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EGPA — Mepolizumab Therapy

Anti-IL-5 biologic treatment for eosinophilic granulomatosis with polyangiitis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is EGPA — Mepolizumab Therapy?

Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is an ANCA-associated small-vessel vasculitis with prominent eosinophilic tissue infiltration. Patients typically have asthma, chronic rhinosinusitis with polyps, peripheral eosinophilia, and multi-organ vasculitis affecting nerves, skin, heart, and gastrointestinal tract.

Mepolizumab is a humanized monoclonal antibody that binds interleukin-5 (IL-5), the principal cytokine for eosinophil maturation and survival. The MIRRA trial (NEJM 2017) showed that 300 mg subcutaneous mepolizumab every four weeks doubled remission rates and significantly reduced oral corticosteroid use in non-severe EGPA, leading to FDA approval in 2017.

Mepolizumab is recommended as adjunctive therapy in EGPA without active life- or organ-threatening disease, alongside low-dose corticosteroids and conventional immunosuppression. Patients are monitored for asthma exacerbations, eosinophil counts, and ANCA status. Severe EGPA still requires high-dose corticosteroids with cyclophosphamide or rituximab induction.

Symptoms

Severe asthma with peripheral eosinophilia
Chronic rhinosinusitis with nasal polyps
Mononeuritis multiplex
Cutaneous purpura and nodules
Cardiomyopathy and pericarditis
Eosinophilic gastroenteritis
Renal involvement (less common)
Constitutional symptoms

Risk Factors

Pre-existing asthma and atopy
Allergic rhinitis or nasal polyposis
Eosinophilia above 1500 cells/microliter
Leukotriene receptor antagonist use
MPO-ANCA positivity (40 percent)
Prior systemic corticosteroid dependence
Family history of vasculitis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Worsening asthma despite high-dose ICS
  • New peripheral neuropathy with eosinophilia
  • Recurrent EGPA flares on prednisolone
  • Inability to taper steroids below 7.5 mg
  • Eosinophil count rising despite therapy

Treatment Methods

01
Mepolizumab 300 mg subcutaneous every four weeks
02
Tapering oral corticosteroid dose
03
Asthma controllers (high-dose ICS-LABA)
04
Conventional immunosuppression as needed
05
Monitoring eosinophils and ANCA status
06
Vaccinations including pneumococcal and influenza
07
Reserved cyclophosphamide or rituximab for severe disease

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.