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Piga MA, Fraticelli P, Antonicelli L, Garritani MS, Ghirelli G, Martini M, Di Vincenzo A, Danieli MG, Moroncini G, Bilò MB. ANCA-negative EGPA: only eosinophils without vasculitis? Insights from anti-T2 biologics. Front Immunol 2023; 14:1325299. [PMID: 38090592 PMCID: PMC10711080 DOI: 10.3389/fimmu.2023.1325299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
The pathogenic role of p-ANCA in eosinophilic granulomatosis with polyangiitis (EGPA) is a long-standing matter of debate. In this work, we report our real-life experience with EGPA patients, treated with biologics targeting type 2 (T2)-eosinophilic inflammation (Mepolizumab, Benralizumab, Dupilumab). Interestingly, we observed EGPA extrarespiratory relapses only in p-ANCA-positive patients (2/5 cutaneous vasculitis, 3/5 constitutional symptoms), with new rise of p-ANCA and normal eosinophil blood count. Notably, revising our cohort with the new ACR 2022 criteria, these five patients were the only ones to satisfy the entry criterion of vasculitis' defined diagnosis at disease onset. These observations may suggest that biologics, selectively turning off T2 inflammation, may have unmasked p-ANCA exclusive role in the pathogenesis of vasculitis in EGPA. Therefore, we raise the question whether EGPA vasculitis exists only in p-ANCA-positive patients, and whether p-ANCA-negative disease is "only eosinophils without vasculitis".
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Affiliation(s)
- Mario Andrea Piga
- National PhD Course in Precision Medicine in Rare Diseases, University of Palermo, Palermo, Italy
| | - Paolo Fraticelli
- Clinica Medica, Internal Medicine Department, Marche University Hospital, Ancona, Italy
| | - Leonardo Antonicelli
- Allergy Unity, Internal Medicine Department, Marche University Hospital, Ancona, Italy
| | | | - Giulia Ghirelli
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Matteo Martini
- Allergy Unity, Internal Medicine Department, Marche University Hospital, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Angelica Di Vincenzo
- Allergy Unity, Internal Medicine Department, Marche University Hospital, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Maria Giovanna Danieli
- Clinica Medica, Internal Medicine Department, Marche University Hospital, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Allergy and Clinical Immunology Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Gianluca Moroncini
- National PhD Course in Precision Medicine in Rare Diseases, University of Palermo, Palermo, Italy
- Clinica Medica, Internal Medicine Department, Marche University Hospital, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Maria Beatrice Bilò
- Allergy Unity, Internal Medicine Department, Marche University Hospital, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Allergy and Clinical Immunology Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
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