290. Asthma Control in Eosinophilic Granulomatosis With Polyangiitis Treated With Rituximab
Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare systemic small vessel necrotizing vasculitis presenting with asthma and eosinophilia. Rituximab (RTX) is effective in ANCA- associated vasculitis (AAV), but benefits in EGPA are unclear. Glucocorticoid (GC) dependent asthma is the main challenge in EGPA management. Our aim was to characterize asthma control and GC dependency in EGPA patients treated with RTX. Methods: Retrospective cohort study of patients diagnosed with EGPA between 2000 and 2017 presenting with GC dependent asthma and treated with RTX for remission-induction in a single center. Standardized data collection was performed, including disease activity assessment, RTX treatment, asthma characterization and control. Results: A total of 17 patients were included. At diagnosis, the majority was myeloperoxidase (MPO)-ANCA positive (13, 76.5%). Non-controlled asthma symptoms were present in 13 (76.5%) patients. Atopy was present in 13 (76.5%) and radiographic changes in 8 (47.1%). RTX was used in three different clinical scenarios: for initial remission-induction (5, 29.4%) in patients with new onset of severe disease (BVAS/WG>3), after failed remission-induction attempts with other immunosuppressant’s (12, 70.6%) or for remission maintenance (9, 52.9%). GCs were used in maintenance at median dose of 25 (16.25–37.5) mg/day. Median time of follow-up since EGPA diagnosis was 38 (17-107) months. Three patients (17.6%) relapsed after RTX. As maintenance treatment in 9 (52.9%) patients, RTX choice was guided mainly by B- cell reconstitution (7, 41.2%). At the end of follow-up, remission was achieved in 15 (88.2%) patients. After induction with RTX, >1 asthma exacerbation occurred in 8 (47.1%) patients but use of bronchodilators was not significantly different. Mepolizumab was used for refractory symptomatic asthma in 2 patients (11.8%), after RTX effect worn off. At the end of follow-up, median serum eosinophils and C-reactive protein were lower (0.10 vs. 1.06 x109/L, p = 0.012; 5vs.27 mg/dL, p = 0.001; respectively). Pulmonary function tests (PFTs) remained unchanged. Remission-induction treatment with RTX allowed a more predictable GC tapering: to a median dose of 5 mg/day at 12 months. However, patients in maintenance with RTX did not need GC for asthma symptomatic control after 12 months. Conclusion: RTX appears as safe with GC sparing efficacy in EGPA. Improvement in inflammatory markers and eosinophilia was observed, but not in PFTs. RTX deserves more detailed studies in randomized controlled clinical trials in EGPA. Abstract 290 Figure Disclosures: None
Source: Rheumatology
Institution: Mayo Clinic
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2927055776