P136 Glucocorticoid sparing effects of reslizumab in the treatment of eosinophilic granulomatosis with polyangiitis

Abstract

Introduction Eosinophilic granulomatosis with polyangiitis (EGPA) is an uncommon but serious disorder characterised by peri-vascular eosinophilic inflammation, severe asthma, peripheral eosinophilia, and potentially devastating extra-pulmonary disease. The mainstay of therapy for EGPA is use of systemic glucocorticoids, with or without concomitant immunosuppression, with consequent significant treatment related morbidity. While it has been shown that high doses of the interleukin (IL)−5 neutralising antibody Mepolizumab have significant steroid-sparing effects in EGPA, there are no published data exploring the utility of Reslizumab – another IL-5 blocker licensed for the treatment of severe asthma – in the management of EGPA. Here we report clinical and patient reported outcomes in a cohort of treatment-refractory, glucocorticoid-dependent EGPA patients with severe asthma commenced on Reslizumab. Methods Patients with EGPA and severe eosinophilic asthma attending a dedicated EGPA clinic were commenced on four-weekly Reslizumab infusions at a dose of 3 mg/kg if they required continuous oral glucocorticoids to maintain disease control and if prior dose weaning efforts had failed. Glucocorticoid doses were reviewed during each 4-weekly consultation and adjusted if deemed appropriate by the treating physician. Glucocorticoid dose, lung function, fractional exhaled nitric oxide (FeNO) were recorded at baseline and following 24 and 48 weeks of treatment, as were the patient reported outcome measures, the Asthma Control Questionnaire (ACQ7) and the mini-Asthma Quality of Life Questionnaire (mini-AQLQ). Results Seven patients with EGPA (57% female; age 49.9±11.5 years; all with extra-pulmonary involvement) were commenced on Reslizumab in April/May 2017. Following 48 weeks of treatment, daily prednisolone doses reduced from 26.6±7.6 mg to 6.1±2.1 mg (p 50% reduction in prednisolone dose, and 5 (71%) reduced below the 7.5 mg/day threshold deemed consistent with remission by EULAR. Mini-AQLQ scores improved from 4.18±1.91 to 5.64±1.66 (Δ1.45; p=0.003), and non-significant improvements were seen in ACQ (from 2.47±2.21 to 1.84±1.84; Δ0.63; p=0.17). Despite the reduction in prednisolone dose, no deterioration was seen in lung function, blood eosinophil counts, troponin levels, or FeNO levels. Conclusion Reslizumab may have a significant steroid sparing effect in EGPA patients with severe asthma, allowing improved symptom control at lower doses of systemic glucocorticoid, without worsening of disease related physiological variables.