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When we wrote our review on eosinophilic granulomatosis with polyangiitis, the 2022 EULAR guidelines<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> for the treatment of ANCA-associated vasculitis had not yet been published and their letter allows us to comment on these guidelines. A certain degree of contradiction in these guidelines on the use of glucocorticoids (GC) has called our attention. There is currently a trend in the need to reduce exposure to GCs for the control of different autoimmune diseases. The EULAR guidelines also advocate for a reduced CG regimen in point 5. Point 12 establishes CGs in monotherapy as first line for induction treatment in non-severe forms. This recommendation is based on the scarcity of evidence on the use of immunosuppressants for sparing GCs in non-severe forms on the one hand, and on the other, on the fact that the MIRRA study, which allowed the approval of mepolizumab in the EGPA,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> included patients with recurrent or refractory forms, and is therefore the intended use in the SmPC. However, the same guidelines (point 14) refer to the fact that most patients will have recurrence and need long-term GCs. The proven efficacy of mepolizumab in non-severe forms, despite the fact that the study design did not include patients with new-onset EGPA, has not been an obstacle to its indication in the ACR 2021 guidelines.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> For this reason, we are also inclined to use mepolizumab in non-severe forms, and to use GCs as monotherapy in very mild forms and with a lower risk of toxicity associated with GCs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Hellmich" 1 => "B. Sanchez-Alamo" 2 => "J.H. Schirmer" 3 => "A. Berti" 4 => "D. Blockmans" 5 => "M.C. Cid" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2023" "volumen" => "2015" "paginaInicial" => "1" "paginaFinal" => "18" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Wechsler" 1 => "P. Akuthota" 2 => "D. Jayne" 3 => "P. Khoury" 4 => "A. Klion" 5 => "C.A. Langford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1702079" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "376" "paginaInicial" => "1921" "paginaFinal" => "1932" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28514601" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Chung" 1 => "C.A. Langford" 2 => "M. Maz" 3 => "A. Abril" 4 => "M. Gorelik" 5 => "G. Guyatt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.24634" "Revista" => array:6 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2021" "volumen" => "73" "paginaInicial" => "1088" "paginaFinal" => "1105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34235880" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000003/v2_202402160843/S2387020624000068/v2_202402160843/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000003/v2_202402160843/S2387020624000068/v2_202402160843/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000068?idApp=UINPBA00004N" ]
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Letter to the Editor
Reply
Respuesta
Carlos Romero Gómez
, María del Mar Ayala Gutiérrez, Halbert Hernández Negrín
Corresponding author
Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
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