Anti-IgE Monoclonal Antibody (Omalizumab) in Refractory and Relapsing Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss): Data on Seventeen Patients.

Abstract

OBJECTIVE:

To describe the efficacy and safety of omalizumab, an anti-IgE monoclonal antibody, in patients with refractory and/or relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA).

METHODS:

We conducted a nationwide retrospective study including EGPA patients who received omalizumab. Response was defined as the absence of asthma and/or sinonasal exacerbations with a prednisone dosage of ≤7.5 mg/day (complete response) or >7.5 mg/day (partial response).

RESULTS:

Seventeen patients (median age 45 years) received omalizumab for severe steroid-dependent asthma (88%) and/or sinonasal involvement (18%). After a median follow-up of 22 months, 6 patients (35%) achieved a complete response, 5 patients (30%) achieved a partial response, and 6 patients (35%) had no improvement. The median Birmingham Vasculitis Activity Score decreased from 2.5 at baseline to 0.5 at 12 months. The median number of exacerbations per month decreased from 1 at baseline to 0 at 12 months, and the median forced expiratory volume in 1 second increased from 63% of the percent predicted at baseline to 85% of the percent predicted at 12 months. The median prednisone dosage decreased from 16 mg/day at baseline to 11 mg/day at 6 months and 9 mg/day at 12 months. Omalizumab was discontinued in 8 patients (47%) during follow-up, because of remission (12.5%), adverse event despite disease remission (12.5%), refractory disease (25%), or relapse (50%). Relapses included retrobulbar optic neuritis attributable to EGPA in 2 patients and severe asthma flare in 2 others.

CONCLUSION:

The results of this study suggest that omalizumab may have a corticosteroid-sparing effect in EGPA patients with asthmatic and/or sinonasal manifestations, but reducing the corticosteroid dose may also increase the risk of severe EGPA flares, which raises the question of the safety of omalizumab in patients with EGPA.

• Authors: Marie Jachiet, Maxime Samson, Vincent Cottin, Jean-Emmanuel Kahn, Guillaume Le Guenno, Philippe Bonniaud, Hervé Devilliers, Laurence Bouillet, Anne Gondouin, Fatma Makhlouf, Nadine Meaux-Ruault, Helder Gil, Boris Bienvenu, André Coste, Matthieu Groh, Violaine Giraud, Stéphane Dominique, Bertrand Godeau, Xavier Puéchal, Chahera Khouatra, Marc Ruivard, Claire Le Jeunne, Luc Mouthon, Loïc Guillevin, Benjamin Terrier, French Vasculitis Study Group
• Journal: Arthritis & rheumatology (Hoboken, N.J.) (Arthritis Rheumatol) Vol. 68 Issue 9 Pg. 2274-82 (09 2016) ISSN: 2326-5205 [Electronic] United States
• PMID: 26946346 (Publication Type: Journal Article)
• Copyright: © 2016, American College of Rheumatology.

Chemical References

• Anti-Allergic Agents
• Omalizumab

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Allergic Agents (therapeutic use)
• Asthma (complications, drug therapy)
• Churg-Strauss Syndrome (complications, drug therapy)
• Female
• Humans
• Male
• Middle Aged
• Omalizumab (adverse effects, therapeutic use)
• Recurrence
• Remission Induction
• Retrospective Studies
• Treatment Outcome
• Young Adult