A 36-Year-Old Woman With a Worsening Cough and Hearing Loss

Nicole Davey-Ranasinghe, MD; Constantine K. Saadeh, MD

Disclosures

September 05, 2019

The primary treatment for EGPA is systemic glucocorticoids. In addition, an immunosuppressive agent is typically added for advanced refractory disease. Various disease-modifying agents have been used as glucocorticoid-sparing or maintenance therapy in patients with EGPA. Variable responses to methotrexate, azathioprine, mycophenolate mofetil, and leflunomide in the setting of EGPA have been reported; however, evidence is lacking to support these therapies.

Other therapies, including intravenous immunoglobulin, rituximab, interferon alpha, and anti-immunoglobulin E, have all been used in EGPA. Anti–interleukin-5 (IL-5) antibodies are available for the treatment of asthma and have affected the treatment options for patients with EGPA. Mepolizumab, a humanized monoclonal antibody to IL-5, is approved by the US Food and Drug Administration (FDA) for the treatment of EGPA. Mepolizumab has been assessed in multiple case reports and in a multicenter randomized, placebo-controlled trial.[4] Mepolizumab resulted in increased frequency of remission and allowed for tapering of prednisolone or prednisone compared with placebo. The dosage of mepolizumab for EGPA is 300 mg every 4 weeks, which is higher than the traditional asthma dosage.

This patient was treated with prednisone at a dosage of 60 mg daily (approximately 0.8 mg/kg). Her symptoms improved after 4 weeks, and a slow steroid taper was initiated. Monitoring of her vasculitis, both clinically and with repeat imaging and laboratory testing, is scheduled. An anti–IL-5 regimen may be initiated, if it is needed as a steroid-sparing agent. She concomitantly received Pneumocystis jirovecii pneumonia prophylaxis. Ongoing close monitoring for all patients with EGPA in a multidisciplinary fashion is essential.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....