b><i>Introduction:</i></b> Data showing effectiveness of mepolizumab in patients with eosinophilic granulomatosis with polyangiitis (EGPA) are limited. <b><i>Methods:</i></b> This is a single-center retrospective chart review of patients with EGPA treated with mepolizumab. Clinical, laboratory, functional parameters and asthma, rhinitis control, and quality of life scores (Asthma Control Test [ACT], Asthma Quality of Life Questionnaire [AQLQ], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], and SinoNasal Outcome Test [SNOT]-22) were evaluated at the baseline, 6th month, and 12th month. Complete response was defined as the absence of asthma and/or ear, nasal symptoms and exacerbations with a prednisone of ≤7.5 mg/day, partial response if it was achieved with a prednisone of >7.5 mg/day. <b><i>Results:</i></b> Overall, 25 patients (18 F/7 M) with a median age of 47 years (23–76) were enrolled. Mepolizumab 100 mg/month was administered (dose increased to 300 mg/month in 3 patients). Mepolizumab significantly decreased daily dose of oral corticosteroid (OCS) from 11.04 mg to 3.65 mg together with a significant improvement in ACT, AQLQ, RQLQ, and SNOT-22 scores and a significant reduction in asthma exacerbations and blood eosinophil count at the 6th and 12th month (all <i>p</i> values <0.05). The mean forced expiratory volume in 1 s increased (at baseline: 1.88 L to 2.46 L at the 12th month [<i>p</i> = 0.037]). Seventy-six percent of patients responded completely at the 6th month and 81.25% at the 12th month. The complete responders at the 6th and 12th month were older than partial responders and nonresponders (<i>p</i> = 0.030 and <i>p</i> = 0.057, respectively). Patients with complete response at the 6th month were on lower doses of OCS than partial responders and nonresponders (<i>p</i> = 0.029). <b><i>Conclusions:</i></b> Low-dose mepolizumab was effective in EGPA patients by improving sinonasal and asthma outcomes, while reducing the need for OCS.

Glucocorticoid-sparing effect of mepolizumab for severe eosinophilic granulomatosis with polyangiitis: a retrospective single-center observational study

“…However, the MEP (+) group also had a signi cantly higher rate of concomitant treatment with AZA than the MEP (−) group. There are previous reports of using AZA, methotrexate, mycophenolate mofetil, cyclosporine, or rituximab concomitantly with MEP [11][12][13]. Given the discrepancy between the 2 groups in our study, we performed a 4-arm comparison.…”

New therapeutic approaches with biological drugs for eosinophilic granulomatosis with polyangiitis

“…After the FDA approved mepolizumab for EGPA at a monthly dose of 300 mg, a recent real-life observational study of 16 patients suggested that mepolizumab at a dose of 100 mg 4 weeks may have a role as a steroid/immunosuppressive sparing agent in patients affected by EGPA. They concluded that, despite the 100 mg dose, the proportion of patients who could discontinue oral CS was higher than in the MIRRA trial [34]. Another study reported the effectiveness of low-dose mepolizumab in 25 patients diagnosed with EGPA.…”

A Case of Eosinophilic Granulomatosis with Polyangiitis Combined with Pulmonary Tuberculosis: A Case Report

“…There is still a lack of understanding of the pathogenesis, pathological alterations, and clinical characteristics of EGPA. It has been reported that the condition of EGPA patients can rapidly deteriorate and lead to death within six months [2] . Therefore, accurate diagnosis and timely treatment are extremely crucial.…”