Successful control of severe eosinophilic granulomatosis with polyangiitis in a pregnancy and perinatal period: A use of mepolizumab

Kasuya, Akira; Kitano, Seiya; Hoshino, Tsuneo; Ishibe, Junichi; Imura, Kie; Goto, Hisao; Miyazawa, Hidehiko; Fujiyama, Toshiharu; Takeo, Naoko; Tokura, Y.

doi:10.1111/1346-8138.14869

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…MIRRA was the first randomized control trial of mepolizumab in the treatment of refractory or relapsing EGPA [25]. Other published studies support the use of mepolizumab for induction and maintenance of remission in refractory, relapsing, or glucocorticoid-dependent EGPA [36-39]. There have been 2 reports of the simultaneous administration of RTX and mepolizumab in refractory cases [40, 41], but in those reports, it was difficult to evaluate the effect of mepolizumab.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Patients with Active Eosinophilic Granulomatosis with Polyangiitis Successfully Treated with Mepolizumab

Tsurikisawa

Oshikata

Watanabe

et al. 2021

Int Arch Allergy Immunol

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Background: In some patients with eosinophilic granulomatosis with polyangiitis (EGPA), remission cannot be induced, despite treatment with corticosteroids and immunosuppressants. We evaluated the clinical features of patients with EGPA in whom mepolizumab was effective. Methods: There were 59 EGPA patients treated at Hiratsuka City Hospital, Japan, between April 2018 and September 2020, and 30 of them received mepolizumab. Twenty (66.7%) experienced a “marked effect” (the daily dose of corticosteroid or immunosuppressant could be decreased, or the interval between intravenous immunoglobulin (IVIG) treatments could be prolonged) and 10 (33.3%) experienced a “weak effect” (these measures were not achieved). Eosinophil numbers, serum IgG levels, daily doses of corticosteroids and immunosuppressants, and the interval between IVIG treatments at diagnosis and before and after mepolizumab initiation were determined. Results: Eosinophil numbers at diagnosis were significantly higher in the marked-effect group than in the weak-effect group (p < 0.05) but not before mepolizumab initiation or at the last visit. Birmingham Vasculitis Activity Scores (BVASs) before mepolizumab initiation (p < 0.05) and at last visit (p < 0.01), and frequency of relapse before treatment initiation (p < 0.05) were significantly higher, and the serum IgG level before mepolizumab treatment was significantly lower in the weak-effect group than in the marked-effect group. The weak-effect group received higher doses of corticosteroids, even if the corticosteroid dose could be reduced for a while after mepolizumab initiation. Conclusion: High peripheral blood eosinophil numbers at EGPA diagnosis were suggestive of a positive clinical response to mepolizumab.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of Patients with Active Eosinophilic Granulomatosis with Polyangiitis Successfully Treated with Mepolizumab

Tsurikisawa

Oshikata

Watanabe

et al. 2021

Int Arch Allergy Immunol

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“…MIRRA was the rst randomized controlled trial of mepolizumab for treating refractory or relapsing EGPA [25]. Other published studies support the use of mepolizumab for the induction and maintenance of remission in refractory, relapsing, or glucocorticoid-dependent EGPA [25,[50][51][52][53]. However, it has not been conclusively determined whether mepolizumab treatment is effective against various vasculitis signs in EGPA or ANCA-positive cases [54].…”

Section: Discussionmentioning

confidence: 99%

“…There are reports that mepolizumab is effective for vascular symptoms in EGPA patients [21,25,[50][51][52][53]57], but there are no reports regarding its effect on long-term prognosis. In the super-responder group, the relapse rate was signi cantly lower in the 3rd year and at the last visit (mean and standard deviation of 4.3 ± 1.0 years after the start of mepolizumab) compared with the 1st year after the start of mepolizumab administration (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Long-term treatment by mepolizumab reduces the relapse rate in patients with eosinophilic granulomatosis with polyangiitis

Masumoto

Oshikata²,

Nakadegawa

et al. 2023

Preprint

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Background: The mainstay of treatment for eosinophilic granulomatosis with polyangiitis (EGPA) is systemic corticosteroid therapy; some patients also receive intravenous immunoglobulins, other immunosuppressive agents, and biologics. Mepolizumab, an anti-interleukin-5 monoclonal antibody, in EGPA patients induces remission and decreases the daily dose of corticosteroids; however, the prognosis of long-term mepolizumab treatment for EGPA and its clinical efficacy are unknown. Methods: Seventy-one EGPA patients were treated at Hiratsuka City Hospital, Japan, between April 2018 and March 2022. We administered mepolizumab for mean 2.8±1.7 years to 43 patients in whom remission could not be induced by conventional treatment. After excluding 18 patients who received mepolizumab for less than 3 years, we classified 15 patients in the “super-responder group” (the daily dose of corticosteroids or another immunosuppressant could be decreased, or the interval between IVIG treatments could be prolonged) and 10 patients in the “responder group” (neither of these changes could be achieved). Eosinophil numbers, serum IgG levels, daily doses of corticosteroids and other immunosuppressants, the Birmingham Vasculitis Activity Score (BVAS), and relapse frequency before and after mepolizumab initiation were determined. Results: Eosinophil numbers at diagnosis or the lowest serum IgG level before mepolizumab treatment were higher in the super-responder group than in the responder group (p < 0.05). In the super-responder group, the prednisolone dose at last visit after mepolizumab initiation was lower than before treatment (p < 0.01) and in the responder group (p < 0.01). In both groups, the number of peripheral blood eosinophils and BVAS decreased after starting mepolizumab compared to before treatment (P < 0.01). BVAS before mepolizumab (p < 0.05) and at the last visit (p < 0.01) in the super-responder group were lower than in the responder group. Relapse rates every year after the start of mepolizumab were lower in the super-responder group than in the responder group (p <0.01). Relapse rates decreased during the 3 years following initiation of mepolizumab treatment (p <0.05) and at the last visit (p <0.01) compared with those at the start of mepolizumab treatment. Conclusions: Treatment with mepolizumab in the super-responder group durably reduced the relapse rate.

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“…Further analysis of treatable traits across the eosinophilic disease spectrum will help to facilitate early, targeted treatment. Although there are some real‐world reports on the use of mepolizumab during pregnancy and the post‐partum period, there are limited data on this subject 126,143 . Of note, an ongoing study (GSK ID: 200870) monitoring the outcome of exposure to mepolizumab during planned and unplanned pregnancies, expected to be completed in 2023, will provide much‐needed data on efficacy and safety among pregnant women.…”

Section: Future Directionsmentioning

confidence: 99%

“…Although there are some realworld reports on the use of mepolizumab during pregnancy and the post-partum period, there are limited data on this subject. 126,143 Of note, an ongoing study (GSK ID: 200870) monitoring the outcome of…”

Section: Mep Olizumab Ha S a Toler Ab Le And Accep Tab Le Safe T Y Pr...mentioning

confidence: 99%

From DREAM to REALITI‐A and beyond: Mepolizumab for the treatment of eosinophil‐driven diseases

Pavord

Bel

Bourdin

et al. 2021

Allergy

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Effective treatment of inflammatory diseases is often challenging owing to their heterogeneous pathophysiology. Understanding of the underlying disease mechanisms is improving and it is now clear that eosinophils play a complex pathophysiological role in a broad range of type 2 inflammatory diseases. Standard of care for these conditions often still includes oral corticosteroids (OCS) and/or cytotoxic immune therapies, which are associated with debilitating side effects. Selective, biological eosinophil‐reducing agents provide treatment options that improve clinical symptoms associated with eosinophilic inflammation and reduce OCS use. Mepolizumab is a humanized monoclonal antibody that binds to and neutralizes interleukin‐5, the major cytokine involved in eosinophil proliferation, activation, and survival. Mepolizumab is approved for the treatment of severe eosinophilic asthma, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Additionally, the efficacy of add‐on mepolizumab has been observed in patients with severe chronic rhinosinusitis with nasal polyposis and chronic obstructive pulmonary disease with an eosinophilic phenotype. Here, we review the development, approval, and real‐world effectiveness of mepolizumab for the treatment of patients with severe eosinophilic asthma, from the DREAM to REALITI‐A studies, and describe how knowledge from this journey extended to the use of mepolizumab and other biologics across a broad spectrum of eosinophilic diseases.

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Successful control of severe eosinophilic granulomatosis with polyangiitis in a pregnancy and perinatal period: A use of mepolizumab

Cited by 8 publications

References 4 publications

Clinical Features of Patients with Active Eosinophilic Granulomatosis with Polyangiitis Successfully Treated with Mepolizumab

Clinical Features of Patients with Active Eosinophilic Granulomatosis with Polyangiitis Successfully Treated with Mepolizumab

Long-term treatment by mepolizumab reduces the relapse rate in patients with eosinophilic granulomatosis with polyangiitis

From DREAM to REALITI‐A and beyond: Mepolizumab for the treatment of eosinophil‐driven diseases

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