https://doi.org/10.4081/reumatismo.2023.1588
Eosinophilic granulomatosis with polyangiitis: sequential use of mepolizumab following rituximab for inadequate asthma control despite vasculitis remission
Submitted: 2 May 2023
Accepted: 1 October 2023
Published: 19 December 2023
Accepted: 1 October 2023
Abstract Views: 1132
PDF: 341
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We report the case of a 54-year-old woman with antineutrophilic cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis presenting with mononeuritis multiplex, intestinal hemorrhage, cardiomyopathy, fever, and worsening asthma symptoms. She was initially treated with steroids and cyclophosphamide but eventually required rituximab to control a vasculitis flare. However, her asthmatic symptoms did not improve, despite attaining vasculitis remission. Symptoms abated only after the treatment transition to mepolizumab. After a 1-year interval, there were no further episodes of asthma exacerbation and no requirement for systemic steroid therapy. This report reinforces the use of rituximab for induction and maintenance of remission in patients with eosinophilic granulomatosis with polyangiitis and predominant vasculitic manifestations, whereas mepolizumab demonstrated better control of the persistent eosinophilic manifestations, ensuing sustained remission and improved quality of life.
Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) consensus task force recommendations for evaluation and management. Eur J Intern Med 2015; 26: 545-53.
DOI: https://doi.org/10.1016/j.ejim.2015.04.022
Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Ruoppolo G, et al. Churg-Strauss syndrome. Autoimmun Rev 2015; 14: 341-8.
DOI: https://doi.org/10.1016/j.autrev.2014.12.004
Chung SA, Langford CA, Maz M, Abril A, Gorelik M, Guyatt G, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol 2021; 73: 1366-83.
DOI: https://doi.org/10.1002/art.41773
Thiel J, Troilo A, Salzer U, Schleyer T, Halmschlag K, Rizzi M, et al. Rituximab as induction therapy in eosinophilic granulomatosis with polyangiitis refractory to conventional immunosuppressive treatment: a 36-month follow-up analysis. J Allergy Clin Immunol Pract 2017; 5: 1556-63.
DOI: https://doi.org/10.1016/j.jaip.2017.07.027
Lugogo N, Domingo C, Chanez P, Leigh R, Gilson MJ, Price RG, et al. Long-term efficacy and safety of mepolizumab in patients with severe eosinophilic asthma: a multi-center, open-label, phase IIIb study. Clin Ther 2016; 38: 2058-70.e1.
DOI: https://doi.org/10.1016/j.clinthera.2016.07.010
Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014; 371: 1198-207.
DOI: https://doi.org/10.1056/NEJMoa1403290
Wechsler ME, Akuthota P, Jayne D, Khoury P, Klion A, Langford CA, et al. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med 2017; 376: 1921-32.
DOI: https://doi.org/10.1056/NEJMoa1702079
Steinfeld J, Bradford ES, Brown J, Mallett S, Yancey SW, Akuthota P, et al. Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol 2019; 143: 2170-7.
DOI: https://doi.org/10.1016/j.jaci.2018.11.041
Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry MJ, Amudala N, et al. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Ann Rheum Dis 2016; 75: 396-401.
DOI: https://doi.org/10.1136/annrheumdis-2014-206095
Akiyama M, Kaneko Y, Takeuchi T. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis: a systematic literature review. Autoimmun Rev 2021; 20: 102737.
DOI: https://doi.org/10.1016/j.autrev.2020.102737
Casal Moura M, Berti A, Keogh KA, Volcheck GW, Specks U, Baqir M. Asthma control in eosinophilic granulomatosis with polyangiitis treated with rituximab. Clin Rheumatol 2020; 39: 1581-90.
DOI: https://doi.org/10.1007/s10067-019-04891-w
Terrier B, Pugnet G, de Moreuil C, Bonnotte B, Benhamou Y, Diot E, et al. Rituximab versus conventional therapeutic strategy for remission induction in eosinophilic granulomatosis with polyangiitis: a double-blind, randomized, controlled trial [abstract]. Arthritis Rheumatol 2021; 73.
Dutertre M, Pugnet G, De Moreuil C, Bonnotte B, Benhamou Y, Chauveau D, et al. Efficacité à long terme des schémas d’induction de la rémission au cours de la granulomatose éosinophilique avec polyangéite : résultats de l’essai REOVAS. Rev Med Interne 2022; 43: A375-6.
DOI: https://doi.org/10.1016/j.revmed.2022.10.085
Inamo J, Kaneko Y, Ota Y, Takeuchi T. Subtypes in eosinophilic granulomatosis with polyangiitis classified according to rheumatoid factor. Clin Rheumatol 2019; 38: 3493-9.
DOI: https://doi.org/10.1007/s10067-019-04680-5
Latorre M, Baldini C, Seccia V, Pepe P, Novelli F, Celi A, et al. Asthma control and airway inflammation in patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol Pract 2016; 4: 512-9.
DOI: https://doi.org/10.1016/j.jaip.2015.12.014
Berti A, Cornec D, Casal Moura M, Smyth RJ, Dagna L, Specks U, et al. Eosinophilic granulomatosis with polyangiitis: clinical predictors of long-term asthma severity. Chest 2020; 157: 1086-99.
DOI: https://doi.org/10.1016/j.chest.2019.11.045
Vergles M, Matković Z, Lalić K, Trkanjec JT, Tudorić N. Mepolizumab as a glucocorticoid-sparing agent in eosinophilic granulomatosis with polyangiitis (EGPA): is a lower dose sufficient? J Asthma 2021; 58: 1675-9.
DOI: https://doi.org/10.1080/02770903.2020.1827417
Afiari A, Gabriel A, Gaiki MR. Concurrent use of mepolizumab and rituximab for eosinophilic granulomatosis with polyangiitis and multisystem involvement. Cureus 2020; 12: e9242.
DOI: https://doi.org/10.7759/cureus.9242
Aguirre-Valencia D, Posso-Osorio I, Bravo JC, Bonilla-Abadía F, Tobón GJ, Cañas CA. Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Clin Rheumatol 2017; 36: 2159-62.
DOI: https://doi.org/10.1007/s10067-017-3780-9
How to Cite
Cremonezi Lammoglia, B. ., de Aguiar Trevise, L. ., Paslar Leal, T. ., Pereira Lopes Vieira Pinto, M. ., Hasselmann, G., & Salles Rosa Neto, N. . (2023). Eosinophilic granulomatosis with polyangiitis: sequential use of mepolizumab following rituximab for inadequate asthma control despite vasculitis remission. Reumatismo, 75(4). https://doi.org/10.4081/reumatismo.2023.1588
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
