The Therapeutic Effects of Systemic Corticosteroid and Immunosuppressants for New-Onset Cases and Mepolizumab for Recurrent Cases of Otitis Media Associated With Eosinophilic Granulomatosis with Polyangiitis.

Abstract

Objective: The aims of this study were to evaluate the otologic features and outcomes of otitis media associated with eosinophilic granulomatosis with polyangiitis (EGPA) and validate the current treatment strategies, including systemic corticosteroid (CS) and immunosuppressants for new-onset cases and therapeutic targeting of interleukin (IL)-5 for recurrent cases.

Study design: Retrospective case series.

Setting: Tertiary referral center.

Patients: Patients with otitis media associated with EGPA were eligible for inclusion.

Intervention: Systemic CS alone or a combination of systemic CS and intravenous cyclophosphamide (IVCY) was performed as induction therapy. Maintenance therapy with oral CS and immunosuppressant, such as rituximab, methotrexate, or azathioprine, was administered. Treatment with mepolizumab was performed at the time of relapse of major organ involvement in EGPA, exacerbation of asthma, and/or recurrence of ear, nose, and throat symptoms after remission induction.

Main outcome measures: Air- and bone-conduction pure-tone thresholds, overall survival rate, EGPA relapse rate, and otitis media recurrence rate.

Results: Systemic CS-based induction therapy achieved remission in all patients with EGPA. In both the CS + IVCY and CS-alone groups, hearing thresholds in the remission and/or resolution phase were significantly better than those at initial presentation at all frequencies (p < 0.01). The 5-year estimated relapse rate of major organ involvement was 29.2%, and the 5-year estimated recurrence rate of otitis media was 43.6%. All cases of recurrent otitis media treated with mepolizumab achieved improvement in otologic symptoms and subsequent reduction in maintenance CS dose. However, half of ears with recurrent otitis media showed repeated secretion and cessation of middle ear discharge and required additional topical CS treatment during mepolizumab administration.

Conclusions: Immunosuppressive treatment affords a good response to systemic manifestations as well as otitis media associated with EGPA. Meanwhile, a significant proportion of patients experienced exacerbation of otitis media during maintenance therapy. Mepolizumab might be the treatment of choice for recurrent cases.