EGPA: mepolizumab started within three months of induction was associated with more remission and less damage

Design

Retrospective multicentre cohort

Population

64 patients with EGPA (16 early mepolizumab, 48 conventional)

Primary outcome

Clinical remission at 1 year (BVAS 0, prednisolone ≤4 mg/day)

Effect

69% vs 27% (P = 0.006); VDI β −0.36 (−0.70 to −0.03)

The Kyushu Vasculitis Cohort compared 16 patients with EGPA who started mepolizumab within three months of remission induction with 48 treated conventionally.

Remission at one year (BVAS 0 on prednisolone 4 mg or less) was 69% with early mepolizumab against 27% (P = 0.006). At two years, all 10 evaluable early patients were in remission, against 29%, and 40% had stopped glucocorticoids against 9%. Early mepolizumab was associated with lower Vasculitis Damage Index over time.

Mepolizumab is usually added for relapsing or refractory disease. This suggests earlier use may reduce steroid exposure and damage, but the groups were small and chosen by clinicians.

• Consider mepolizumab early in EGPA with steroid-dependent asthma or ENT disease.
• Aim for prednisolone 4 mg or less as the remission target.
• Track damage with the VDI at each review.
• In India, cost limits access — prioritise patients with high steroid exposure.

Why it matters

It questions reserving anti-IL-5 therapy for relapse.

Don't overread it

Sixteen treated patients, non-randomised; clinicians may have chosen early mepolizumab for patients who were going to do well.

The statistics, in plain English

The two-year comparison rests on 10 early-treated patients; percentages from groups this small move sharply with each patient.

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