Mepolizumab for the treatment of eosinophilic granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome; EGPA) is an ANCA-associated vasculitis characterized by the presence of eosinophilic asthma/rhinosinusitis and the disease of peripheral nervous system, kidneys, skin, heart and other organs. ANCA can be detected in a one third of EGPA patients. Initially, patients with EGPA are usually treated with glucocorticoids ± immunosuppressive agents. Mepolizumab, a monoclonal antibody against interleukin (IL)-5, can be used in patients with refractory or recurrent EGPA who do not respond to standard therapy. IL-5 is the main cytokine that regulates differentiation, activation, survival, and maturation of eosinophils. Efficacy and favorable safety profile of mepolizumab were established in the double-blind, placebo- controlled, clinical trial in 136 EGPA patients. Administration of mepolizumab compared to placebo resulted in significant improvement in remission and relapses rates andallowed for reduced glucocorticoid use.