Medical Graduate, University of Patras Medical School, Patras, Greece.
Internal Medicine Resident, General Hospital of East Achaia, Kalavryta, Greece.
Rheumatol Int. 2023 Jul;43(7):1245-1252. doi: 10.1007/s00296-023-05326-1. Epub 2023 Apr 21.
Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, mostly affecting small-sized arteries and usually occurring in patients with an allergic background. Eosinophils seem to play a significant role in the pathogenesis of the disease and, therefore, biologics targeting interleukin 5 (IL5), a cytokine tightly linked to eosinophils, have emerged as a promising therapeutic tool. A systematic review of Medline was conducted from 2007 to 2022 to search for data regarding the use of anti-IL5 therapies in patients with EGPA. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. The efficacy and safety of mepolizumab, an anti-IL5 monoclonal antibody (mAb), was confirmed by a randomized controlled trial (RCT), although a significant proportion of patients did not respond to this treatment. Other studies showed that both doses of 100 mg and 300 mg of mepolizumab are almost equally effective in EGPA. Benralizumab, an anti-IL5 receptor mAb has preliminary promising results and an RCT is planned to be conducted. Apart from their clinical efficacy in EGPA, anti-IL5 therapies may have steroid-sparing properties. Anti-IL5 therapies seem to be effective and safe in patients with refractory/relapsing EGPA and can be used as a steroid-sparing treatment. Nevertheless, more research is needed to clarify the pathophysiology of the disease; this may potentially lead to the identification of biomarkers to pinpoint patients most likely to respond to anti-IL5-blockade.
嗜酸性肉芽肿性多血管炎（EGPA）是一种抗中性粒细胞胞浆抗体（ANCA）相关性血管炎，主要影响小动脉，通常发生在过敏背景的患者中。嗜酸性粒细胞似乎在疾病发病机制中发挥重要作用，因此，靶向白细胞介素 5（IL5）的生物制剂已成为一种有前途的治疗工具，白细胞介素 5 是一种与嗜酸性粒细胞密切相关的细胞因子。从 2007 年到 2022 年，对 Medline 进行了系统评价，以搜索有关 EGPA 患者使用抗 IL5 治疗的数据。还在 ClinicalTrials.gov 和世界卫生组织试验门户中搜索了正在进行或未发表的试验。一项随机对照试验（RCT）证实了抗 IL5 单克隆抗体（mAb）美泊利珠单抗的疗效和安全性，尽管相当一部分患者对此治疗无反应。其他研究表明，美泊利珠单抗的 100mg 和 300mg 两种剂量在 EGPA 中几乎同样有效。抗 IL5 受体 mAb 贝那利珠单抗初步结果有希望，计划进行 RCT。除了在 EGPA 中的临床疗效外，抗 IL5 治疗可能具有类固醇节省特性。抗 IL5 治疗似乎对难治性/复发性 EGPA 患者有效且安全，可作为类固醇节省治疗。然而，需要进一步研究来阐明疾病的病理生理学；这可能有助于确定生物标志物，以确定最有可能对 IL5 阻断有反应的患者。
