Vasculitis & polymyalgia rheumatica
Dupilumab for relapsing or refractory sinonasal and/or asthma manifestations in eosinophilic granulomatosis with polyangiitis: a European retrospective study
Authors' conclusion
These results suggest that dupilumab may be effective in treating patients with EGPA-related ENT manifestations. However, EGPA flares occurred in one-third of patients and were preceded by eosinophilia in 88%, suggesting that caution is required.
Study context
- Population
- Patients with relapsing and/or refractory eosinophilic granulomatosis with polyangiitis (EGPA) treated with off-label dupilumab, Europe
- Participants
- 51 patients
- Outcome
- Response (complete: Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone ≤4 mg/day; partial: BVAS=0 and prednisone >4 mg/day)
- Follow-up
- Median 13.1 months
Methodological detailsobservational, multicentre, off-label use, Primary indication for dupilumab: disabling ear, nose and throat (ENT) symptoms in 92%
- Observational
- Multicentre
- Off-label use
- Primary indication for dupilumab: disabling ENT symptoms in 92%
Main finding
As reported in the abstract
Complete response
21
41%
Partial response
12
24%
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| EGPA relapse while on dupilumab | Dupilumab 31% |
- EGPA relapse while on dupilumab — Relapse associated with blood eosinophilia
- 14/16 (88%)
EGPA relapse while on dupilumab
- Median eosinophil count at dupilumab start significantly lower in relapsers than non-relapsers, as was median time between stopping anti-IL-5/IL-5R and switching to dupilumab
Safety
Adverse events · median follow-up of 13.1 months
- Serious adverse events (AEs)
- 2
- Patients reporting AEs: 18 (35%)
Eosinophilia (eosinophil count >500/mm³)
- Peak eosinophil count, median (IQR 1268-4501)
- 2195/mm³
- Time to peak, weeks (IQR 4-36)
- 13
- Eosinophilia associated with relapse
- 41%
- Patients with eosinophilia: 34 (67%)
Original publication
Dupilumab for relapsing or refractory sinonasal and/or asthma manifestations in eosinophilic granulomatosis with polyangiitis: a European retrospective study. Ann Rheum Dis. Published 21 September 2023. doi:10.
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