Effectiveness and safety of mepolizumab in combination with corticosteroids in patients with eosinophilic granulomatosis with polyangiitis.
Corticosteroid
Eosinophilic granulomatosis with polyangiitis
Mepolizumab
Treatment
Journal
Arthritis research & therapy
ISSN: 1478-6362
Titre abrégé: Arthritis Res Ther
Pays: England
ID NLM: 101154438
Informations de publication
Date de publication:
16 03 2021
16 03 2021
Historique:
received:
19
10
2020
accepted:
22
02
2021
entrez:
17
3
2021
pubmed:
18
3
2021
medline:
22
6
2021
Statut:
epublish
Résumé
Mepolizumab (MPZ), an anti-interleukin-5 antibody, is effective for the treatment of 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 MPZ (300 mg) for relapsing/refractory EGPA resistant to corticosteroids (CS) for 1 year in real-world settings. We administered MPZ (300 mg) to 16 patients with relapsing/refractory EGPA resistant to CS (Post-MPZ). We also retrospectively collected data from the same patients for the 12 months before the administration of MPZ (Pre-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 counts, changes in concomitant CS doses/concomitant immunosuppressant use, MPZ retention rate, and incidence of adverse events. The clinical course was compared between Pre-MPZ and Post-MPZ. The 12-month remission rate after the initiation of MPZ was 75%. No change was observed in BVAS, eosinophil count, or concomitant CS dose over time in the Pre-MPZ group, whereas all these parameters were significantly decreased over time in the Post-MPZ group. The number of patients using concomitant immunosuppressant also decreased over time in the Post-MPZ group. VDI did not increase in either group. The MPZ retention rate was 100% and only three patients (18.8%) had infections. Changes in BVAS, eosinophil count, and cumulative concomitant CS dose were significantly lower in the Post-MPZ group than in the Pre-MPZ group. There was no significant difference in the changes in VDI between the groups. This study demonstrated that MPZ is effective and safe for EGPA. Furthermore, MPZ decreases disease activity, increases remission rate, and has a CS-sparing effect.
Sections du résumé
BACKGROUND
Mepolizumab (MPZ), an anti-interleukin-5 antibody, is effective for the treatment of 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 MPZ (300 mg) 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 (Post-MPZ). We also retrospectively collected data from the same patients for the 12 months before the administration of MPZ (Pre-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 counts, changes in concomitant CS doses/concomitant immunosuppressant use, MPZ retention rate, and incidence of adverse events. The clinical course was compared between Pre-MPZ and Post-MPZ.
RESULTS
The 12-month remission rate after the initiation of MPZ was 75%. No change was observed in BVAS, eosinophil count, or concomitant CS dose over time in the Pre-MPZ group, whereas all these parameters were significantly decreased over time in the Post-MPZ group. The number of patients using concomitant immunosuppressant also decreased over time in the Post-MPZ group. VDI did not increase in either group. The MPZ retention rate was 100% and only three patients (18.8%) had infections. Changes in BVAS, eosinophil count, and cumulative concomitant CS dose were significantly lower in the Post-MPZ group than in the Pre-MPZ group. There was no significant difference in the changes in VDI between the groups.
CONCLUSION
This study demonstrated that MPZ is effective and safe for EGPA. Furthermore, MPZ decreases disease activity, increases remission rate, and has a CS-sparing effect.
Identifiants
pubmed: 33726827
doi: 10.1186/s13075-021-02462-6
pii: 10.1186/s13075-021-02462-6
pmc: PMC7962235
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Antibodies, Monoclonal, Humanized
0
mepolizumab
90Z2UF0E52
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
86Références
Arthritis Rheum. 1990 Aug;33(8):1094-100
pubmed: 2202307
Arthritis Rheumatol. 2017 Nov;69(11):2175-2186
pubmed: 28678392
Arthritis Rheum. 2013 Jan;65(1):270-81
pubmed: 23044708
Arthritis Rheum. 1997 Feb;40(2):371-80
pubmed: 9041949
Ann Rheum Dis. 2009 Dec;68(12):1827-32
pubmed: 19054820
N Engl J Med. 2017 May 18;376(20):1921-1932
pubmed: 28514601
Ann Rheum Dis. 2016 Sep;75(9):1583-94
pubmed: 27338776
Arthritis Care Res (Hoboken). 2016 Mar;68(3):374-87
pubmed: 26315340
Arthritis Rheum. 2013 Jan;65(1):1-11
pubmed: 23045170
Ann Rheum Dis. 2007 Mar;66(3):283-92
pubmed: 16728460
J Rheumatol. 2018 Aug;45(8):1159-1166
pubmed: 29907668
Intern Med. 2019 Dec 15;58(24):3583-3587
pubmed: 31391393
Allergy Asthma Immunol Res. 2020 Sep;12(5):885-893
pubmed: 32638567
Am J Pathol. 1951 Mar-Apr;27(2):277-301
pubmed: 14819261
Eur J Intern Med. 2015 Sep;26(7):545-53
pubmed: 25971154