The NUCALA patient

Once you have diagnosed eosinophilic granulomatosis with polyangiitis (EGPA), it is important to determine if NUCALA should be a part of your treatment strategy.

Although there is no typical EGPA presentation, these hypothetical profiles provide a composite of patients in the clinical trial.1,2 These profiles are not intended to represent all patients with EGPA.

PATIENT PROFILE

High dose prednisone patient type
High dose prednisone patient type

David, age 37 | Diagnosed at age 35

“I look healthy on the outside and it’s hard to explain. I worry about my EGPA disease, and I dislike having to take such a high dose of prednisone to help keep me from flaring.”

Medical history

EGPA-related symptoms:

  • Adult-onset asthma
  • Nasal polyps, allergic rhinosinusitis
  • Myalgia
  • Anosmia

BVAS* at last visit:

  • 0

Primary clinical concern:

  • Patient has required 10 mg to 15 mg of a daily oral corticosteroid (OCS) to control his EGPA-related symptoms and flares. Attempts to decrease his steroid dose have been unsuccessful, leading to relapse

Current therapy

  • Prednisone 10 mg/day
  • Fluticasone propionate/salmeterol 500/50 mcg twice daily

Current labs/tests

  • Eosinophils: 750 cells/μL (more than 11% of total white blood cells)
  • ANCA-positive

PATIENT PROFILE

Daily oral corticosteroids and immunosuppressants patient type
Daily oral corticosteroids and immunosuppressants patient type

Diane, age 49 | Diagnosed at age 46

“My symptoms are currently under control, but only with daily oral corticosteroids and immunosuppressants. I wish I had fewer relapses.”

Medical history

EGPA-related symptoms:

  • Adult-onset asthma and rhinitis
  • Numbness and pain in hands and feet

BVAS* at last visit:

  • 3

Primary clinical concern:

  • Patient has a history of multiple relapses. She has been taking varying doses of oral steroids for asthma for 6 years, which was then diagnosed as EGPA. Her latest relapse was 6 months ago, with EGPA symptoms that involved increased difficulty with hand grip and numbness in her feet
  • The relapse was successfully treated with IV cyclophosphamide (concluded 4 weeks ago) and high-dose steroids. Despite this treatment, she continues to experience residual foot numbness. Patient’s symptoms are currently managed on an immunosuppressant and steroids, but she would like to discontinue the oral steroid, if possible

Current therapy

  • Prednisone 7.5 mg daily
  • Methotrexate 20 mg weekly
  • Folic acid 2 mg daily
  • Fluticasone propionate/salmeterol 500/50 mcg twice daily

Current labs/tests

  • Eosinophils: 350 cells/μL (5% of white blood cells)
  • ANCA-positive

PATIENT PROFILE

Repeated flares patient type
Repeated flares patient type

John, age 55 | Diagnosed at age 48

“I’m frustrated by the lack of control over my EGPA symptoms and repeated flares. Even when my symptoms are controlled, I’m always waiting for the hammer to drop.”

Medical history

EGPA-related symptoms:

  • Asthma, sinusitis, and nasal growths
  • Muscle and joint pain

BVAS* at last visit:

  • 4

Primary clinical concern:

  • Patient experienced 3 relapses in the last 3 years, including an ICU admission for respiratory disease. Despite treatment with oral corticosteroids, immunosuppressants, and inhaled asthma medications, the patient’s muscle and joint pain and respiratory symptoms have not been well-controlled

Current therapy

  • Prednisone 10 mg daily
  • Azathioprine 150 mg daily
  • BREO 200/25 mcg daily
  • Albuterol 2 puffs, 3 times a day, as needed

Current labs/tests

  • Eosinophils: 500 cells/μL (8% of white blood cells)
  • ANCA-negative
  • Positive biopsy of the muscle that showed perivascular eosinophilic infiltration

*BVAS is typically used to assess vasculitis activity in clinical trials, but is not routinely used in clinical practice.3

ANCA=antineutrophil cytoplasmic antibody; BVAS=Birmingham Vasculitis Activity Score; ICU=intensive care unit.