The effects of mepolizumab on peripheral circulation and neurological symptoms in eosinophilic granulomatosis with polyangiitis (EGPA) patients

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

doi:10.1016/j.alit.2020.08.005

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…Thus, eosinophil depletion via mepolizumab could effectively counteract this pathogenetic mechanism. To date, the possible role of mepolizumab in the control of EGPA neurologic manifestations was reported only in a retrospective study of 6 patients ( 30 ). Our results, however, must be taken with caution, as other factors may contribute to the improvement of neuropathy, including progressive nerve function recovery or delayed effects of previous and concomitant therapies.…”

Section: Discussionmentioning

confidence: 99%

Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study

Bettiol¹,

Urban²,

Dagna³

et al. 2021

Arthritis & Rheumatology

104

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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.

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Section: Discussionmentioning

confidence: 99%

Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study

Bettiol¹,

Urban²,

Dagna³

et al. 2021

Arthritis & Rheumatology

104

View full text Add to dashboard Cite

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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.…”

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

confidence: 72%

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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“…Anti-IL5 therapy with mepolizumab in severe EGPA succeeded in the maintenance of remission, in reducing relapses, in reducing the steroid dose and in controlling active asthma in patients with severe EGPA [ 36 , 37 ]. It was also found that mepolizumab may be effective in patients with peripheral neuropathy, especially with the co-administration of intravenous immunoglobulin (IVIG) [ 38 – 42 ].…”

Section: Resultsmentioning

confidence: 99%

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

2023

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Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, mostly affecting small-sized arteries and usually occurring in patients with an allergic background. Eosinophils seem to play a significant role in the pathogenesis of the disease and, therefore, biologics targeting interleukin 5 (IL5), a cytokine tightly linked to eosinophils, have emerged as a promising therapeutic tool. A systematic review of Medline was conducted from 2007 to 2022 to search for data regarding the use of anti-IL5 therapies in patients with EGPA. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. The efficacy and safety of mepolizumab, an anti-IL5 monoclonal antibody (mAb), was confirmed by a randomized controlled trial (RCT), although a significant proportion of patients did not respond to this treatment. Other studies showed that both doses of 100 mg and 300 mg of mepolizumab are almost equally effective in EGPA. Benralizumab, an anti-IL5 receptor mAb has preliminary promising results and an RCT is planned to be conducted. Apart from their clinical efficacy in EGPA, anti-IL5 therapies may have steroid-sparing properties. Anti-IL5 therapies seem to be effective and safe in patients with refractory/relapsing EGPA and can be used as a steroid-sparing treatment. Nevertheless, more research is needed to clarify the pathophysiology of the disease; this may potentially lead to the identification of biomarkers to pinpoint patients most likely to respond to anti-IL5-blockade.

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The effects of mepolizumab on peripheral circulation and neurological symptoms in eosinophilic granulomatosis with polyangiitis (EGPA) patients

Cited by 13 publications

References 9 publications

Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study

Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study

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

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

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