Mepolizumab in patients with eosinophilic granulomatosis with polyangiitis in remission: What is the right dose?

After the pivotal randomized controlled trial in which patients with eosinophilic granulomatosis polyangiitis (EGPA) received 300 mg mepolizumab every 4 weeks, US Food and Drug Administration expanded approved use of to treat EGPA. Conversely, Europe, is not yet licensed for EGPA severe asthma, clinicians can only 100 mg/4 wk regimen that has already been these patients. Therefore, we read great interest Clinical Communication by Caminati et al1Caminati M. Crisafulli E. Lunardi C. Micheletto Festi G. Maule al.Mepolizumab asthmatic remission phase.J Allergy Clin Immunol Pract. 2021; 9: 1386-1388Abstract Full Text PDF PubMed Scopus (7) Google Scholar on follow-up 16 severely remission, whom was administered monthly. Their study found significant improvement Asthma Control Test score, blood eosinophil count, forced expiratory volume 1 second (FEV1) percent predicted exacerbation rate at 3 6 months after treatment initiation. Importantly, oral glucocorticoids (GCs) could be completely discontinued 9 (56%). We performed a real-life retrospective Cochin Hospital consecutive uncontrolled GC-dependent asthma achievement remission. classified according American College Rheumatology criteria.2Masi A.T. Hunder G.G. Lie J.T. Michel B.A. Bloch D.A. Arend W.P. al.The 1990 criteria classification Churg-Strauss syndrome (allergic angiitis).Arthritis Rheum. 1990; 33: 1094-1100Crossref (1698) Response defined as reduction daily GC dose 5 or less and/or greater than 50% annual exacerbations while continued receive 12 months. A total 23 monthly vasculitis median 63 (range, 40.5-129 month). Patients were aged 55 years 47.5-62 years) 39.1% women. Mean 1.74 ± 1.63, count 490/mm3 365-752), 10 mg/d 7.5-15 mg/d), FEV1 64% 51% 89%) (Figure 1). year treatment, 62% responders, but one weaned from GCs (4.3%). also observed exacerbation, dose, Treatment switched other IL5-blocking therapies five patients: benralizumab (n = 3) 2). Our data confirm findings al3Wechsler M.E. Akuthota P. Jayne D. Khoury Klion A. Langford C.A. placebo polyangiitis.N Engl J Med. 2017; 376: 1921-1932Crossref (384) suggest may effective GC-sparing agent persistent However, patient GC-free months, whereas prednisone withdrawn two additional escalation wk. This dose-response effect. lower complete withdrawal accordance 18% arm able discontinue GCs.3Wechsler These discrepancies relate differences initial patients' characteristics variations concomitant treatments. limited its design, lack control group, missing data. Nevertheless, treating many higher needed optimal outcomes some would highly interesting findings. Reply “Mepolizumab remission: What right dose?”The Journal Immunology: In PracticeVol. 9Issue 7PreviewWe are grateful Akdime coauthors1 their valuable contribution debate place relevance anti-IL5 biologic treatments (EGPA), currently represents challenging hot topic. By confirming our data,2 coauthors phase supports concept precisely defining target population specific essential when managing drugs, especially context Full-Text