Perspectives de traitement par biomédicaments dans la granulomatose éosinophilique avec polyangéite (Churg-Strauss)

Abstract

After the inflammatory rheumatic diseases, eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss) perfectly illustrates the breakthrough of the advent of biologics in the management of ANCA-associated vasculitides. To improve the management of patients, biologics will have to demonstrate that they allow sustained remission, steroid sparing, and reduction of side effects and accrual damage, improvement of the quality of life of patients with an acceptable medico-economic ratio. Anti-CD20 rituximab treatment of EGPA remains at present not validated but large randomized trials are ongoing in France, both as induction and maintenance therapy. They are made possible thanks to the emergence of consensual definition of assessment criteria for this vasculitis and the structuring of investigators’ networks such as the French Vasculitis Study Group (FVSG). Interleukine-5 is another promising therapeutic target in EGPA, the blocking of which is the objective of an international pivotal mepolizumab trial, after its marketing authorization in eosinophilic asthma. Preliminary results are encouraging as maintenance therapy. Further trials will evaluate other targets in this rare disease, such as interleukin-4 and -13. Let us hope that this new era of biological response modifiers for EGPA allow the emergence of new therapies, which will improve patients’ quality of life.