Reslizumab Associated With Significant Reduction in Corticosteroid Use in Eosinophilic Granulomatosis With Polyangiitis

Treatment with intravenous reslizumab was associated with a significant reduction in systemic oral corticosteroid (OCS) use and improved patient-reported outcomes among patients with eosinophilic granulomatosis with polyangiitis (EGPA), according to study results published in European Respiratory Society Open Research.

To examine outcomes in patients who had established EGPA and severe eosinophilic asthma receiving long-term continuous OCS to maintain disease control, researchers administered 4-weekly reslizumab infusions at a dose of 3 mg/kg. They recorded clinical data including OCS dose, lung function, exhaled nitric oxide fraction level, 7-item Asthma Control Questionnaire (ACQ7) and mini-Asthma Quality of Life Questionnaire (AQLQ) scores at baseline and at 48 weeks of treatment.

Nine patients (mean age, 48.2±11.7 years; 44% women) with OCS-dependent EGPA and severe eosinophilic asthma were started on reslizumab between April 2017 and February 2019. After 48 weeks of treatment, mean maintenance OCS dose was significantly reduced, from a prednisolone equivalent of 23.4±9.1 mg/d to 5.9±4.8 mg/d (P <.001). Results showed a nonstatistically significant improvement in mean ACQ7 score from 2.1±2.1 to 1.5±1.8 (P =.081) and improvement in mean mini-AQLQ score from 4.6±1.8 to 5.9±1.6 (P =.001). Lung function showed no significant improvements and Birmingham Vascular Activity Score did not indicate any deterioration. Peripheral eosinophil counts remained suppressed, despite reduced OCS exposure. Researchers did not note any treatment-limiting adverse effects in the cohort, excluding in 2 patients.

Limitations included the possibility of a bias because the study was not a clinical trial, the lack of a control group, and the fact that reslizumab may be less effective in modulating extrapulmonary vasculitic disease phenotypes, while patients in the study had persistent severe asthma EGPA phenotype.

“Our data suggest that reslizumab may be a therapeutic option in patients [with] EGPA with concomitant severe eosinophilic asthma, facilitating what appears to be a significant reduction in OCS exposure in patients with refractory, suboptimally controlled disease,” the researchers concluded.

Reference

Kent BD, d’Ancona G, Fernandes M, et al. Oral corticosteroid-sparing effects ofreslizumab in the treatment of eosinophilic granulomatosis with polyangiitis [published online January 20, 2020]. ERJ Open Res. doi:10.1183/23120541.00311-2019