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Practitioner's Corner
J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398 © 2019 Esmon Publicidad
the BVAS was 0, and FEV1 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 ß2-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. FEV1 was
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 FEV1 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 FEV1 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.
Funding
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.
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Manuscript received March 4, 2019; accepted for publication
April 25, 2019.
Vania Cecilia Prudencio Ribera
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