Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Omalizumab, an anti-IgE monoclonal antibody, has proven efficacy for the treatment of moderate-to-severe and severe-persistent allergic asthma and allergic rhinitis, with a favorable safety profile. Only rare and contrasting results have been reported for eosinophilic granulomatosis with polyangiitis (EGPA).
To describe omalizumab efficacy and safety in patients with refractory and/or relapsing EGPA, we conducted a nationwide retrospective study on EGPA patients who had received omalizumab in these situations. Complete response was defined as the absence of asthma and/or sinonasal exacerbations with a prednisone dose ≤7.5 mg/day, and partial response as the absence of exacerbations with a prednisone dose >7.5 mg/day.
Results: Seventeen patients (median age: 45 years) took omalizumab for severe steroid-dependent asthma (88%) and/or sinonasal involvement (18%), always combined with only corticosteroids, (53%) or with adjunction of other immunosuppressive agents/another immunosuppressant (47%). After median follow-up of 22 months, 6 (35%) patients achieved complete responses, 5 (30%) had partial responses and 6 (35%) showed no improvement. Overall median BVAS dropped from 2.5 at baseline to 1 and 0.5 at 6 and 12 months, respectively. Median numbers of exacerbations decreased from 1/month at baseline to 0 at 6 and 12 months, and median forced expiratory volume in 1 second increased from 63% at baseline to 82% and 85% of the average predicted value at 6 and 12 months, respectively. Median prednisone dose decreased from 16 mg/day at baseline to 11 and 9 mg/day at 6 and 12 months, respectively. Eight patients stopped omalizumab, 25% because of remission, 25% for refractory disease or 50% for relapse. Relapses included EGPA-attributable retrobulbar optic neuritis (n=2) and severe asthma attacks (2 others). No other severe adverse events occurred.
Results of this study suggest that omalizumab provides mild efficacy and corticosteroid-sparing effect in EGPA with asthmatic and/or sinonasal manifestations. Severe flares occurred in a quarter of the patients raising the question of its safety in this setting.
To cite this abstract in AMA style:Jachiet M, Samson M, Cottin V, Kahn JE, Le Guenno G, Bonniaud P, Bouillet L, Gondouin A, Makhlouf F, Meaux Ruault N, Gil H, Devilliers H, Bienvenu B, Coste A, Giraud V, Dominique S, Godeau B, Puéchal X, Khouatra C, Ruivard M, Le Jeunne C, Mouthon L, Guillevin L, Terrier B. Anti-IgE Monoclonal Antibody in Refractory and/or Relapsing Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss): Data from 17 Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/anti-ige-monoclonal-antibody-in-refractory-andor-relapsing-eosinophilic-granulomatosis-with-polyangiitis-churg-strauss-data-from-17-patients/. Accessed January 22, 2018.
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