EGPA large artery involvement and new treatments for ANCA vasculitis

Last week our team published a new finding in eosinophilic granulomatosis with polyangiitis (EGPA), the demonstration of large vasculitis on PET/CT scan. EGPA is typically thought to involve small vessels only and this new finding may help to explain why some patients with EGPA experience blockages and clots in their large arteries. The arrow in the image attached shows inflammation (green colour) in the major artery in the upper arm (brachial artery).

This article, along with two patients I saw last week with EGPA made me reflect on the advances in treatment of this condition and the two other forms of ANCA vasculitis (GPA and MPA) in the past few years. Medications which block IL5, a key cytokine (chemical which activates the immune system) have proven incredibly successful in managing both eosinophilic asthma and EGPA in patients who would otherwise need to be treated with long-term corticosteroids. A new medication for GPA and MPA which targets a specific part of the immune system, the C5a complement component, is, as of last month, available in Australia. As with IL5 blockers, it offers an option for clinicians and patients to minimise corticosteroid usage. We are exceptionally lucky to live in a time with ever improving treatments for these conditions.