D3.151 - Anti-IL5 biologics in eosinophilic granulomatosis with polyangiitis patients followed in a severe asthma multidisciplinary unit: functional and clinical outcomes

Eosinophilic granulomatosis with polyangiitis (EGPA) frequently presents with severe eosinophilic asthma and upper airway disease, requiring long-term multidisciplinary follow-up. While anti-IL5 biologics are used in EGPA, real-world data focusing on asthma control and functional respiratory outcomes remain limited. We describe clinical characteristics and longitudinal asthma-related outcomes of EGPA patients from a severe asthma multidisciplinary unit.

We conducted a retrospective observational study of patients with EGPA (2022 ACR/EULAR classification) and severe asthma. Demographics, disease duration and severity, anti‑neutrophil cytoplasmic antibody (ANCA) status, blood eosinophil counts, total immunoglobulin E (IgE), pulmonary function, use of biologics and remission status were extracted. Remission was defined as BVAS=0 or absence of active systemic disease for at least 6 months.

Ten patients with EGPA and severe asthma were identified (median age 57 years [range: 22-77], 60% male). All had comorbid chronic rhinosinusitis with nasal polyposis (CRSwNP) and at least one systemic manifestation, most frequently peripheral neuropathy (n=6) and cutaneous involvement (n=5). Three were ANCA‑positive.

Anti-IL5 biologic therapy with mepolizumab was initiated in 6 patients for uncontrolled severe eosinophilic asthma and CRSwNP. In 3 of these patients, an additional immunossupressant was added (rituximab=2; azathioprine=1). Three others are awaiting biologic initiation (mepolizumab=2; benralizumab=1). One patient achieved control only with azathioprine (Table 1).

The mean follow‑up was 27 months. In patients with at least 12 months post biologic initiation (n=6), peripheral blood eosinophil counts and total IgE concentrations markedly reduced, with all demonstrating asthma control at follow up (average ACT 23, range: 20-25), with no significant decline in lung function (Figure 1). Six patients (mepolizumab=5, azathioprine=1) were in remission. No treatment-limiting adverse events of anti-IL5 therapy were observed and no deaths occurred. 

In our case series, EGPA patients demonstrated clinical improvements in asthma control with no functional decline and stable systemic disease under anti-IL5 therapy. 

These results underscore the importance of multidisciplinary care units, enabling a comprehensive and integrated approach to the management of EGPA in patients with predominantly eosinophilic airway involvement.