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EGPA FFS 0 Treatment — SCE Rheumatology MCQ

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ModerateVasculitisEGPA FFS 0 TreatmentSCE Rheumatology

A 60-year-old man with EGPA (previously Churg-Strauss syndrome) has an FFS of 0. His disease is limited to asthma eosinophilia and mild skin vasculitis. According to current guidelines what is the recommended treatment?

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Correct answer: E — Glucocorticoids alone may be sufficient for EGPA with FFS 0; steroid-sparing agents (Mepolizumab Azathioprine) are added if relapsing or steroid-dependent

EGPA treatment is stratified by the Five Factor Score. For FFS 0 (no cardiac renal severe GI or CNS involvement) glucocorticoids alone may be sufficient for induction. However relapse is common on tapering and steroid-sparing agents are often needed. Mepolizumab (anti-IL-5) is now NICE-approved for relapsing/refractory EGPA based on the MIRRA trial demonstrating significant relapse reduction. Azathioprine and Methotrexate are conventional steroid-sparing options. For FFS ≥1 more intensive induction with Cyclophosphamide or Rituximab is recommended alongside glucocorticoids. Asthma management with optimised inhaled therapy is an important parallel treatment.

Reference: BSR 2025 AAV guidelines; Wechsler ME et al 2017 MIRRA trial