Three cases of relapsed eosinophilic sinusitis without eosinophilia during mepolizumab maintenance therapy for eosinophilic granulomatosis with polyangiitis.

Publisher: Springer Country of Publication: Germany NLM ID: 8211469 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-9949 (Electronic) Linking ISSN: 07703198 NLM ISO Abbreviation: Clin Rheumatol Subsets: MEDLINE

Publication: <2008->: Heidelberg : Springer
Original Publication: Brussels : Acta Medica Belgica, [1982-

Antibodies, Monoclonal, Humanized*/administration & dosage ; Antibodies, Monoclonal, Humanized*/adverse effects ; Eosinophilia*/complications ; Eosinophilia*/drug therapy ; Granulomatosis with Polyangiitis*/drug therapy ; Granulomatosis with Polyangiitis*/complications ; Recurrence* ; Sinusitis*/diagnosis ; Sinusitis*/immunology; Humans ; Eosinophils ; Interleukin-5/antagonists & inhibitors

We present three cases of eosinophilic granulomatosis with polyangiitis (EGPA) where patients experienced relapse of eosinophilic sinusitis without peripheral eosinophilia while on remission maintenance therapy with mepolizumab (MPZ), an anti-interleukin (IL)-5 monoclonal antibody. Despite the initial control of symptoms with high-dose prednisolone (PSL) and MPZ, patients experienced a relapse of nasal obstruction and eosinophilic infiltration in nasal mucosal biopsies. Notably, relapses occurred despite normal peripheral eosinophil counts, indicating the localized nature of eosinophilic inflammation. While IL-5 inhibitors effectively reduce peripheral blood eosinophils, eosinophilic sinusitis may persist due to local factors such as IL-4-mediated inflammation. IL-4 has been implicated in promoting eosinophil migration into nasal tissues, suggesting that IL-5 inhibitors alone may not sufficiently suppress eosinophilic infiltration in such cases. These findings highlight the importance of considering the possibility of eosinophilic sinusitis relapse in EGPA patients treated with IL-5 inhibitors and reduced glucocorticoid doses. Further research is warranted to elucidate the mechanisms underlying local eosinophilic inflammation and optimize treatment strategies for EGPA patients.
(© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

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Keywords: Eosinophilia; Eosinophilic granulomatosis with polyangiitis; Eosinophilic sinusitis; Mepolizumab

0 (Antibodies, Monoclonal, Humanized)
0 (Interleukin-5)
90Z2UF0E52 (mepolizumab)

Date Created: 20240909 Date Completed: 20241018 Latest Revision: 20241105

20241105

10.1007/s10067-024-07133-w

39249645