Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study.
Creators: name: Bettiol, Alessandra
name: Urban, Maria Letizia
name: Dagna, Lorenzo
name: Cottin, Vincent
name: Franceschini, Franco
name: Del Giacco, Stefano
name: Schiavon, Franco
name: Neumann, Thomas
name: Lopalco, Giuseppe
name: Novikov, Pavel
name: Baldini, Chiara
name: Lombardi, Carlo
name: Berti, Alvise
name: Alberici, Federico
name: Folci, Marco
name: Negrini, Simone
name: Sinico, Renato Alberto
name: Quartuccio, Luca
name: Lunardi, Claudio
name: Parronchi, Paola
name: Moosig, Frank
name: Espígol-Frigolé, Georgina
name: Schroeder, Jan
name: Kernder, Anna Luise
name: Monti, Sara
name: Silvagni, Ettore
name: Crimi, Claudia
name: Cinetto, Francesco
name: Fraticelli, Paolo
name: Roccatello, Dario
name: Vacca, Angelo
name: Mohammad, Aladdin J
name: Hellmich, Bernhard
name: Samson, Maxime
name: Bargagli, Elena
name: Cohen Tervaert, Jan Willem
name: Ribi, Camillo
name: Fiori, Davide
name: Bello, Federica
name: Fagni, Filippo
name: Moroni, Luca
name: Ramirez, Giuseppe Alvise
name: Nasser, Mouhamad
name: Marvisi, Chiara
name: Toniati, Paola
name: Firinu, Davide
name: Padoan, Roberto
name: Egan, Allyson
name: Seeliger, Benjamin
name: Iannone, Florenzo
name: Salvarani, Carlo
name: Jayne, David
name: Prisco, Domenico
name: Vaglio, Augusto
name: Emmi, Giacomo
name: European EGPA Study Group
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: European EGPA Study Group

description: OBJECTIVE: Mepolizumab proved to be an efficacious treatment for eosinophilic granulomatosis with polyangiitis (EGPA) at a dose of 300 mg every 4 weeks in the randomized, controlled MIRRA trial. In a few recently reported studies, successful real-life experiences with the approved dose for treating severe eosinophilic asthma (100 mg every 4 weeks) were observed. We undertook this study to assess the effectiveness and safety of mepolizumab 100 mg every 4 weeks and 300 mg every 4 weeks in a large European EGPA cohort. METHODS: We included all patients with EGPA treated with mepolizumab at the recruiting centers in 2015-2020. Treatment response was evaluated from 3 months to 24 months after initiation of mepolizumab. Complete response to treatment was defined as no disease activity (Birmingham Vasculitis Activity Score [BVAS] = 0) and a prednisolone or prednisone dose (or equivalent) of ≤4 mg/day. Respiratory outcomes included asthma and ear, nose, and throat (ENT) exacerbations. RESULTS: Two hundred three patients, of whom 191 received a stable dose of mepolizumab (158 received 100 mg every 4 weeks and 33 received 300 mg every 4 weeks) were included. Twenty-five patients (12.3%) had a complete response to treatment at 3 months. Complete response rates increased to 30.4% and 35.7% at 12 months and 24 months, respectively, and rates were comparable between mepolizumab 100 mg every 4 weeks and 300 mg every 4 weeks. Mepolizumab led to a significant reduction in BVAS score, prednisone dose, and eosinophil counts from 3 months to 24 months, with no significant differences observed between 100 mg every 4 weeks and 300 mg every 4 weeks. Eighty-two patients (40.4%) experienced asthma exacerbations (57 of 158 [36%] who received 100 mg every 4 weeks; 17 of 33 [52%] who received 300 mg every 4 weeks), and 31 patients (15.3%) experienced ENT exacerbations. Forty-four patients (21.7%) experienced adverse events (AEs), most of which were nonserious AEs (38 of 44). CONCLUSION: Mepolizumab at both 100 mg every 4 weeks and 300 mg every 4 weeks is effective for the treatment of EGPA. The 2 doses should be compared in the setting of a controlled trial.