Anti-IgE Monoclonal Antibody in Refractory and/or Relapsing Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss): Data from 17 Patients

Marie Jachiet¹, Maxime Samson², Vincent Cottin³, Jean-Emmanuel Kahn⁴, Guillaume Le Guenno⁵, Philippe Bonniaud⁶, Laurence Bouillet⁷, Anne Gondouin⁸, Fatma Makhlouf⁷, Nadine Meaux Ruault⁹, Helder Gil⁸, Hervé Devilliers¹⁰, Boris Bienvenu¹¹, André Coste¹², Violaine Giraud¹³, Stephane Dominique¹⁴, Bertrand Godeau¹⁵, Xavier Puéchal¹⁶, Chahéra Khouatra¹⁷, Marc Ruivard¹⁸, Claire Le Jeunne¹⁹, Luc Mouthon²⁰, Loïc Guillevin²¹ and Benjamin Terrier¹⁶, ¹Dermatology, Cochin Hospital, Paris, France, ²Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France, ³Division of Pneumology, Hôpital Louis-Pradel, Hospices Civils de Lyon, Lyon 1, Lyon, France, ⁴Internal Medicine, Foch Hospital, Suresnes, France, ⁵Internal Medicine department, Clermont-Ferrand, France, ⁶CHU, Dijon, France, ⁷CHU, Grenoble, France, ⁸CHU, Besancon, France, ⁹Internal Medicine and Clinical Immunology, CHU de Besançon, Besançon, France, ¹⁰Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France, ¹¹Internal Medicine, Hospital Caen, Caen, France, ¹²CHI, Créteil, France, ¹³Hôpital Ambroise Paré, Boulogne Billancourt, France, ¹⁴Pneumology, Rouen University Hospital, Rouen, France, ¹⁵Henri Mondor, Créteil, France, ¹⁶Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France, ¹⁷CHU Lyon, Lyon, France, ¹⁸CHU Clermont-Ferrand, Clermont–Ferrand, France, ¹⁹Department of Internal Medicine, Hotel-Dieu Hospital, AP-HP, Paris, Paris, France, ²⁰Department of Internal Medicine, Department of Internal Medicine, Cochin Hospital, Referent Center for Necrotizing Vasculitis and Systemic Sclerosis, Paris-Descartes University, AP-HP, Paris, France, ²¹Internal Medicine, Hopital Cochin, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Biologics, Churg-Strauss syndrome, treatment and vasculitis

Session Information

Date: Sunday, November 8, 2015

Title: Vasculitis Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

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).

Methods:

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.

Conclusion:

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.

Disclosure: M. Jachiet, None; M. Samson, None; V. Cottin, None; J. E. Kahn, None; G. Le Guenno, None; P. Bonniaud, None; L. Bouillet, None; A. Gondouin, None; F. Makhlouf, None; N. Meaux Ruault, None; H. Gil, None; H. Devilliers, None; B. Bienvenu, None; A. Coste, None; V. Giraud, None; S. Dominique, None; B. Godeau, None; X. Puéchal, None; C. Khouatra, None; M. Ruivard, None; C. Le Jeunne, None; L. Mouthon, None; L. Guillevin, None; B. Terrier, None.

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). https://acrabstracts.org/abstract/anti-ige-monoclonal-antibody-in-refractory-andor-relapsing-eosinophilic-granulomatosis-with-polyangiitis-churg-strauss-data-from-17-patients/. Accessed .

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