Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?

Yes, I would consider early starting biologics for infiltrative EGPA.

Currently available data for mepolizumab and benralizumab suggest that they provide a benefit for preventing relapse across disease manifestations, suggesting there is efficacy across both infiltrative and vasculitic manifestations. However, there is no robust data on induction outcomes in patients with organ-threatening vasculitic manifestations such as glomerulonephritis or severe infiltrative manifestations such as cardiomyopathy, as they were excluded from the phase 3 trials of IL5 agents. Therefore, I would have some hesitation with using IL-5 as the primary non-glucocorticoid induction agent in patients with those manifestations, particularly in light of the REOVAS trial demonstrating efficacy of rituximab similar to cyclophosphamide ...