Early mepolizumab initiation during remission induction is associated with lower organ damage burden in EGPA: a multicentre cohort study.

Abstract

Objective: The objective of this study was to evaluate whether early mepolizumab initiation during remission induction is associated with favourable clinical outcomes and lower organ damage burden in patients with eosinophilic granulomatosis with polyangiitis (EGPA).

Methods: This retrospective multicentre cohort study used data from the Kyushu Vasculitis Cohort Study. Patients with EGPA were classified into an early mepolizumab group, in which mepolizumab was initiated within 3 months of remission induction, and a conventional group. The primary end point was clinical remission at 1 year, defined as BVAS = 0 with prednisolone ≤4 mg/day. Secondary end points included remission at 6 months and 2 years, glucocorticoid exposure, relapse, mortality, and organ damage as assessed by the Vasculitis Damage Index (VDI). Longitudinal VDI values from 6 months to 2 years were analysed using a linear mixed-effects model.

Results: Sixty-four patients were included (early mepolizumab, n = 16; conventional, n = 48). Clinical remission at 1 year was achieved more frequently in the early mepolizumab group than in the conventional group (69% vs 27%; P = 0.006). At 2 years, remission was achieved in 10/10 (100%) vs 13/45 (29%) evaluable patients (P < 0.001), and glucocorticoid discontinuation was achieved in 4/10 (40%) vs 4/45 (9%) of those patients (P = 0.029). BVAS decreased markedly in both groups. Early mepolizumab initiation was associated with lower longitudinal VDI values (β = -0.36, 95% CI -0.70 to -0.03; P = 0.032).

Conclusion: Early mepolizumab initiation was associated with higher remission rates, lower glucocorticoid exposure and lower organ damage burden during the first 2 years in EGPA.