How is Eosinophilic Granulomatosis with Polyangiitis treated

How is Eosinophilic Granulomatosis with Polyangiitis treated?

The treatment of choice is GCs. Patients with a FFS of 0 may be managed with GCs alone. However, flares occur in 35% when GCs are tapered.

Patients with poor prognostic factors (FFS ≥1) need GCs (60–80 mg/day divided dose), and cyclophosphamide (monthly pulse) should be considered as well.

Those with severe presentations may benefit from 3 days of pulsed methylprednisolone (1 g/day). Up to 10% of patients are resistant to conventional therapy.

These patients may benefit from mepolizumab or rituximab.

Mepolizumab, an antibody to IL-5, was approved by the FDA for treatment of EGPA late in 2017 and is the first medication to receive FDA approval for EGPA.

Of note, the randomized trial that led to FDA approval included a patient population with low rates of renal involvement (<1%), alveolar hemorrhage (<5%), palpable purpura (13%), and ANCA positivity (20%).

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