The effects of mepolizumab on peripheral circulation and neurological symptoms in eosinophilic granulomatosis with polyangiitis (EGPA) patients.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing small vessel vasculitis. Extensive infiltration of eosinophils causes multisystem clinical symptomatology.1 Neurological symptoms contribute greatly to morbidity.2 It is known that treatment with prednisolone alone is associated with a 40% relapse rate during tapering.3 Mepolizumab, an IL 5 antagonist monoclonal antibody, can be used in prednisolone resistant cases4 to reduce the dose of prednisolone and to prevent recurrence. However, its use in relieving neurological symptoms is unknown. LaserDoppler flowmetry, used as an indicator of microscopic peripheral circulation, has been shown to be a simple and reproducible modality to diagnose peripheral artery diseases.5 We administered mepolizumab to patients with recurrent EGPA, recorded their symptoms and laboratory data, and assessed the ability of laserDoppler flowmetry to quantify their peripheral circulation and neurological pathology by measuring skin perfusion pressure (SPP) This was a retrospective observational study. Six patients (five female and one male) diagnosed with recurrent EGPA at Nihon University Itabashi Hospital from 2016 to 2019 using criteria from the American College of Rheumatology (ACR),6 were studied. The mean age (mean SD) of onset of EGPA was 57.1 17.2 y. white blood cell (WBC) count was 14.85 3.57 109/L, with 7.97.5 2.05 109/L, peripheral eosinophils. Serum immunoglobulin E (IgE) was 1974.3 1014.9 IU/mL, C reactive protein (CRP) was 4.12 3.2 mg/dL and erythrocyte sedimentation rate (ESR) was 54.8 11.2 mm/h. Myeloperoxidase anti neutrophil cytoplasmic antibody (MPO ANCA) positivity was found in 2/6 cases (192.9 128.2 IU/mL) The Birmingham vasculitis activity score (BVAS) was 14.3 1.5. The patients' global scale (GS) of neurological symptoms (maximum 1/4 100% was 69.1 28.7% Skin biopsy or peripheral nerve biopsy specimens from 5 subjects had shown leukocytoclastic vasculitis and/or necrotizing vasculitis with eosinophilic infiltration (Table 1) Fractional exhaled nitric oxide (FeNO) measurements, SPP, and nerve conduction studies had not been measured before or after 24 weeks of prednisolone treatment. This research was approved by the Nihon University School of Medicine ethics committee (No. RK 190312 18) The Wilcoxon signed rank test was employed to detect statistically significant
Allergology international official journal of the Japanese Society of Allergology