使用生物制剂治疗复发性和/或难治性嗜酸性肉芽肿性多血管炎：来自欧洲合作研究的数据。
Use of Biologics to Treat Relapsing and/or Refractory Eosinophilic Granulomatosis With Polyangiitis: Data From a European Collaborative Study.
机构信息
National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France.
University Medical Center Freiburg and University of Freiburg, Freiburg, Germany.
出版信息
Arthritis Rheumatol. 2021 Mar;73(3):498-503. doi: 10.1002/art.41534. Epub 2021 Jan 23.
OBJECTIVE
To describe the efficacy and safety of biologics for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA).
METHODS
A retrospective European collaborative study was conducted in patients with EGPA who received treatment with biologics for refractory and/or relapsing disease.
RESULTS
Among the 147 patients with EGPA included in the study, 63 received rituximab (RTX), 51 received mepolizumab (MEPO), and 33 received omalizumab (OMA). At the time of inclusion, the median Birmingham Vasculitis Activity Score (BVAS) was 8.5 (interquartile range [IQR] 5-13) in the RTX group, while the median BVAS in the OMA group was 2 (IQR 1-4.5) and the median BVAS in the MEPO group was 2 (IQR 1-5). In patients receiving RTX, the median BVAS declined both at 6 months (median 1, IQR 0-4.5) and at 12 months (median 0, IQR 0-2), and the frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 49%, 24%, 24%, and 3%, respectively. For the treatment of glucocorticoid (GC)-dependent asthma, patients who received MEPO had a much better GC-sparing effect and overall response than did patients who received OMA. The frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 15%, 33%, 48%, and 4%, respectively, in the OMA group and 78%, 10%, 8%, and 4%, respectively, in the MEPO group. Remission rates at 12 months were 76% and 82% among patients receiving MEPO at a doses of 100 mg and 300 mg, respectively.
CONCLUSION
These results suggest that RTX could be effective in treating relapses of EGPA vasculitis. MEPO is highly effective with a good safety profile in patients with GC-dependent asthma. Our data suggest that 100 mg MEPO monthly could be an acceptable dosage for first-line therapy in selected instances of EGPA, recognizing, however, that this has not been compared to the validated dosage of 300 mg monthly.
目的
描述生物制剂治疗嗜酸性肉芽肿性多血管炎（EGPA）的疗效和安全性。
方法
对接受生物制剂治疗难治性和/或复发性疾病的 EGPA 患者进行了一项回顾性欧洲合作研究。
结果
在纳入的 147 例 EGPA 患者中，63 例接受了利妥昔单抗（RTX）治疗，51 例接受了美泊利珠单抗（MEPO）治疗，33 例接受了奥马珠单抗（OMA）治疗。在纳入时，RTX 组的伯明翰血管炎活动评分（BVAS）中位数为 8.5（四分位距 [IQR] 5-13），OMA 组的 BVAS 中位数为 2（IQR 1-4.5），MEPO 组的 BVAS 中位数为 2（IQR 1-5）。在接受 RTX 治疗的患者中，6 个月时（中位数 1，IQR 0-4.5）和 12 个月时（中位数 0，IQR 0-2）BVAS 的中位数均下降，缓解率、部分缓解率、治疗失败率和因不良反应而停止治疗的频率分别为 49%、24%、24%和 3%。对于治疗糖皮质激素（GC）依赖性哮喘，接受 MEPO 治疗的患者与接受 OMA 治疗的患者相比，GC 节省效果和总体反应更好。在 OMA 组中，缓解率、部分缓解率、治疗失败率和因不良反应而停止治疗的频率分别为 15%、33%、48%和 4%，而在 MEPO 组中分别为 78%、10%、8%和 4%。接受 MEPO 100mg 和 300mg 治疗的患者在 12 个月时的缓解率分别为 76%和 82%。
结论
这些结果表明 RTX 可能对治疗 EGPA 血管炎的复发有效。MEPO 对 GC 依赖性哮喘患者具有高度疗效和良好的安全性。我们的数据表明，在某些情况下，每月 100mg 的 MEPO 可能是 EGPA 一线治疗的可接受剂量，但需要注意的是，这尚未与每月 300mg 的已验证剂量进行比较。
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