Eosinophilic granulomatosis with polyangiitis biologic therapy — SCE Rheumatology MCQ

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ModerateVasculitisEosinophilic granulomatosis with polyangiitis biologic therapySCE Rheumatology

A 50-year-old woman with relapsing eosinophilic granulomatosis with polyangiitis has severe steroid-dependent asthma and sinus disease. There is no active glomerulonephritis or alveolar haemorrhage. Eosinophils rise during steroid taper. She has osteoporosis from repeated prednisolone courses. What is the most appropriate biologic?

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Correct answer: D — Mepolizumab

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

Mepolizumab is best because mepolizumab targets IL-5 and is used for relapsing or refractory EGPA with eosinophilic asthma phenotype. A is less suitable because tocilizumab is used in selected GCA and RA rather than EGPA asthma phenotype; C is less suitable because belimumab is an SLE biologic; D is less suitable because abatacept is a T-cell co-stimulation modulator used in RA, not standard EGPA; E is less suitable because secukinumab is used in IL-17-mediated spondyloarthritis/PsA pathways. Clinical pearl: EGPA biologic choice depends on whether disease is eosinophilic/asthmatic or organ-threatening vasculitic.

Reference: EULAR AAV recommendations 2022; NICE asthma biologic guidance