Clinical Effectiveness of Dupilumab in Eosinophilic Granulomatosis With Polyangiitis: A Retrospective Observational Study

Abstract

BackgroundDupilumab, a monoclonal antibody targeting the interleukin-4 receptor alpha subunit, has shown efficacy in eosinophilic disorders; however, its role in eosinophilic granulomatosis with polyangiitis (EGPA) remains uncertain. This study compared the clinical outcomes of patients with EGPA treated with conventional therapy, with or without dupilumab, focussing on its effects on disease activity and vasculitic phenotypes.Patients and MethodsFrom a prospective, single-centre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis, we retrospectively selected three patients with EGPA who received conventional therapy with dupilumab and six age- and sex-matched patients who received conventional therapy without dupilumab. The Birmingham Vasculitis Activity Score (BVAS), peripheral eosinophil count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed at EGPA diagnosis, dupilumab initiation and last follow-up. Changes in vascular manifestations before and after dupilumab treatment were evaluated.ResultsThe eosinophilic conditions for which dupilumab was initiated were well controlled in all three patients receiving the drug. In contrast, two of the six patients who did not receive dupilumab showed worsening eosinophilic manifestations. All three patients demonstrated clinical improvement in EGPA following dupilumab treatment, with reductions in the BVAS, eosinophil count, ESR and CRP levels. No worsening of vasculitic phenotypes was observed, even after prolonged exposure (up to 45 months).ConclusionsDupilumab may help control the eosinophilic phenotypes of EGPA, thereby contributing to overall disease activity control without exacerbating vasculitic phenotypes. However, given the small sample size and retrospective nature of this study, larger prospective trials are required to confirm its efficacy in EGPA.