Mepolizumab and OCS Use in Eosinophilic Granulomatosis With Polyangiitis

In patients with eosinophilic granulomatosis with polyangiitis (EGPA), treatment with the anti–interluekin-5 monoclonal antibody mepolizumab is associated with reduced use of oral corticosteroids (OCS). Data from the phase 3 MIRRA study (ClinicalTrials.gov Identifier: NCT02020889) were utilized to explore the OCS-sparing effect of mepolizumab in patients with EGPA. Results of the analysis were presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, November 4 to 8, 2021.

In the  MIRAA study, patients with relapsing/refractory EGPA who had been receiving stable doses of prednisolone/prednisone of 7.5 to 50 mg/day for at least 4 weeks prior to baseline were randomized in a 1 to 1 ratio to mepolizumab 300 mg or placebo, administered subcutaneously every 4 weeks for 52 weeks, plus standard of care. Following a recommended protocol, OCS was tapered per clinician judgment. The investigators analyzed the mean OCS daily dose during weeks 48 through 52 and cumulative OCS exposure during the treatment period. A post-hoc analysis evaluated accrued weeks of OCS of up to 4 mg/day, as well as the percentage of patients who were receiving OCS of up to 4 mg/day at weeks 36 and 48.

A total of 136 individuals were enrolled in the study; 68 in the mepolizumab group and 68 in the placebo group. Between weeks 48 and 52, more participants treated with mepolizumab vs placebo received lower average daily doses of prednisolone/ prednisone (odds ratio [OR], 0.20; 95% CI, 0.09-0.41; P <.001). Further, the mean cumulative OCS exposure was also decreased with mepolizumab compared with placebo over the treatment period (3286.9 [2095.83] mg vs 4710.0 [2625.82] mg, respectively).

Accrued weeks of OCS of up to 4 mg/day were increased with mepolizumab vs placebo over the treatment period (OR, 5.06; 95% CI, 2.47-10.38; P <.001). Additionally, the percentage of patients who received up to 4 mg/day of OCS therapy at both week 36 and week 48 was also greater with mepolizumab than with placebo (41% vs 10%, respectively; OR, 6.63; 95% CI, 2.57-17.12; P <.001).

The researchers concluded that the reduced OCS use reported among mepolizumab-treated patients in the current study is a key therapeutic objective in this population of patients with EGPA, given the fact that OCS use is associated with adverse effects.

Reference  

Wechsler M, Jayne D, Terrier B, et al. Oral corticosteroid–sparing  effect of mepolizumab in patients with eosinophilic granulomatosis with polyangiitis.  Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract A043.