Previous Page  58 / 80 Next Page
Show Menu
Previous Page 58 / 80 Next Page
Page Background

Practitioner's Corner

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398

© 2019 Esmon Publicidad

the BVAS was 0, and FEV


was 92% of predicted. There were

no exacerbations, and we were able to reduce prednisone to

2.5 mg/d.

The other patient was a 27-year-old nonsmoking man with

a long history of recurrent nasal polyposis and eosinophilic

asthma treated with high-dose inhaled corticosteroids and long-

acting ß


-agonists, antileukotrienes, and oral corticosteroids.

His symptoms were uncontrolled, and he had considerable peak

flow variability (>15%). He presented with erythematous skin

lesions (Figure) compatible with biopsy-proven eosinophilic

extravascular granuloma and bilateral, patchy, ground glass

opacities, with an upper lung distribution on the chest CT scan

(SupplementaryMaterial). The blood tests revealed eosinophilia

(40%), increased CRP and IgE levels (2.28 mg/dL and 2970 IU/

mL, respectively), and negative ANCA titers. FEV



115% of predicted. The patient was initially treated with

prednisone 60 mg/d (0.75 mg/kg/d), with 10 mg/d the lowest

dose reached because of recurrent symptoms when it was

reduced. Subcutaneous mepolizumab was started at 300 mg

every 4 weeks. Before starting mepolizumab, the laboratory

values were as follows: blood eosinophil count, 35%; serum

IgE, 996 IU/mL; and CRP, 0.26 mg/dL. The BVAS was ˃3,

and FEV


was 108% of predicted. Six months later, the patient

was asymptomatic without exacerbations. In addition, blood

eosinophilia and IgE levels decreased (1.2% and 209 IU/mL,

respectively), BVAS was 0, and FEV


was 89% of predicted.

Therefore, the dose of corticosteroid was reduced.

No allergic reactions or adverse events or relapses were

associated with mepolizumab in either case.

In summary, our results are consistent with those of

previous studies [6-8]. Mepolizumab may be considered a

therapeutic option in patients with refractory corticosteroid

EGPA in order to reduce the dose of corticosteroids and their

adverse effects and thus improve quality of life.


The authors declare that no funding was received for the

present study.

Conflicts of Interest

Dr. Garcia Moguel has participated in advisory boards

and acted as a speaker/investigator for Novartis, AstraZeneca,

Teva, GSK, Chiesi, Allergy therapeutics, Leti, Stallergenes,

ALK-Abelló, Mundipharma, Pfizer, and Orion Pharma.

The remaining authors declare that they have no conflicts

of interest.


1. Mahr A, Moosig F, Neumann T. Eosinophilic granulomatosis

with polyangiitis (Churg–Strauss): evolutions in classification,

etiopathogenesis, assessment and management. Curr Opin

Rheumatol. 2014;26:16-23.

2. Watts RA, Lane S.What is known about the epidemiology of the

vasculitides? Best Pract Res Clin Rheumatol. 2005;19:191-207.

3. Samson M, Puéchal X, Devilliers H, Ribi C, Cohen P, Stern M,

et al. Long-term outcomes of 118 patients with eosinophilic

Manuscript received March 4, 2019; accepted for publication

April 25, 2019.

Vania Cecilia Prudencio Ribera


granulomatosis with polyangiitis (Churg–Strauss syndrome)

enrolled in two prospective trials. J Autoimmun. 2013;43:60-9.

4. Jachiet M, Samson M, Cottin V. Anti-IgE Monoclonal Antibody

(Omalizumab) in Refractory and Relapsing Eosinophilic

Granulomatosis With Polyangiitis (Churg-Strauss): Data on

Seventeen Patients. Arthritis Rheumatol. 2016;68:2274-82.

5. Pavord ID, Korn S, Howarth P. Mepolizumab for severe

eosinophilic asthma (DREAM): a multicentre, doubleblind,

placebo-controlled trial. Lancet. 2012;380:651-9.

6. Kim S, Marigowda G, Oren E, Israel E, Wechsler ME.

Mepolizumab as a steroid sparing treatment option in

patients with Churg-Strauss syndrome. J Allergy Clin Immunol.


7. Moosig F, Gross WL, Herrmann K, Bremer JP, Hellmich B.

Targeting interleukin-5 in refractory and relapsing Churg-

Strauss syndrome. Ann Intern Med. 2011;155:341-3.

8. 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.


9. Pradhan RR, Nepal G, Mandal S. Safety and Efficacy of

Mepolizumab in Patients with Eosinophilic Granulomatosis

with Polyangiitis. Pulm Med. 2019;2019:4376380.

10. 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.