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Masumoto N, Oshikata C, Nakadegawa R, Motobayashi Y, Osada R, Manabe S, Kaneko T, Tsurikisawa N. Long-term mepolizumab treatment reduces relapse rates in super-responders with eosinophilic granulomatosis with polyangiitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:40. [PMID: 37179316 PMCID: PMC10182616 DOI: 10.1186/s13223-023-00801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The mainstay of treatment for eosinophilic granulomatosis with polyangiitis (EGPA) is systemic corticosteroid therapy; some patients also receive intravenous immunoglobulins, other immunosuppressive agents, and biologics. Mepolizumab, an anti-interleukin-5 monoclonal antibody, induces remission and decreases the daily corticosteroid dose; however, the clinical efficacy of mepolizumab in EGPA and the prognosis with long-term treatment with this drug are unknown. METHODS Seventy-one EGPA patients were treated at Hiratsuka City Hospital, Japan, between April 2018 and March 2022. We administered mepolizumab for a mean of 2.8 ± 1.7 years to 43 patients in whom remission could not be induced by conventional treatment. After excluding 18 patients who had received mepolizumab for less than 3 years, we classified 15 patients into a "super-responder group" (the daily dose of corticosteroids or other immunosuppressant could be decreased, or the interval between IVIG treatments could be prolonged) and 10 patients into a "responder group" (neither of these changes was achievable). Eosinophil numbers, serum IgG levels, daily doses of corticosteroids and other immunosuppressants, Birmingham Vasculitis Activity Score (BVAS), and relapse frequency before and after mepolizumab initiation were determined. RESULTS Blood eosinophil count at diagnosis and the lowest serum IgG level before mepolizumab treatment were significantly higher in super-responders than in responders (p < 0.05). In super-responders, the prednisolone dose at last visit on mepolizumab treatment was lower than that before treatment (p < 0.01) and lower than that at last visit in the responders (p < 0.01). In both groups, peripheral blood eosinophil numbers and BVAS were lower after starting mepolizumab than before (p < 0.01). BVAS before mepolizumab (p < 0.05) and at last visit (p < 0.01) were lower in super-responders than in responders. Relapse rates every year after the start of mepolizumab were lower in super-responders than in responder groups (p < 0.01). In super-responders, relapse rates were lower during the 3 years following mepolizumab initiation (p < 0.01) and at last visit (p < 0.01) were significantly lower than after 1 year of treatment. CONCLUSION Mepolizumab treatment of super-responders sustainably reduced the relapse rate.
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Affiliation(s)
- Nami Masumoto
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Chiyako Oshikata
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
- Department of Allergy and Respirology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan
| | - Ryo Nakadegawa
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
| | - Yuto Motobayashi
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
| | - Reeko Osada
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
| | - Saki Manabe
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Naomi Tsurikisawa
- Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama, 245-8575, Japan.
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
- Department of Allergy and Respirology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.
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Tsurikisawa N, Oshikata C, Watanabe M, Fukuda N, Yamaguchi T, Kiyohara H, Kaneko T. Clinical Features of Patients with Active Eosinophilic Granulomatosis with Polyangiitis Successfully Treated with Mepolizumab. Int Arch Allergy Immunol 2021; 182:744-756. [PMID: 33887721 DOI: 10.1159/000514505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In some patients with eosinophilic granulomatosis with polyangiitis (EGPA), remission cannot be induced, despite treatment with corticosteroids and immunosuppressants. We evaluated the clinical features of patients with EGPA in whom mepolizumab was effective. METHODS There were 59 EGPA patients treated at Hiratsuka City Hospital, Japan, between April 2018 and September 2020, and 30 of them received mepolizumab. Twenty (66.7%) experienced a "marked effect" (the daily dose of corticosteroid or immunosuppressant could be decreased, or the interval between intravenous immunoglobulin (IVIG) treatments could be prolonged) and 10 (33.3%) experienced a "weak effect" (these measures were not achieved). Eosinophil numbers, serum IgG levels, daily doses of corticosteroids and immunosuppressants, and the interval between IVIG treatments at diagnosis and before and after mepolizumab initiation were determined. RESULTS Eosinophil numbers at diagnosis were significantly higher in the marked-effect group than in the weak-effect group (p < 0.05) but not before mepolizumab initiation or at the last visit. Birmingham Vasculitis Activity Scores (BVASs) before mepolizumab initiation (p < 0.05) and at last visit (p < 0.01), and frequency of relapse before treatment initiation (p < 0.05) were significantly higher, and the serum IgG level before mepolizumab treatment was significantly lower in the weak-effect group than in the marked-effect group. The weak-effect group received higher doses of corticosteroids, even if the corticosteroid dose could be reduced for a while after mepolizumab initiation. CONCLUSION High peripheral blood eosinophil numbers at EGPA diagnosis were suggestive of a positive clinical response to mepolizumab.
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Affiliation(s)
- Naomi Tsurikisawa
- Department of Allergy and Respirology, Hiratsuka City Hospital, Hiratsuka, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chiyako Oshikata
- Department of Allergy and Respirology, Hiratsuka City Hospital, Hiratsuka, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Maiko Watanabe
- Division of Microbiology, National Institute of Health Sciences, Kawasaki, Japan
| | - Nobuhiko Fukuda
- Department of Allergy and Respirology, Hiratsuka City Hospital, Hiratsuka, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takanori Yamaguchi
- Department of Internal Medicine, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Hikari Kiyohara
- Department of Allergy and Respirology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Raffray L, Guillevin L. Updates for the treatment of EGPA. Presse Med 2020; 49:104036. [PMID: 32652104 DOI: 10.1016/j.lpm.2020.104036] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 05/19/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is the least frequent antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). Major advances of our knowledge on its pathophysiology have revealed features of both AAV and eosinophilic disorders. The development of targeted biotherapies for both diseases opened new possibilities for EGPA management. In this review, we highlight the rationale underlying the routine treatment strategy, which relies mainly on corticosteroids, with immunosuppressant adjunction for severe disease. However, novel therapies are still needed for refractory/relapsing disease and to alleviate the corticosteroid-dependence of asthma and chronic rhinosinusitis. At present, the most promising biotherapies target either eosinophil biology, like mepolizumab, an anti-interleukin-5, or the B-cell compartment, with rituximab. Recent clinical data on new treatment options are discussed and therapeutic strategies are proposed.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, CS11021, Saint Denis, Reunion
| | - Loïc Guillevin
- Referral Center for Rare Systemic and Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris Cedex 14, France.
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Raffray L, Guillevin L. Treatment of Eosinophilic Granulomatosis with Polyangiitis: A Review. Drugs 2019; 78:809-821. [PMID: 29766394 DOI: 10.1007/s40265-018-0920-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) is a rare type of anti-neutrophil cytoplasm antibody-associated vasculitis. Nevertheless, eosinophilic granulomatosis with polyangiitis stands apart because it has features of vasculitis and eosinophilic disorders that require targeted therapies somewhat different from those used for other anti-neutrophil cytoplasm antibody-associated vasculitides. Considerable advances have been made in understanding the underlying pathophysiology of eosinophilic granulomatosis with polyangiitis that have highlighted the key role of eosinophils and opened new therapeutic opportunities. Its conventional treatment relies mainly on agents that decrease inflammation: corticosteroids and immunosuppressant adjunction for severe manifestations. New therapeutic approaches are needed for refractory disease, relapses and issues associated with corticosteroid dependence, especially for asthma manifestations. Drugs under evaluation mostly target eosinophils and B cells. Results of low-evidence-based trials suggested possible efficacies of biologicals: B-cell-blocking rituximab and anti-immunoglobulin E omalizumab. Recently, the first large-scale randomised controlled trial on eosinophilic granulomatosis with polyangiitis proved the efficacy of anti-interleukin-5 mepolizumab. That finding opens a new era in eosinophilic granulomatosis with polyangiitis management, with mepolizumab approval but also in future drug evaluations and trial designs for eosinophilic granulomatosis with polyangiitis. Additional studies are needed to determine which patients would benefit most from targeted therapies and achieve personalised treatment for patients with eosinophilic granulomatosis with polyangiitis. Herein, we review eosinophilic granulomatosis with polyangiitis characteristics and provide an overview of established and novel pharmacological agents.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, Saint Denis, Réunion Island, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Université Paris Descartes, Paris, France.
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Tsurikisawa N, Oshikata C, Watanabe M, Tsuburai T, Kaneko T, Saito H. Innate immune response reflects disease activity in eosinophilic granulomatosis with polyangiitis. Clin Exp Allergy 2018; 48:1305-1316. [PMID: 29908086 DOI: 10.1111/cea.13209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a disease characterized by allergic granulomatosis, necrotizing vasculitis, and peripheral blood eosinophilia. Interleukin (IL)-33, thymic stromal lymphopoietin (TSLP), and type 2 innate lymphoid cells (ILC2) are involved in the innate and type 2 immune responses in EGPA. However, the relationships among these molecules and the mechanisms underlying the development of EGPA remain unknown. OBJECTIVE We investigated the relationships among peripheral blood eosinophil count, serum IL-33 and TSLP concentration, and peripheral blood ILC2 count in patients with EGPA, chronic eosinophilic pneumonia (CEP), or bronchial asthma (BA). METHODS We recruited 86 patients with EGPA in three groups (remission, relapse, and onset), 25 patients with CEP at active or inactive stages of disease, and 11 patients with BA. In patients with EGPA, CEP, or BA, serum IL-33, sST2, and TSLP concentrations were determined using ELISA and peripheral blood ILC2 counts (as Lin-1- CD127+ CRTH2+ cells) were determined using flow cytometry. RESULTS Peripheral blood eosinophil count or ILC2 count, and serum sST2 or TSLP concentration were higher in patients with EGPA at onset than in those with EGPA at relapse or remission, or in those with BA or CEP. Serum IL-33 concentration was higher in patients with EGPA at relapse than in those with EGPA at onset or remission, or in those with BA or CEP. In a logistic regression model, EGPA disease activity was correlated with serum IL-33 concentration and peripheral blood ILC2 count, but not daily systemic and inhaled corticosteroid dose or immunosuppressant use. Eosinophil count was correlated with peripheral blood ILC2 count and serum TSLP concentration, but not serum IL-33 concentration. CONCLUSIONS Increased peripheral blood ILC2 count and serum IL-33 concentration were associated with disease activity in EGPA. Increases in serum IL-33 concentration may indicate the presence of active vasculitis rather than peripheral or tissue eosinophilia.
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Affiliation(s)
- Naomi Tsurikisawa
- Department of Allergy, Hiratuska City Hospital, Hiratsuka, Japan.,Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chiyako Oshikata
- Department of Allergy, Hiratuska City Hospital, Hiratsuka, Japan.,Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Maiko Watanabe
- Division of Microbiology, National Institute of Health Science, Kawasaki, Japan
| | - Takahiro Tsuburai
- Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Respirology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Saito
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
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Cho WC, Ramlal B, Fiel-Gan M, Song X. Rare Manifestations of Churg-Strauss Syndrome with Mediastinal and Hilar Lymphadenopathies: Report of an Autopsy Case. J Pathol Transl Med 2017; 53:66-69. [PMID: 29249116 PMCID: PMC6344804 DOI: 10.4132/jptm.2017.12.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/13/2017] [Indexed: 01/23/2023] Open
Affiliation(s)
- Woo Cheal Cho
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
| | - Bharat Ramlal
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
| | - Mary Fiel-Gan
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
| | - Xianyuan Song
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
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Necrotizing eosinophilic granulomatous lymphadenitis with ring- and C-shaped granulomas—an underrecognized specific manifestation of nodal Churg-Strauss syndrome. J Hematop 2017. [DOI: 10.1007/s12308-017-0297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tsurikisawa N, Oshikata C, Kinoshita A, Tsuburai T, Saito H. Longterm Prognosis of 121 Patients with Eosinophilic Granulomatosis with Polyangiitis in Japan. J Rheumatol 2017; 44:1206-1215. [PMID: 28572468 DOI: 10.3899/jrheum.161436] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We investigated the risk factors for relapse or prognosis of eosinophilic granulomatosis with polyangiitis (EGPA) in Japanese patients presenting to our hospital. METHODS From June 1999 through March 2015, we retrospectively recruited 121 patients with EGPA according to the American College of Rheumatology criteria. Frequent relapse was defined as disease occurrence at least once every 2 years after a period of initial remission. The study endpoint was the last examination performed. We used multiple logistic regression to analyze risk factors for relapse or survival in EGPA. RESULTS Gastrointestinal (GI) involvement with both abnormalities on endoscopy and biopsy (p < 0.01) and symptoms; myocardial involvement with both abnormalities on 1 or more cardiac investigations and symptoms (p < 0.01); and treatment at initial or maintenance with immunosuppressants (p < 0.01) or administration of intravenous immunoglobulin (IVIG; p < 0.01) were associated significantly more often with frequent relapse than with infrequent. Overall 5-, 10-, and 20-year survival rates were 91.1%, 83.7%, and 68.6%, respectively. Survival in EGPA was associated with age of onset < 65 years. Age at onset of EGPA was the only significant predictor of survival (p < 0.01). Myocardial or GI tract involvement did not affect mortality risk. CONCLUSION Patients with myocardial or GI tract involvement had frequent relapses, but these conditions were not reflected in increased mortality. Treatment with immunosuppressants or IVIG in addition to corticosteroids might have improved the prognosis in Japanese patients with EGPA.
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Affiliation(s)
- Naomi Tsurikisawa
- From the Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Minami-ku Sagamihara, Japan. .,N. Tsurikisawa, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; C. Oshikata, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; A. Kinoshita, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; T. Tsuburai, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; H. Saito, PhD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital.
| | - Chiyako Oshikata
- From the Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Minami-ku Sagamihara, Japan.,N. Tsurikisawa, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; C. Oshikata, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; A. Kinoshita, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; T. Tsuburai, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; H. Saito, PhD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital
| | - Arisa Kinoshita
- From the Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Minami-ku Sagamihara, Japan.,N. Tsurikisawa, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; C. Oshikata, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; A. Kinoshita, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; T. Tsuburai, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; H. Saito, PhD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital
| | - Takahiro Tsuburai
- From the Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Minami-ku Sagamihara, Japan.,N. Tsurikisawa, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; C. Oshikata, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; A. Kinoshita, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; T. Tsuburai, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; H. Saito, PhD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital
| | - Hiroshi Saito
- From the Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Minami-ku Sagamihara, Japan.,N. Tsurikisawa, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; C. Oshikata, MD, Department of Respirology, National Hospital Organization Saitama National Hospital, and Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; A. Kinoshita, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; T. Tsuburai, MD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital; H. Saito, PhD, Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital
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Seeliger B, Förster M, Happe J, Forberg T, Moeser A, Neumann T, Kroegel C. Interferon-α for Induction and Maintenance of Remission in Eosinophilic Granulomatosis with Polyangiitis: A Single-center Retrospective Observational Cohort Study. J Rheumatol 2017; 44:806-814. [DOI: 10.3899/jrheum.160907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 12/19/2022]
Abstract
Objective.Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by frequent relapses following induction therapy. Interferon-α (IFN-α) can reverse the underlying Th2-driven immune response and has successfully induced remission in previous reports. We undertook this study to investigate its efficacy and safety in patients with EGPA.Methods.We conducted a retrospective monocentric cohort study including 30 patients (16 women) with active EGPA under IFN-α treatment. Primary endpoints were remission induction, occurrence of relapses, prednisolone (PSL) dosage at time of remission, and adverse events. Remission was defined by a Birmingham Vasculitis Activity Score (BVAS) of 0. Pulmonary function tests were recorded at baseline and at time of remission. Health-related quality of life was analyzed by questionnaire at baseline and following 12 months of treatment.Results.At baseline, the median BVAS was 6 (interquartile range 4–13.5) and remission or partial response was achieved in 25/30 patients. After initiation of IFN-α treatment, the median PSL dosages could be reduced from 17.5 mg/day at baseline to 5.5 mg/day at time of remission. Following remission, 17 relapses (5 major) in 16 patients were observed. Pulmonary function tests improved and the time of hospitalization decreased. Adverse events at initiation of treatment were common, but mostly transient. Severe adverse events occurred during treatment in 4 patients (autoimmune hepatitis, n = 1; drug-induced neuropathy, n = 3).Conclusion.IFN-α treatment results in high rate of remission and maintenance in EGPA with significant reduction in oral corticosteroids, although reversible adverse events may occur. IFN-α represents an alternative therapeutic option in cases of refractory to standard treatment.
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An atypical caseof Churg-Strauss syndrome. Rev Clin Esp 2015; 215:e25-8. [PMID: 25686653 DOI: 10.1016/j.rce.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/06/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
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Seeliger B, Foerster M, Neumann T, Moeser A, Happe J, Kehler N, Kroegel C. Interferon-α induced remission in three patients with eosinophilic granulomatosis and polyangiitis. A case study. Respir Med Case Rep 2013; 10:60-3. [PMID: 26029516 PMCID: PMC3920446 DOI: 10.1016/j.rmcr.2013.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/21/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small vessel vasculitis associated with asthma and eosinophilia. Optimal therapy for maintenance of remission is yet to be defined. We present a case-series of three patients with EGPA in whom IFN-α, an immunomodulatory cytokine induced remission, which was maintained even after discontinuation of the drug. In all patients (ages 60, 51, and 50 years), remission was associated with normalisation of eosinophil counts and IgE-levels. Moreover, the patients remained in remission for one to four years. Two patients did not need further immunosuppression, one patient required low dose maintenance therapy. Although reversible side effects occur, IFN-α-therapy induces long-term remission of EGPA even after discontinuation of treatment.
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Affiliation(s)
- B. Seeliger
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
- Corresponding author. Pneumology & Allergology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07749 Jena, Thuringia, Germany.
| | - M. Foerster
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - T. Neumann
- Rheumatology/Osteology, Internal Medicine III, Jena University Hospital, Germany
| | - A. Moeser
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - J. Happe
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - N. Kehler
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - C. Kroegel
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
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Della-Torre E, Tresoldi M, Scotti R, Praderio L, Mellone R, Ponzoni M, Doglioni C, Sabbadini MG. Atypical presentation of Churg-Strauss syndrome or an undescribed hypereosinophilic disease? J Allergy Clin Immunol 2011; 128:908-11. [PMID: 21872916 DOI: 10.1016/j.jaci.2011.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/10/2011] [Accepted: 07/14/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
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Dibao-Dona C, Damade R, Pavic M. Une acné particulièrement floride. Rev Med Interne 2009; 30:192-5. [DOI: 10.1016/j.revmed.2008.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stemmler HJ, Hoelzl M, Moosmann N, Becker C, Lennertz A, Babaryka G. [Lymphadenopathy and constitutional symptoms. Progress of a low-grade follicular lymphoma?]. Internist (Berl) 2006; 47:528-32. [PMID: 16601988 DOI: 10.1007/s00108-005-1563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders.A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
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Affiliation(s)
- H J Stemmler
- Medizinische Klinik III, Klinikum Grosshadern der LMU München.
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15
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Chan AT, Flossmann O, Mukhtyar C, Jayne DRW, Luqmani RA. The role of biologic therapies in the management of systemic vasculitis. Autoimmun Rev 2006; 5:273-8. [PMID: 16697969 DOI: 10.1016/j.autrev.2006.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 01/26/2006] [Indexed: 11/19/2022]
Abstract
The recent development of biologic therapies capable of selectively targeting components of the immune system has revolutionised the treatment of inflammatory arthritides. The steady increase in use of biologic agents coupled with the expansion in the knowledge of the pathogenesis of vascular inflammation has led to their application in the treatment of primary systemic vasculitis. These agents may have a role in addition to or in place of conventional immunosuppression and also be effective when the latter fails to induce remission. The use of biologics as targeted therapies has also, in reverse, improved our understanding of the pathophysiology of vascular inflammation. While the advent of biologics heralds a new era in the management of the systemic vasculitis, evidence for their efficacy is still in its infancy and has yet to match that of conventional immunosuppressants. In this review, we examine the up-to-date evidence for the use of biologics in systemic vasculitis, including TNF-alpha inhibitors, and highlight the challenges facing their use. We examine the rationale for using biologics based on the pathophysiology of vasculitis. Issues of toxicity and pharmacovigilance with the use of biologics are also discussed. Finally, future directions and predictions are presented.
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Affiliation(s)
- A T Chan
- Rheumatology Department, Nuffield Orthopaedic Centre, Windmill Road, Headington Oxford OX3 7LD, UK
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Silva CIS, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A. Churg-Strauss syndrome: high resolution CT and pathologic findings. J Thorac Imaging 2005; 20:74-80. [PMID: 15818205 DOI: 10.1097/01.rti.0000155268.00125.de] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate high-resolution CT findings in 7 patients with Churg-Strauss syndrome and to compare the CT with the histopathologic findings. MATERIALS AND METHODS High-resolution CT scans of 7 asthmatic patients (4 women, 3 men, age range, 34-62 years, mean 49 years) with Churg-Strauss syndrome were reviewed by 2 observers. Histologic specimens of lung obtained at surgical (n = 3) or transbronchial (n = 3) biopsy or autopsy (n = 1) were reviewed by an expert lung pathologist. The diagnosis of Churg-Strauss was based on clinical, laboratory, and histologic findings. RESULTS Parenchymal and airway abnormalities included ground-glass opacities (n = 5), areas of air-space consolidation (n = 4), centrilobular nodules (n = 5), nodules 1-3 cm in diameter (n = 3), interlobular septal thickening (n = 4), bronchial wall thickening (n = 4), and areas of atelectasis (n = 1). Surgical biopsy (n = 3) and autopsy (n = 1) specimens demonstrated airspace disease in 3 patients, interlobular septal thickening in 3 patients, and airway abnormalities in 2 patients. Histologically, the airspace disease included eosinophilic pneumonia (n = 2) and small foci of organizing pneumonia (n = 1). The septal thickening was due to edema combined with numerous (n = 2) or few (n = 1) eosinophils. The airway abnormalities (n = 2) included muscle hypertrophy and large airway wall necrosis (n = 1) and eosinophilic infiltration of the airway walls (n = 1). Transbronchial biopsy (n = 3) demonstrated increased eosinophils. CONCLUSION The main high-resolution CT findings of Churg-Strauss syndrome consist of airspace consolidation or ground-glass opacities, septal lines, and bronchial wall thickening. These reflect the presence of eosinophilic infiltration of the airspaces, interstitium, and airways, and interstitial edema.
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Butterfield JH. Interferon treatment for hypereosinophilic syndromes and systemic mastocytosis. Acta Haematol 2005; 114:26-40. [PMID: 15995323 DOI: 10.1159/000085560] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypereosinophilic syndromes (HES) and systemic mastocytosis (SMCD) are heterogeneous disorders with clinical symptoms from local and remote effects of excessive proliferation of eosinophils and mast cells, respectively. Interferon alpha (IFN-alpha), alone or in combination with other medications, can be a useful, and at times life-saving, treatment for patients with HES. Receptors for IFN-alpha are present on eosinophils, and clinical benefits are due to its effect on eosinophil proliferation, migration, activation, and survival. These effects are likely mediated through multiple pathways including, but not limited to, inhibition of eosinophil colony-forming cells, upregulation of IFN-gamma synthesis, and inhibition of production of eosinophil-active cytokines by T cells, mast cells, and mononuclear cells. IFN-alpha has been life-saving for patients with intractable HES that were resistant to prednisone, hydroxyurea, and other agents. Resistance to the eosinopenic effect of IFN-alpha does not develop and the dose of IFN-alpha necessary to maintain control of eosinophilia often decreases with time. The combination of IFN-alpha and hydroxyurea is very useful and allows dosage reduction of IFN-alpha and better control of hypereosinophilia than with either agent alone. The efficacy of IFN-alpha for treatment of SMCD has been more difficult to establish, with both favorable and unfavorable results reported. The disparate results may have resulted from the small number of patients with SMCD treated with IFN-alpha, the use of various criteria for a "successful" treatment outcome, short duration of treatment and follow-up, and the use of modest dosages. In reported series, side effects from IFN-alpha have frequently been dose-limiting. IFN-alpha improves many of the clinical symptoms of SMCD including dermatological, hematological, gastrointestinal, and systemic symptoms associated with histamine release. IFN-alpha has a beneficial effect on skeletal symptoms because of its ability to increase bone density and reduce painful episodes from vertebral fractures. No consistent improvement in bone marrow infiltration by mast cells has been demonstrated except in a recent study employing high dosages of IFN-alpha. A beneficial effect from the combination of IFN-alpha and prednisone has been reported for several patients, suggesting that combined use of these two medications may provide synergism in treatment outcomes.
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Affiliation(s)
- J H Butterfield
- Divisions of Allergy and Immunology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Simon HU, Seelbach H, Ehmann R, Schmitz M. Clinical and immunological effects of low-dose IFN-alpha treatment in patients with corticosteroid-resistant asthma. Allergy 2003; 58:1250-5. [PMID: 14616099 DOI: 10.1046/j.1398-9995.2003.00424.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Interferon (IFN)-alpha is a cytokine that possesses potent anti-viral and immunoregulatory activities. We aimed to assess clinical and immunological effects of low-dose IFN-alpha in patients with severe corticosteroid-resistant asthma with and without Churg-Strauss syndrome. There is currently no efficient pharmacological treatment available for this group of patients. METHODS We studied 10 patients with corticosteroid-resistant asthma, in which 3x10(6) IU/day IFN-alpha were administrated in addition to the prednisone dose given already before introduction of the cytokine therapy. The prednisone dose was gradually reduced dependent on the clinical situation and used as a clinical readout to evaluate the efficacy of the cytokine therapy. To distinguish between IFN-alpha- and prednisone-mediated immunological changes, the corticosteroid dose was kept constant for at least 2 weeks upon introduction of the cytokine therapy in seven patients. The effects of treatment on clinical and immunological parameters were measured at 2-4 weeks and 5-10 months depending on the availability of the patient. RESULTS Interferon-alpha treatment rapidly improved the clinical situation as assessed by lung function parameters and required prednisone dose. Important immunological changes included: decreased leukocyte numbers, increased relative numbers of CD4+ T cells, increased differentiation of T helper (Th)1 cells, and increased expression of interleukin (IL)-10 in peripheral blood mononuclear cells. CONCLUSION Interferon-alpha treatment was associated with dramatic improvements in the condition of patients with corticosteroid-resistant asthma with and without Churg-Strauss syndrome. Potential mechanisms of action include the establishment of a correct Th1/Th2 balance and the induction of the anti-inflammatory IL-10 gene.
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Affiliation(s)
- H-U Simon
- Department of Pharmacology, University of Bern, Bern High-Altitude Clinic Davos-Wolfgang, Davos, Switzerland
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Bouros D. Interferons and Their Application in Lung Diseases. Chest 2003. [DOI: 10.1016/s0012-3692(15)31715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kroegel C, Mock B, Reissig A. Interferons and Their Application in Lung Diseases. Chest 2003; 124:2406; author reply 2406-7. [PMID: 14665534 DOI: 10.1378/chest.124.6.2406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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