New onset EGPA in patients on biologics for severe asthma (SA)- a multi-centre case series
<bold>Background:</bold> There have been reports of emergent EGPA in patients established on biologics (mAb) for SA. It is unclear if this phenomenon is related to maintenance oral corticosteroid (mOCS) wean and if inflammatory biomarkers can predict the onset of EGPA. <bold>Methods:</bold> Members of the ERS Severe Heterogeneous Asthma Research Collaboration, Patient-centred (SHARP-CRC) were invited to submit cases via an online form. Results are median (range) unless otherwise specified. EGPA was diagnosed based on clinical trial definition.<sup>1</sup> <bold>Results:</bold> 27 cases (52% female) were submitted. All had adult-onset asthma. 2 patients (7%) were on dupilumab, 3 (11%) omalizumab, 4 (15%) mepolizumab and 18 (67%) benralizumab. 22 (81%) were on mOCS at mAb initiation. Patients on mOCS had received similar amounts of OCS in the year pre-mAb (3000mg, 300-4300mg) as patients not on mOCS (received OCS for exacerbations; 2260mg, 800-3700mg). EGPA was diagnosed 22 (4-240) weeks after starting mAb. In mOCS patients, wean started at 7 (4-24) weeks; EGPA was diagnosed 18 (2-25) weeks after wean started. Timing and rate of wean was not associated with EGPA diagnosis. For 7 patients, EGPA had been suspected prior to mAb initiation; in these patients the diagnosis was made earlier- 12 (6-32) weeks after starting mAb. Peak historic eosinophil count was 1500 (500-12000) cells/uL and not correlated with eosinophil count at EGPA diagnosis, 1400 (0-22000) cells/uL. There was no correlation between baseline FeNO and FeNO at EGPA diagnosis. 13 (48%) were ANCA positive. <bold>Conclusion:</bold> In our case-series, type of mAb, baseline biomarkers, mOCS use or rate of OCS wean were not related to and did not predict EGPA onset. 1. Wechsler et al. NEJM 2017
Authors
- Piotr Kuna (ORCID: https://orcid.org/0000-0003-2401-0070)
- Sabina Škrgat (ORCID: https://orcid.org/0000-0002-0136-4733)
- Aruna T. Bansal (ORCID: https://orcid.org/0000-0002-7262-6534)
- Εleftherios Ζervas (ORCID: https://orcid.org/0000-0001-7436-4550)
- Marco Caminati (ORCID: https://orcid.org/0000-0001-7383-1487)
- Zsuzsanna Csoma
- Vratislav Sedlák (ORCID: https://orcid.org/0000-0003-3536-6347)
- Kristina Biekšienė (ORCID: https://orcid.org/0009-0008-8933-5283)
- Svetlana Sergejeva
- Hitasha Rupani (ORCID: https://orcid.org/0000-0002-0150-138X)
- Saša Rink
- Els J.M. Weersink (ORCID: https://orcid.org/0000-0001-7146-1398)
- Branislava Milenković (ORCID: https://orcid.org/0000-0002-0767-6869)
- Celeste Porsbjerg (ORCID: https://orcid.org/0000-0003-4825-9436)
- Peter Kopač (ORCID: https://orcid.org/0000-0001-7261-6689)
- Alexandra M. Nanzer (ORCID: https://orcid.org/0000-0002-7928-6317)
- Paddy Dennison
- Gary J. Anderson
- Valentyna Yasinka
Institutions
- University of Verona (IT)
- Lithuanian University of Health Sciences (LT)
- University of Ljubljana (SI)
- The University of Melbourne (AU)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Parks Victoria (AU)
- Bispebjerg Hospital (DK)
- University Hospital Southampton NHS Foundation Trust (GB)
- University of Łódź (PL)
- Chest Diseases Hospital (KW)
- University Clinic of Pulmonary and Allergic Diseases Golnik (SI)
- Amgen (United Kingdom) (GB)
- Medical University of Lodz (PL)
- Swedish Asthma and Allergy Association (SE)
- Institute for Pulmonary Diseases of Vojvodina (RS)
- Czech Society for Ornithology (CZ)
- Országos Korányi Tbc és Pulmonológiai Intézet (HU)
- University of Tartu (EE)
- University of Amsterdam (NL)
Publication Details
- Published
- 2024-09-14
- DOI
- https://doi.org/10.1183/13993003.congress-2024.pa2179
- Primary Topic
- Asthma and respiratory diseases
- Type
- article
- Field-Weighted Citation Impact
- 0.00