Real-world Treatment Patterns in Patients With Eosinophilic Granulomatosis With Polyangiitis (EGPA)

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Abstract RATIONALE: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody-associated vasculitis that confers significant disease burden.This real-world study aimed to identify current treatment patterns of patients with EGPA. METHODS: Data were drawn from the Adelphi Real World EGPA Disease Specific Programme™, a cross-sectional survey of physicians and patients in France, Germany, Italy, Spain, the UK, and the US from July–December 2023. Data on current and ≤5 previous treatments were retrieved from patient medical history. Outputs were stratified based on whether patients were currently prescribed anti-interleukin-5/Rα therapy (anti-IL-5/Rα; mepolizumab or benralizumab), or another treatment such as glucocorticoids, immunosuppressants, intravenous immunoglobulin and plasma exchange, or another biologic. At time of data capture, mepolizumab was the only biologic approved for EGPA. Analyses were descriptive. RESULTS: In all patients (N=503), mean (SD) age was 49.5 (15.3) years; 50% were female. Overall, 70% (n=351) of patients were receiving oral or parenteral glucocorticoids. The median dose of glucocorticoids (combined oral/parenteral) was 8 mg/day, with the greatest proportion of patients receiving 4.1–7.5 mg/day (37%; n=131), and 21% (n=72) receiving >20 mg/day. In total, 36% (n=183), 50% (n=251) and 27% (n=138) of patients were receiving immunosuppressant, biologic and anti-IL-5/Rα treatment, respectively. For patients receiving immunosuppressant or anti-IL-5/Rα treatment, 52% (n=96/183) and 51% (n=70/138), respectively, were receiving combination therapy with a glucocorticoid. Of 171 patients with ≥1 diagnosed comorbidity, 57% (n=97) were receiving anti-IL-5/Rα treatment for EGPA; physicians considered comorbidities when deciding to initiate anti-IL-5/Rα treatment in 52% (n=50) of these patients. Anti-IL-5/Rα treatment was most prescribed by pulmonologists (n=30/138; 22%), allergists/immunologists (n=25/138; 18%), gastroenterologists (n=21/138; 15%), and hematologists (n=21/138; 15%). Key reasons for prescribing anti-IL-5/Rα treatment were speed of onset (n=17/34; 50%), symptomatic relief (n=17/34; 50%), to reduce dose/duration of glucocorticoids (n=15/34; 44%), and to improve quality of life (n=15/34; 44%). For patients assessed by physicians as having moderate or severe disease at start of treatment, 85% (n=94/111) of those receiving an anti-IL-5/Rα had high levels of physician satisfaction with their current disease control. Additional results are summarized in Table 1. CONCLUSION: In a real-world clinical setting, many patients with EGPA were prescribed glucocorticoids, with more than 1 in 5 receiving >20 mg/day, and 27% received anti-IL-5/Rα treatment. Anti-IL-5/Rα treatment was most often prescribed by pulmonologists and allergists/immunologists for reasons such as speed of onset, symptomatic relief, to reduce dose/duration of glucocorticoids and to improve quality of life. Confidential – Not for Public Consumption or Distribution