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Use of Biologics to Treat Relapsing and/or Refractory Eosinophilic Granulomatosis With Polyangiitis: Data From a European Collaborative Study
Author(s) -
Canzian Alice,
Venhoff Nils,
Urban Maria Letizia,
Sartorelli Silvia,
Ruppert AnneMarie,
Groh Matthieu,
Girszyn Nicolas,
Taillé Camille,
Maurier François,
Cottin Vincent,
Moreuil Claire,
Germain Vincent,
Samson Maxime,
Jachiet Marie,
Denis Laure,
Rieu Virginie,
Smets Perrine,
Pugnet Grégory,
Deroux Alban,
Durel CécileAudrey,
Aouba Achille,
Cathébras Pascal,
Deligny Christophe,
Faguer Stanislas,
Gil Helder,
Godeau Bertrand,
Lifermann François,
PhinHuynh Sophie,
Ruivard Marc,
Bonniaud Philippe,
Puéchal Xavier,
Kahn JeanEmmanuel,
Thiel Jens,
Dagna Lorenzo,
Guillevin Loïc,
Vaglio Augusto,
Emmi Giacomo,
Terrier Benjamin
Publication year - 2021
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41534
Subject(s) - medicine , interquartile range , granulomatosis with polyangiitis , mepolizumab , rituximab , refractory (planetary science) , adverse effect , eosinophilic , gastroenterology , vasculitis , tolerability , surgery , omalizumab , retrospective cohort study , microscopic polyangiitis , asthma , disease , eosinophil , immunology , pathology , immunoglobulin e , physics , lymphoma , astrobiology , antibody
Objective To describe the efficacy and safety of biologics for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). Methods A retrospective European collaborative study was conducted in patients with EGPA who received treatment with biologics for refractory and/or relapsing disease. Results Among the 147 patients with EGPA included in the study, 63 received rituximab (RTX), 51 received mepolizumab (MEPO), and 33 received omalizumab (OMA). At the time of inclusion, the median Birmingham Vasculitis Activity Score (BVAS) was 8.5 (interquartile range [IQR] 5–13) in the RTX group, while the median BVAS in the OMA group was 2 (IQR 1–4.5) and the median BVAS in the MEPO group was 2 (IQR 1–5). In patients receiving RTX, the median BVAS declined both at 6 months (median 1, IQR 0–4.5) and at 12 months (median 0, IQR 0–2), and the frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 49%, 24%, 24%, and 3%, respectively. For the treatment of glucocorticoid (GC)–dependent asthma, patients who received MEPO had a much better GC‐sparing effect and overall response than did patients who received OMA. The frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 15%, 33%, 48%, and 4%, respectively, in the OMA group and 78%, 10%, 8%, and 4%, respectively, in the MEPO group. Remission rates at 12 months were 76% and 82% among patients receiving MEPO at a doses of 100 mg and 300 mg, respectively. Conclusion These results suggest that RTX could be effective in treating relapses of EGPA vasculitis. MEPO is highly effective with a good safety profile in patients with GC‐dependent asthma. Our data suggest that 100 mg MEPO monthly could be an acceptable dosage for first‐line therapy in selected instances of EGPA, recognizing, however, that this has not been compared to the validated dosage of 300 mg monthly.