Modern methods for the treatment of EGPA.
| Treatment strategy | Route | Dose/use case | Biomarkers | Mechanism of action | Indication | Results | References |
|---|---|---|---|---|---|---|---|
| GCs | Oral or IV; initial high doses followed by tapering | Prednisone: initial dose 0.5–1 mg/kg/day | Elevated eosinophil count, CRP, ESR | Anti-inflammatory; immunosuppressive, reduces eosinophils | First-line treatment; initial management of all patients | Rapid symptom improvement is essential for initial control | [54, 55] |
| CYC | Oral or IV | 2 mg/kg/day for 3–6 months | ANCA, eosinophil count, CRP | Alkylating agent; immunosuppressive, reduces B and T cells | Life-threatening condition | Effective in reducing remission in severe cases | [56, 57] |
| Methotrexate | Oral or SC | 15–25 mg weekly; folic acid supplementation recommended | CRP, ESR, liver enzymes | Antimetabolite; inhibits dihydrofolate reductase, reduces inflammation | For individuals on maintenance therapy and those with mild conditions | Useful in maintaining remission | [58, 59] |
| Azathioprine | Oral | 1–2 mg/kg/day | CRP, ESR, liver enzymes, TPMT enzyme levels | Purine synthesis inhibitor; immunosuppressive, reduces T and B cells | Maintenance treatment | Effective in maintaining remission; reduces steroid use | [60, 61] |
| Mepolizumab | SC | 300 mg every 4 weeks | Eosinophil count | Monoclonal antibody against IL-5; reduces eosinophil production and survival | EGPA is refractory or relapses, especially when there is eosinophilic tissue infiltration | Reduction in exacerbations and maintenance of remission | [62, 63] |
| Rituximab | IV | 375 mg/m2 each week for four weeks, or 1,000 mg on days | CD20, B-cell count, ANCA | The monoclonal antibody that suppresses CD20 and reduces B cells | Patients with cyclophosphamide contraindicated or who exhibit refractory instances | Effective in inducing remission in refractory cases | [64, 65] |
| Benralizumab | SC | 30 mg every 4 weeks for 3 doses, then every 8 weeks | Eosinophil count | Monoclonal antibody against IL-5 receptor alpha; depletes eosinophils | Considering refractory EGPA | Reduces exacerbations and maintains remission | [66, 67] |
TPMT: thiopurine methyltransferase; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; ANCA: anti-neutrophil cytoplasmic antibody; EGPA: eosinophilic granulomatosis with polyangiitis.
We extend our heartfelt gratitude to the management of Rungta International Skills University, Bhilai, for their unwavering support and encouragement throughout this work. Their dedication to fostering a research-conducive environment has been instrumental in completing this review.
PK: Writing—original draft, Conceptualization. AG: Methodology, Resources, Writing—original draft. SKG: Writing—review & editing, Project administration, Supervision, Validation. TMJ and DKM: Data curation. All authors read and approved the submitted version.
The authors declare that they have no conflicts of interest.
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