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EGPA — SCE Rheumatology MCQ

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ModerateVasculitisEGPASCE Rheumatology

A 60-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA) has asthma requiring daily oral Prednisolone with eosinophilia, sinusitis, and mononeuritis multiplex but no renal involvement. p-ANCA (MPO) is positive. Which treatment is most appropriate for non-severe EGPA?

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Correct answer: D — Mepolizumab with glucocorticoids

ACR/VF 2021 guidelines conditionally recommend Mepolizumab (anti-IL-5) with glucocorticoids for active non-severe EGPA, over conventional immunosuppressives. Mepolizumab showed significant steroid-sparing effect in the MIRRA trial. Cyclophosphamide or Rituximab is reserved for severe EGPA (e.g. cardiac, renal, or CNS involvement). This patient has non-severe EGPA (no organ-threatening disease) making Mepolizumab the most appropriate choice.

Reference: ACR/Vasculitis Foundation 2021 - Guideline for management of ANCA-associated vasculitis; Wechsler ME et al 2017 MIRRA trial