{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:41:25Z","timestamp":1776091285971,"version":"3.50.1"},"reference-count":19,"publisher":"PAGEPress Publications","issue":"4","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reumatismo"],"abstract":"<jats:p>We report the case of a 54-year-old woman with antineutrophilic cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis presenting with mononeuritis multiplex, intestinal hemorrhage, cardiomyopathy, fever, and worsening asthma symptoms. She was initially treated with steroids and cyclophosphamide but eventually required rituximab to control a vasculitis flare. However, her asthmatic symptoms did not improve, despite attaining vasculitis remission. Symptoms abated only after the treatment transition to mepolizumab. After a 1-year interval, there were no further episodes of asthma exacerbation and no requirement for systemic steroid therapy. This report reinforces the use of rituximab for induction and maintenance of remission in patients with eosinophilic granulomatosis with polyangiitis and predominant vasculitic manifestations, whereas mepolizumab demonstrated better control of the persistent eosinophilic manifestations, ensuing sustained remission and improved quality of life.<\/jats:p>","DOI":"10.4081\/reumatismo.2023.1588","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T08:56:42Z","timestamp":1702976202000},"source":"Crossref","is-referenced-by-count":3,"title":["Eosinophilic granulomatosis with polyangiitis: sequential use of mepolizumab following rituximab for inadequate asthma control despite vasculitis remission"],"prefix":"10.4081","volume":"75","author":[{"given":"B.","family":"Cremonezi Lammoglia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"De Aguiar Trevise","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Paslar Leal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6345-3440","authenticated-orcid":false,"given":"M.","family":"Pereira Lopes Vieira Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Hasselmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8457-5132","authenticated-orcid":false,"given":"N.","family":"Salles Rosa Neto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"6007","doi-asserted-by":"crossref","unstructured":"Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) consensus task force recommendations for evaluation and management. Eur J Intern Med 2015; 26: 545-53.","DOI":"10.1016\/j.ejim.2015.04.022"},{"key":"6008","doi-asserted-by":"crossref","unstructured":"Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Ruoppolo G, et al. Churg-Strauss syndrome. Autoimmun Rev 2015; 14: 341-8.","DOI":"10.1016\/j.autrev.2014.12.004"},{"key":"6009","doi-asserted-by":"crossref","unstructured":"Chung SA, Langford CA, Maz M, Abril A, Gorelik M, Guyatt G, et al. 2021 American College of Rheumatology\/Vasculitis Foundation Guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol 2021; 73: 1366-83.","DOI":"10.1002\/art.41773"},{"key":"6010","doi-asserted-by":"crossref","unstructured":"Thiel J, Troilo A, Salzer U, Schleyer T, Halmschlag K, Rizzi M, et al. Rituximab as induction therapy in eosinophilic granulomatosis with polyangiitis refractory to conventional immunosuppressive treatment: a 36-month follow-up analysis. J Allergy Clin Immunol Pract 2017; 5: 1556-63.","DOI":"10.1016\/j.jaip.2017.07.027"},{"key":"6011","doi-asserted-by":"crossref","unstructured":"Lugogo N, Domingo C, Chanez P, Leigh R, Gilson MJ, Price RG, et al. Long-term efficacy and safety of mepolizumab in patients with severe eosinophilic asthma: a multi-center, open-label, phase IIIb study. Clin Ther 2016; 38: 2058-70.e1.","DOI":"10.1016\/j.clinthera.2016.07.010"},{"key":"6012","doi-asserted-by":"crossref","unstructured":"Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014; 371: 1198-207.","DOI":"10.1056\/NEJMoa1403290"},{"key":"6013","doi-asserted-by":"crossref","unstructured":"Wechsler ME, Akuthota P, Jayne D, Khoury P, Klion A, Langford CA, et al. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med 2017; 376: 1921-32.","DOI":"10.1056\/NEJMoa1702079"},{"key":"6014","doi-asserted-by":"crossref","unstructured":"Steinfeld J, Bradford ES, Brown J, Mallett S, Yancey SW, Akuthota P, et al. Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol 2019; 143: 2170-7.","DOI":"10.1016\/j.jaci.2018.11.041"},{"key":"6015","doi-asserted-by":"crossref","unstructured":"Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry MJ, Amudala N, et al. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Ann Rheum Dis 2016; 75: 396-401.","DOI":"10.1136\/annrheumdis-2014-206095"},{"key":"6016","doi-asserted-by":"crossref","unstructured":"Akiyama M, Kaneko Y, Takeuchi T. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis: a systematic literature review. Autoimmun Rev 2021; 20: 102737.","DOI":"10.1016\/j.autrev.2020.102737"},{"key":"6017","doi-asserted-by":"crossref","unstructured":"Casal Moura M, Berti A, Keogh KA, Volcheck GW, Specks U, Baqir M. Asthma control in eosinophilic granulomatosis with polyangiitis treated with rituximab. Clin Rheumatol 2020; 39: 1581-90.","DOI":"10.1007\/s10067-019-04891-w"},{"key":"6018","unstructured":"Terrier B, Pugnet G, de Moreuil C, Bonnotte B, Benhamou Y, Diot E, et al. Rituximab versus conventional therapeutic strategy for remission induction in eosinophilic granulomatosis with polyangiitis: a double-blind, randomized, controlled trial [abstract]. Arthritis Rheumatol 2021; 73."},{"key":"6019","doi-asserted-by":"crossref","unstructured":"Dutertre M, Pugnet G, De Moreuil C, Bonnotte B, Benhamou Y, Chauveau D, et al. Efficacit\u00e9 \u00e0 long terme des sch\u00e9mas d\u2019induction de la r\u00e9mission au cours de la granulomatose \u00e9osinophilique avec polyang\u00e9ite : r\u00e9sultats de l\u2019essai REOVAS. Rev Med Interne 2022; 43: A375-6.","DOI":"10.1016\/j.revmed.2022.10.085"},{"key":"6020","doi-asserted-by":"crossref","unstructured":"Inamo J, Kaneko Y, Ota Y, Takeuchi T. Subtypes in eosinophilic granulomatosis with polyangiitis classified according to rheumatoid factor. Clin Rheumatol 2019; 38: 3493-9.","DOI":"10.1007\/s10067-019-04680-5"},{"key":"6021","doi-asserted-by":"crossref","unstructured":"Latorre M, Baldini C, Seccia V, Pepe P, Novelli F, Celi A, et al. Asthma control and airway inflammation in patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol Pract 2016; 4: 512-9.","DOI":"10.1016\/j.jaip.2015.12.014"},{"key":"6022","doi-asserted-by":"crossref","unstructured":"Berti A, Cornec D, Casal Moura M, Smyth RJ, Dagna L, Specks U, et al. Eosinophilic granulomatosis with polyangiitis: clinical predictors of long-term asthma severity. Chest 2020; 157: 1086-99.","DOI":"10.1016\/j.chest.2019.11.045"},{"key":"6023","doi-asserted-by":"crossref","unstructured":"Vergles M, Matkovi\u0107 Z, Lali\u0107 K, Trkanjec JT, Tudori\u0107 N. Mepolizumab as a glucocorticoid-sparing agent in eosinophilic granulomatosis with polyangiitis (EGPA): is a lower dose sufficient? J Asthma 2021; 58: 1675-9.","DOI":"10.1080\/02770903.2020.1827417"},{"key":"6024","doi-asserted-by":"crossref","unstructured":"Afiari A, Gabriel A, Gaiki MR. Concurrent use of mepolizumab and rituximab for eosinophilic granulomatosis with polyangiitis and multisystem involvement. Cureus 2020; 12: e9242.","DOI":"10.7759\/cureus.9242"},{"key":"6025","doi-asserted-by":"crossref","unstructured":"Aguirre-Valencia D, Posso-Osorio I, Bravo JC, Bonilla-Abad\u00eda F, Tob\u00f3n GJ, Ca\u00f1as CA. Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). 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