ArticleFrontiers in immunology2026
Glucocorticoid discontinuation in eosinophilic granulomatosis with polyangiitis treated with mepolizumab: associations with tapering patterns and initiation timing.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) requires prolonged glucocorticoid (GC) therapy in many patients, leading to substantial treatment-related morbidity. Although accumulating evidence has demonstrated the GC-sparing effects of mepolizumab (MPZ) and increasing numbers of patients achieving GC reduction or discontinuation, the patterns of GC tapering and discontinuation, including the influence of MPZ initiation timing, remain unclear. Materials and methods: We conducted a retrospective cohort study of EGPA patients treated with MPZ at a single center in Japan. We evaluated time to GC discontinuation and temporal changes according to MPZ initiation year. The interval from GC initiation to MPZ initiation was also assessed. Early GC discontinuation was defined as GC-free status within 500 days based on the observed temporal distribution of events. Time-to-event outcomes were analyzed using Kaplan-Meier and Cox regression, and early GC-free status was assessed using logistic regression. Results: Thirty-six patients were included. During a median follow-up of 4.6 years, GC discontinuation was achieved in 31 patients (86.1%), including 20 (55.6%) who achieved early GC-free status. The median time from MPZ initiation to GC discontinuation was 452 days. Higher eosinophil counts at MPZ initiation were independently associated with GC discontinuation (HR 1.45, 95% CI 1.08-1.96), whereas the interval from GC initiation to MPZ initiation was not. MPZ initiation in more recent years was associated with earlier GC discontinuation (OR 6.00, 95% CI 1.54-23.44), reflecting faster GC tapering after MPZ initiation. Vasculitis Damage Index (VDI) increased in 4 patients (11.1%) and was infrequent among those achieving early GC-free status. Conclusions: GC discontinuation was achieved in a high proportion of EGPA patients treated with MPZ. Accelerated GC tapering after MPZ initiation was associated with shorter GC treatment duration without an apparent increase in organ damage.
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