AB0766 STEP-DOWN TREATMENT WITH MEPOLIZUMAB FOR EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA). REAL-LIFE EXPERIENCE OF A SINGLE-CENTER COHORT

Background

Mepolizumab is an anti-interleukin-5 (IL-5) agent approved for EGPA at the dose of 300 mg every 4 weeks. However, from real-life studies, evidence is accruing of its comparable effectiveness at “asthma-dose” of 100 mg every 4 weeks. The preferred approach at our center is to start mepolizumab 300 mg/4 weeks and to reduce to 100 mg/4 weeks once remission is achieved (Birmingham Vasculitis Activity Score - BVAS=0), asthma is controlled (Asthma Control Test – ACT >20), eosinophil count is normalized and glucocorticoids are withdrawn (step-down approach).

Objectives

To assess the long term-efficacy of step-down treatment with mepolizumab in EGPA.

Methods

We reviewed medical charts of patients with EGPA treated with mepolizumab from April 2014 to December 2022. We divided patients by homogeneous dosing schedule and compared disease activity and characteristics at baseline and over time.

Results

We treated 38 patients for a median follow up of 38 months (IQR 29-53). Seven patients underwent a step-up approach (starting with mepolizumab 100 mg/4w and subsequent switching to mepolizumab 300 mg/4w in case of failure). Among them, only 1 patient (17%) needed a dose increase due to uncontrolled respiratory symptoms. Mepolizumab 300 mg/4w was started in 31 patients allowing a step-down in 9 (29%), without any patient having to increase the dose again. Both subgroups of the step-down strategy showed significant reduction in terms of BVAS, ACT, serum eosinophils and daily prednisone dose at last follow-up. At the same time presented a high proportion of nasal exacerbations (33 vs. 9% p=0.31). [Table 1]

Conclusion

In our experience, a step-down approach with mepolizumab in EGPA is reasonable and allows to safely reach the low-dose regimen in a great proportion of patients. Nasal polyps are the new challenge for physicians treating EGPA in an age where a steroid-free remission is an achievable target.

REFERENCES:

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Acknowledgements:

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Disclosure of Interests

None Declared.