REAL-WORLD EVIDENCE ON THE LONG-TERM USE AND DRUG SURVIVAL OF MEPOLIZUMAB IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA)
Authors: C. Koutsianas et al.
EGPA is a rare form of ANCA-associated vasculitis with a high glucocorticoid burden. Mepolizumab (MEPO; monoclonal anti-IL-5 biologic) is approved for its treatment. However, real-world data are scarce.
Retrospective data of 16 EGPA patients treated with MEPO are reported (females: 87.5%, mean age: 52.4 years, mean disease duration at MEPO start: 4.4 years, ANCA+: 25%). At baseline, the median (IQR) BVASv3 was 6 and the history of EGPA systemic involvement was: lung 94%, ΕΝΤ 94%, musculoskeletal 50%, heart 50%, peripheral nervous system 37.5%, skin 25% and gastrointestinal 25%. 11/16 had previously failed various immunosuppressive (MTX, AZA, MMF, CYC) and 3/16 omalizumab treatment.
At MEPO start, all patients were on GCs (median prednisolone dose: 12.5 mg/day), while 62.5% were on IS (MMF=6, MTX=2, RTX=2). During follow-up [median (IQR)=12 (19) months], there was a statistically significant reduction in GC dose (median, from 12.5 to 2.5mg/day, p=0.002; 3/16 patients discontinued GCs), BVASv3 (median, from 6 to 0, p=0.007). The cumulative drug survival at 6, 12 and 18 months was 100%, 100% and 83% respectively. MEPO was discontinued in 2 patients due to relapsing disease, while it was well tolerated in all patients without withdrawals for safety issues. In 3 subjects MEPO was used concurrently with rituximab (RTX) with good tolerability.
In this real-world study, MEPO was efficacious and safe, with a high retention rate and significant GC-sparing effects. The impact of the study is reduced by a low percentage of ANCA positivity (25% of patients) and the lack of kidney involvement. Nevertheless, the data are a strong argument for the use of this biologic agent in the treatment of eosinophilic vasculitis.