A 55-year-old man with known eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss) has recurrent sinus disease, asthma, peripheral eosinophilia >1500 cells/μL, and positive p-ANCA (anti-MPO). He develops wrist drop. The first-line biological therapy approved for relapsing or refractory EGPA is:
- A Mepolizumab ✓
- B Rituximab
- C Belimumab
- D Tocilizumab
Correct answer: A. Mepolizumab
Explanation
Mepolizumab (anti-IL-5 monoclonal antibody) was approved by FDA for relapsing/refractory EGPA in 2017 based on the MIRRA trial, which showed significant reduction in accrued weeks in remission and relapse rates. It targets the IL-5 pathway that drives eosinophilic inflammation central to EGPA pathogenesis. Rituximab is used for ANCA-associated vasculitis (MPA, GPA) and has limited evidence in EGPA. Belimumab targets BAFF and is used in SLE. Tocilizumab (anti-IL-6) is used for giant cell arteritis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.