PATIENTS with eosinophilic granulomatosis with polyangiitis (EGPA) who have achieved long-term remission may safely reduce their dose of mepolizumab, according to a new study.
Researchers at a single centre in Italy followed 45 EGPA patients who were initially treated with the high-dose regimen of mepolizumab 300 mg every 4 weeks. After maintaining steroid-free remission for over a year, 12 patients (27%) transitioned to a lower dose of 100 mg every 4 weeks. Over a median follow-up period of 27.5 months after stepping down, half of these patients remained in complete remission without systemic glucocorticoids.
Importantly, no patients experienced asthma or vasculitis flares during the step-down period. However, 50% experienced recurrence of sinonasal symptoms, which were managed through either dose escalation or local therapy adjustment.
The findings suggest that step-down therapy may reduce treatment burden and glucocorticoid dependence for select EGPA patients. Yet, the recurrence of upper airway symptoms underscores the need for individualized management and close monitoring.
While the study is limited by its retrospective and single-centre design, it provides promising evidence that a tailored, lower-dose approach could be viable in long-term EGPA care. Larger prospective studies are needed to confirm optimal dosing strategies for maintaining remission while minimising side effects.
Aleksandra Zurowska, EMJ
Reference
Moroni L et al. Step-down treatment with mepolizumab for eosinophilic granulomatosis with polyangiitis: a real-life single-centre study. Rheumatology. 2025; DOI: 10.1093/rheumatology/keaf201.
