Real-life efficacy and safety of mepolizumab for eosinophilic granulomatosis with polyangiitis

Abstract

• Mepolizumab (MPZ), an anti-IL5 monoclonal antibody, is a promising treatment for eosinophilic manifestations in eosinophilic granulomatosis with polyangiitis (EGPA). • Little is known on safety and efficacy of MPZ in EGPA in real-life. • This study provides evidence supporting routine use of MPZ use as a safe and effective treatment for refractory eosinophilic manifestations in patients with EGPA. • An apparent rise in minor infections during MPZ treatment warrants further studies. Little is known about the efficacy and safety of the anti-interleukin 5 monoclonal antibody mepolizumab (MPZ) in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in real-life. We thus evaluated disease activity, damage and disease-related complications in 14 patients with EGPA receiving MPZ for refractory disease for a median time of 16 months in comparison with up to five years before MPZ start. Asthma exacerbation rates, the Birmingham Vasculitis Activity Score and corticosteroid dosage decreased during MPZ ( p < 0.001, p < 0.001 and p = 0.001, respectively). Five patients could discontinue prednisone. Infection rates were higher during MPZ ( p < 10 –6 ), but no rises in hospitalizations, asthma exacerbations or damage accrual were observed. Real-life data confirm the effectiveness of MPZ in refractory EGPA with active asthma. Higher infections rates are in line with other studies and might be due to relative overreporting secondary to increased visit frequency, although a pharmacological effect could not be ruled out.