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. 2021 Jun;3(6):404-412.
doi: 10.1002/acr2.11263. Epub 2021 May 25.

Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America

Irena Doubelt  1 , David Cuthbertson  2 , Simon Carette  1 , Sharon A Chung  3 , Lindsy J Forbess  4 , Nader A Khalidi  5 , Curry L Koening  6 , Carol Langford  7 , Carol A McAlear  8 , Larry W Moreland  9 , Paul A Monach  10 , Philip Seo  11 , Ulrich Specks  12 , Robert F Spiera  13 , Jason M Springer  14 , Antoine G Sreih  8 , Kenneth J Warrington  12 , Peter A Merkel  8 , Christian Pagnoux  1 ; Vasculitis Clinical Research Consortium
Affiliations

Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America

Irena Doubelt et al. ACR Open Rheumatol. 2021 Jun.

Abstract

Objective: To describe clinical manifestations and outcomes in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in North America.

Methods: Analysis of patients aged 18 years or older who fulfilled the 1990 American College of Rheumatology Classification Criteria for EGPA enrolled in the Vasculitis Clinical Research Consortium from 2003 to 2019. Main clinical characteristics, treatments, outcomes, and accumulated damage were studied.

Results: The cohort included 354 patients; 59% female; age at diagnosis of 50.0 (±14) years; 39% were antineutrophil cytoplasm antibody (ANCA) positive. Time from diagnosis to last follow-up was 7.0 (±6.2) years; 49.4% had one or more relapse. Patients positive for ANCA more commonly had neurological and kidney involvement when compared with patients negative for ANCA, who had more cardiac and lung manifestations. At last study visit, only 35 (12.6%) patients had been off all therapy for more than 2 years during their follow-up. The overall mortality rate was 4.0% and did not differ by ANCA status or cyclophosphamide use. Scores on the Vasculitis Damage Index (VDI) for 134 patients with two or more visits and more than 1 year of follow-up increased from 1.7 (±1.8) at enrollment (3.7 [±5.1] years after diagnosis) to 3.35 (±2.1) at last follow-up (7.5 [±5.8] years after diagnosis), mainly represented by chronic asthma (67.5%), peripheral neuropathy (49.6%), and chronic sinusitis (31.3%). Longer duration of glucocorticoid use and relapse were associated with higher VDI scores.

Conclusion: This analysis describes the many clinical manifestations and varied outcomes of EGPA and highlights the ongoing need to attain more sustained, long-term remission to limit the accrual of disease-related damage.

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Figures

Figure 1
Figure 1
Main items of damage at last follow‐up visit for all patients with patients with eosinophilic granulomatosis with polyangiitis and ≥1 year of follow‐up after diagnosis (n = 268) in the Vasculitis Clinical Research Consortium. GFR, glomerular filtration rate; VDI, Vasculitis Damage Index.
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