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Background: Mepolizumab (MPZ) has demonstrated efficacy in clinical trials for patients with eosinophilic granulomatosis with polyangiitis (EGPA) 1; however, there is a limited number of studies comparing the disease course between individuals treated with MPZ (MPZ group) and those who were not treated with MPZ (non-MPZ group) in a real-world setting. Objectives: This study aimed to compare the disease course and outcomes between the two groups and assess the long-term efficacy of MPZ in the Kansai multicenter REVEAL cohort. Methods: We enrolled 113 patients with EGPA who were registered in the cohort until June 2023. Retrospective data on clinical characteristics, disease activities, organ damage, treatments, and outcomes were collected. To minimize potential confounding factors, we performed propensity score matching (PSM). All statistical analyses were conducted using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan). Results: After performing PSM, we identified a total of 37 pairs of matched patients. The clinical characteristics, including age at onset, sex, disease duration, antineutrophil cytoplasmic antibody positivity, Birmingham Vasculitis Activity Score (BVAS) at onset, and Five-factor score, were comparable between the two groups. The 5-year survival rates were significantly higher in the MPZ group compared to the non-MPZ group (MPZ group: 100%, non-MPZ group: 86.5%, log-rank: p=0.028) (Figure 1A). The BVAS at the last observation was significantly lower in the MPZ group (p=0.028). The MPZ group also had significantly lower glucocorticoid (GC) doses at the last observation (median; MPZ group: 4mg/day, non-MPZ group: 5mg/day, p=0.011) (Figure 1B), with a higher proportion achieving GC dose ≤ 4mg/day (MPZ group: 51.4%, non-MPZ group: 24.2%, p=0.027) (Figure 1C). The results of the multivariate logistic regression analysis showed that achieving a GC dose of ≤ 4mg/day was positively associated with MPZ administration (OR 3.55, 95%CI=1.15–11.0, p=0.028) and inversely associated with wheeze at disease onset (OR 0.103, 95%CI=0.0197–0.544, p=0.0074). Conclusion: Mepolizumab not only contributes to disease activity control but also reduces the required GC dose, which may lead to prolonged survival in patients with EGPA. REFERENCES: 1 Wechsler ME, Akuthota P, Jayne D, Khoury P, Klion A, Langford CA, et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med. 2017;376(20):1921-32. Acknowledgements: NIL. Disclosure of Interests: Mayu Shiomi: None declared, Ryu Watanabe Speakers bureau: Asahi Kasei, Chugai, Eli Lilly, GSK, and UCB Japan., Grant/research support from: AbbVie., Shogo Matsuda Speakers bureau: AbbVie., Grant/research support from: Japan Intractable Diseases Research Foundation., Takuya Kotani Speakers bureau: Abbvie, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Pfizer., Ayana Okazaki: None declared, Yuichi Masuda: None declared, Tsuneyasu Yoshida: None declared, Mikihito Shoji: None declared, Ryosuke Tsuge: None declared, Keiichiro Kadoba: None declared, Ryosuke Hiwa Speakers bureau: AbbVie, Asahi Kasei, Brystol-Meyers Squibb, Eisai, Eli Lilly, GSK, Kissei, Pfizer, and Daiichi Sankyo., Grant/research support from: GSK., Wataru Yamamoto: None declared, Motomu Hashimoto Speakers bureau: Brystol Meyers, Chugai, Eisai, Eli Lilly, and Tanabe Mitsubishi., Grant/research support from: AbbVie, Asahi Kasei, Astellas, Brystol Meyers, Eisai, Daiichi Sankyo, Eli Lilly, Novartis Pharma, and Taisho Toyama.
Shiomi et al. (Sat,) studied this question.