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Abstract: PO1950

Anti-IL-5 Therapy in Eosinophilic Granulomatosis with Polyangiitis (EGPA): An 18-Month Follow-Up Study of a Steroid-Sparing Therapeutic Approach

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Egan, Allyson Catherine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Sivasothy, Pasupathy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Gore, Robin B., Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Owen, Caroline Mary, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Jones, Rachel B., Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Smith, Rona M., Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Willcocks, Lisa C., Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Burns, Stella M., Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  • Jayne, David R.W., University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
Background

EGPA is a small vessel vasculitis with protean renal manifestations including necrotizing glomerulonephritis, eosinophilic interstitial nephritis and obstructive uropathy. In the randomized, placebo-controlled MIRRA trial for relapsing and refractory EGPA, adjuvant therapy with 300mg anti-IL5 mAB Mepolizumab [MEPO], accrued longer times in remission, reduced steroid exposure and reduced relapse rates.

Methods

The aim of our study was to analyze the outcome for EGPA patients who received 100mg s/c of MEPO monthly for 18 months and beyond. This retrospective, descriptive study analyzed 13 patients with EGPA, who received 100mg s/c of MEPO therapy monthly. Time points of assessment included MEPO commencement [M0] and ≧ 18 months [>M18].

Results

This study demonstrates that anti-IL5 therapy serves as a favorable model for steroid minimization in EGPA, with an overall 50% reduction in steroid dosage. Additional reduction in conventional immunosuppressants was also observed in 3 patients. ANCA positive serology normalized in all four patients. Well tolerated, it demonstrated considerable clinical benefit, with 12 patients [92.3%] continuing anti-IL5 therapy beyond 18 months. Renal function was preserved. One patient had MEPO switched to Rituximab to treat both EGPA and new onset rheumatoid arthritis. Three patients were switched to alternative anti-IL5 therapies, benralizumab (x2) and Reslizumab (x1).

Conclusion

The relapsing nature of EGPA places a potential dependency of therapy on steroids, underscoring the importance of targeted pathway specific biologics to minimize steroid exposure, prevent tissue damage and ensure early response to therapy. There was a 50% reduction in steroid dosage in this study, with preserved renal function.