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Mepolizumab EGPA — ESENeph MCQ

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ModerateRenal VasculitisMepolizumab EGPAESENeph

A 48-year-old woman with eosinophilic granulomatosis with polyangiitis (EGPA) has recurrent asthma exacerbations and peripheral eosinophilia despite remission of renal vasculitis. Her maintenance immunosuppression controls the vasculitis. What biologic agent has been specifically approved for EGPA?

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Correct answer: E — Mepolizumab (anti-IL-5)

Mepolizumab is an anti-IL-5 monoclonal antibody specifically approved for EGPA (MIRRA trial). It reduces eosinophil counts and allows glucocorticoid dose reduction. While Rituximab is used for ANCA-vasculitis induction/maintenance, Mepolizumab targets the eosinophilic component of EGPA specifically. For organ-threatening renal involvement, standard AAV treatment is still needed (per KDIGO 2024). Mepolizumab serves as maintenance/steroid-sparing therapy and for eosinophilic manifestations.

Reference: Wechsler et al 2017 – MIRRA Trial; NICE TA769 – Mepolizumab for EGPA