In the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) “today we have biotechnological drugs available that allow us to control the disease and significantly reduce the dose of cortisone and therefore the damage from drug accumulation. Two antibodies have been added to the classic immunosuppressants monoclonal drugs that are used in a specific way: mepolizumab, a fairly recent discovery, which is an anti-interleukin 5, and rituximab which blocks B lymphocytes. With these drugs it is possible to have a remission, therefore a normal life, in over 90% of cases. The prescription of these drugs is reserved for specialized centers, to guarantee the quality of care and control of expenditure. Roberto Giacomelli, full professor of Rheumatology and director of UOC Immunorheumatology at the Campus Bio-Medico University Hospital of Rome, explains it to Adnkronos on the occasion of a training event, promoted by GSK, which was held in Florence in recent days.
Research on EGPA, he underlines, “is very limited” by the fact that it is a “rare disease that affects 2-5 people per million inhabitants, therefore we estimate 30-40 new cases per year in Italy. Among the vasculitis is in fact, it is among the rarest and therefore research proceeds more slowly than in more widespread diseases. What we know about this disease is that “an immune cell, “the eosinophil which generally defends us from parasitic infections – explains Giacomelli – in these patients. has an aggressive role due to mechanisms we do not know, probably a genetic predisposition, it infiltrates the tissues and destroys them. Research is on systems capable of blocking this aspect. In the limited knowledge of the pathogenetic mechanisms”, that is, at the origin of EGPA , “over the last twenty years, molecules have been produced, known as monoclonal antibodies, which allow us to limit the activity and aggressiveness of eosinophils”.
The problem is that “the disease – specifies the specialist – has a long period in which it manifests itself with asthma and nasal polyposis, and only when eosinophils infiltrate the liver, heart, kidneys, lungs and brain and peripheral nervous system does it appear as a whole. Generally the diagnosis is around the age of 40, when it is already complex.” For “about 10 years”, therefore, the patient finds himself consulting various doctors, based on the manifestations of the pathology. “The specialists who can see a disease with an atypical onset or different clinical manifestations are the most varied”, clarifies the rheumatologist, observing that, after the diagnosis, “it is necessary for the patient to be followed by a multidisciplinary team, but a coordination figure who in this case – he concludes – is the rheumatologist”.
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