Successful early introduction of mepolizumab for peripheral neuropathy with a peripheral circulatory disorder in a patient with myeloperoxidase anti-neutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis

Nishihara, Masahiro; Hamaguchi, Marina; Ikumi, Natsumi; Nishiwaki, Atsuma; Sugiyama, K.; Nagasawa, Y.; Tsuzuki, Hiroshi; Yoshizawa, Shoei; Tanikawa, Yutaka; Asatani, Shinya; Kobayashi, Hitomi; Takei, Masami; Kitamura, Noboru

doi:10.1080/24725625.2021.1916159

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…We have previously reported the safety and effectiveness of MPZ in maintenance therapy in relapsing and refractory EGPA in clinical settings [7]. MPZ is an effective agent for maintenance therapy; moreover, since MPZ has been used as remission induction therapy for steroid-resistant EGPA, it has started to attract increased attention [8][9][10][11]. In the present study, we assessed the safety and effectiveness of MPZ at a dose of 300 mg/ month in combination with high-dose CS as remission induction therapy for EGPA in real-world clinical settings.…”

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confidence: 99%

Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study

et al. 2022

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Objectives To investigate the safety and effectiveness of mepolizumab (MPZ), an anti-interleukin-5 antibody, as remission induction therapy for severe eosinophilic granulomatosis with polyangiitis (EGPA). Methods The clinical courses of patients with severe EGPA over 6 months were retrospectively investigated and compared between patients treated with high-dose corticosteroid (CS) plus MPZ therapy (MPZ group, n = 7) and those treated with high-dose CS plus intravenous cyclophosphamide (IVCY) pulse therapy (IVCY group, n = 13). The primary endpoints were the MPZ retention rate and the IVCY completion rate. The secondary endpoints were adverse events and changes in the Birmingham Vasculitis Activity Score (BVAS), Vascular Damage Index (VDI), eosinophil counts, and concomitant CS doses, and the extent and rates of these changes were compared between the MPZ and IVCY groups. Results Regarding the primary endpoints, the MPZ retention rate was 100%, and the IVCY completion rate was 61.5%. Regarding the secondary endpoints, adverse events were detected in 2/7 patients (28.6%) in the MPZ group and 7/13 patients (53.8%) in the IVCY group. BVAS and eosinophil counts significantly decreased in both groups at and after month 1, but there was no significant difference in the magnitude of changes between the two groups. VDI scores did not significantly increase in either group, and the degree of changes did not significantly differ between the two groups. Although concomitant CS doses significantly decreased at and after month 1 in both groups, the rates of decrease in CS doses at and after month 3 were significantly higher in the MPZ group. Conclusions This study suggested that the use of MPZ as remission induction therapy for severe EGPA might be safe and effective for controlling disease activity and reducing CS doses.

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confidence: 99%

Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study

et al. 2022

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“…The efficacy of mepolizumab in treating neuropathy associated with peripheral circulation disorders in ANCAnegative EGPA has been previously reported (17). Furthermore, early introduction of mepolizumab reportedly improves peripheral neuropathy of EGPA at an early stage (18); therefore, in this case, we started treatment with mepolizumab monotherapy to stop the progression of peripheral neuropathy. After treatment with mepolizumab, the peripheral blood eosinophil count decreased markedly, the BVAS improved from 20 to 10 points, the SPP increased from 28 to 46 mmHg, and the patient's subjective symptoms partially improved.…”

Section: Mcv: Motor Nerve Conduction Velocity Scv: Sensory Nerve Cond...mentioning

confidence: 70%

Anti-neutrophil Cytoplasmic Antibody-negative Eosinophilic Granulomatosis with Polyangiitis Complicated with Peripheral Neuropathy that Underwent Remission Induction with Mepolizumab Monotherapy

et al. 2023

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A 72-year-old woman was admitted to our hospital with numbness in her lower extremities and hypereosinophilia. She was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). On admission, she was suspected of being complicated with pneumonia and sepsis; therefore, treatment with mepolizumab monotherapy was begun, resulting in partial improvement. After the possibility of a complicating infection was ruled out, corticosteroids were initiated, followed by intravenous gamma globulin therapy. Although the induction of remission of EGPA with mepolizumab monotherapy is not usually recommended, induction with mepolizumab monotherapy may be an option in terms of safety and clinical efficacy in some cases.

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“…In a case report of mepolizumab, neuropathy improved 4 weeks after mepolizumab administration following methylprednisolone pulse and intravenous immunoglobulin in a patient with EGPA ( Nishihara et al, 2021 ). A recent retrospective case study in six patients with EGPA demonstrated the efficacy of mepolizumab on neuropathy refractory to OCS with intravenous immunoglobulin over 12 weeks ( Kitamura et al, 2021 ).…”

Section: Efficacy Of Benralizumab On Cardiac and Neurological Involve...mentioning

confidence: 99%

Perspectives on the Efficacy of Benralizumab for Treatment of Eosinophilic Granulomatosis With Polyangiitis

et al. 2022

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Two types of interleukin (IL)-5 antibody biologics, anti-IL-5 antibodies (mepolizumab) and anti-IL-5α receptor antibodies (benralizumab), are indicated for severe asthma. While high-dose mepolizumab is also indicated for EGPA, benralizumab is indicated only for severe asthma. Benralizumab is characterized by antibody-dependent cell-mediated cytotoxicity activity, giving them specific and rapid anti-IL-5α receptor binding abilities and the ability to target a high number of eosinophils in tissues as well as peripheral blood. Recently, reports on the efficacy of benralizumab as a treatment for EGPA have been published, along with reports on some cases that are difficult to treat with existing oral corticosteroids and mepolizumab. Therefore, we focus on the perspective of the efficacy and safety of benralizumab as a treatment for EGPA patients with steroid dependence in this review. A total of 41 patients with EGPA were treated with benralizumab. After the introduction of benralizumab, oral corticosteroids could be reduced to 10 mg/day or less in all cases and to less than 5 mg/day in 80% or more of the cases. Discontinuation of oral corticosteroids was achieved in more than 40% of patients with EGPA. Benralizumab was effective in patients with mepolizumab-refractory EGPA and intractable cardiac and neuropathy complications. Efficient elimination of eosinophils is expected to improve the remission rate of EGPA with benralizumab treatment. Although the total number of patients was small, benralizumab was safe and tolerable in a wide range of age groups, suggesting efficacy in severe cases with EGPA.

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Successful early introduction of mepolizumab for peripheral neuropathy with a peripheral circulatory disorder in a patient with myeloperoxidase anti-neutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis

Cited by 6 publications

References 16 publications

Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study

Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study

Anti-neutrophil Cytoplasmic Antibody-negative Eosinophilic Granulomatosis with Polyangiitis Complicated with Peripheral Neuropathy that Underwent Remission Induction with Mepolizumab Monotherapy

Perspectives on the Efficacy of Benralizumab for Treatment of Eosinophilic Granulomatosis With Polyangiitis

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