Medical Journal Reviews
The International Eosinophil Society (IES) selects articles on a monthly basis for their importance to scientists and clinicians interested in the eosinophil. We welcome Medical Journal Review submissions from IES Members for consideration. Your review should be clear, compelling, and appeal to our international membership.
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August 2025
Eosinophils and EGPA: How Far Can Mepolizumab Go?
Article: Efficacy and Safety of Mepolizumab 300 mg in Eosinophilic Granulomatosis With Polyangiitis: A Meta-Analysis of Eight Retrospective Studies
Spataro F, Cacciapaglia F, Carlucci P, et al.
European Journal of Allergy and Clinical Immunology. 2025
Reviewed by Palma Carlucci, University of Bari Aldo Moro, Bari, Italy
This meta-analysis addresses a question that remains crucial for clinicians managing eosinophilic granulomatosis with polyangiitis (EGPA): to what extent can mepolizumab truly reduce corticosteroid dependence in this complex and heterogeneous disease? Read more
By pooling data from eight retrospective studies and covering 165 patients treated with mepolizumab 300 mg per month, this study confirms a consistent signal: an average daily reduction of about 6 mg of prednisone, which remains significant even when outliers are removed. Yet the marked heterogeneity highlights an important reality: not all patients benefit equally. Those with significant cardiac or peripheral nervous system involvement, for instance, show a more limited response, suggesting that IL-5 blockade alone may not suffice when vasculitic damage dominates the clinical picture.
The safety data are completely reassuring: mostly mild to moderate adverse events, with no therapy discontinuations due to toxicity, supporting mepolizumab as a tolerable option for patients burdened by long-term steroid exposure. However, this meta-analysis inevitably shares the limitations of its sources: small, retrospective studies with variable designs and tapering protocols, which calls for caution when translating these results into routine practice.
What clearly emerges is the need for better stratification tools. EGPA is not a uniform disease, and precise biomarkers that can predict who will benefit most from IL-5 inhibition are still lacking. As the field evolves, head-to-head comparisons with other biologics could help refine treatment strategies and define the best approach for each disease phenotype.
In summary, eosinophils remain a compelling therapeutic target, but they are not the sole driver of EGPA’s pathogenesis. Mepolizumab represents a valuable option for reducing steroid burden in carefully selected patients, but personalised approaches remain essential. This work is a reminder that even in 2025, EGPA continues to challenge both our understanding of eosinophils and our ambition to manage them wisely.
Palma Carlucci is a specialist in Allergy and Clinical Immunology, with particular expertise in respiratory and drug allergies, severe asthma, and eosinophilic disorders such as Hypereosinophilic Syndrome and Eosinophilic Granulomatosis with Polyangiitis. She graduated from the University of Pavia and completed her studies at the University of Bari.
Her clinical and research work focuses on advanced allergen immunotherapy, drug desensitization protocols and the integration of biologics into precision medicine for complex allergic conditions. She has authored several publications and meta-analyses in international journals and actively contributes to national scientific initiatives, including the SIAAIC consensus statement on managing Hypereosinophilic Syndrome.
Past Reviews
March 2025
Eosinophils at the Table: Is a Milk-Only Diet Effective for Pediatric Eosinophilic Esophagitis?
Reviewed by Nicholas Genovese, Jefferson Einstein Philadelphia Hospital, Pennsylvania, United States
January 2025
Eosinophils in Check: The Promise of Benralizumab in EGPA Management
Reviewed by Federico Spataro & Antonio Giovanni Solimando, University of Bari, Italy
Eosinophils Under Fire: Benralizumab for Eosinophilic Asthma and COPD Exacerbations
Reviewed by Carlos Andrés Celis-Preciado, University of Sherbrooke, Canada
October 2024
Biannual Depemokimab for Severe Eosinophilic Asthma
Reviewed by Santi Nolasco, University of Catania, Italy
September 2024
Nutrient-derived signals regulate eosinophil adaptation to the small intestine
Reviewed by Clotilde Lacroix, University of Bonn, Germany
Single-cell proteomics and transcriptomics capture eosinophil development and identify the role of IL-5 in their lineage transit amplification
Reviewed by Alexandre Ecrement, University of Franche-Comté, Franche-Comté, France
August 2024
Utility of eosinophil peroxidase as a biomarker of eosinophilic inflammation in asthma
Reviewed by Nicholas Genovese, Jefferson Einstein Philadelphia Hospital, Pennsylvania, United States
July 2024
Eosinophil Depletion with Benralizumab for Eosinophilic Esophagitis
Reviewed by Mario Ynga-Durand, MD, PhD, Cincinnati Children's Hospital Medical Center, Ohio, United States
June 2024
Subsets of sputum eosinophils in asthma exacerbations
Reviewed by Jakub Novosad, MD, PhD, Institute of Clinical Immunology and Allergy, University Hospital, Hradec Kralove, Czech Republic
April 2024
Eosinophils potentiate anti-bacterial immunity
Reviewed by Roopa Hebbandi Nanjundappa, MSc, PhD, Dalhousie University, Halifax, Canada
March 2024
Nourishing insights: diet-driven adaptation of eosinophils
Reviewed by Krishan Chhiba, MD, PhD, Northwestern University, Chicago, United States
February 2024
Eosinophils identified as a major contributor to bone homeostasis via eosinophil peroxidase activity
Reviewed by Nana-Fatima Haruna, PhD Candidate, Northwestern University, Chicago, United States
January 2024
Transcriptomic profiling of the acute mucosal response to local food injections in adults with eosinophilic esophagitis
Reviewed by Eva Gruden, Pharmacist, Medical University of Graz, Austria
December 2023
Bordetella spp. block eosinophil recruitment to suppress the generation of early mucosal protection
Reviewed by Rachael FitzPatrick, PhD Candidate, Reynolds Laboratory at the University of Victoria, Canada
October 2023
Neuromedin U programs eosinophils to promote mucosal immunity of the small intestine
Reviewed by Beth Jacobson, PhD with input from Marc Rothenberg, MD, PhD
Chronic HDM exposure shows time-of-day and sex-based differences in inflammatory response associated with lung circadian clock disruption
Reviewed by Julia Teppan, MSc.Ph.D.Student