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CASE REPORT article

Front. Allergy

Sec. Therapies and Therapeutic Targets

Volume 6 - 2025 | doi: 10.3389/falgy.2025.1661047

Case report: Sequential Use of Tezepelumab and Mepolizumab for Eosinophilic Otitis Media in EGPA: A Steroid-Sparing Strategy

Provisionally accepted
Osamu  MatsunoOsamu Matsuno1*Masahiro  KawamotoMasahiro Kawamoto2Tansri  WibowoTansri Wibowo1Yutaka  IshidaYutaka Ishida1Atsushi  OgataAtsushi Ogata1
  • 1Department of Allergy and Rheumatoid disease,Osaka Habikino Medical Center, Habikino, Japan
  • 2Kawamoto Clinic, Nara, Japan

The final, formatted version of the article will be published soon.

Even in eosinophilic granulomatosis with polyangiitis (EGPA), not all manifestations of eosinophilic inflammation respond equally to anti–interleukin-5 (IL-5) therapy. We report a case of steroid-refractory eosinophilic otitis media (EOM) in a patient with EGPA, where systemic symptoms such as asthma and chronic rhinosinusitis initially responded to high-dose mepolizumab, but relapsed upon corticosteroid tapering. Introduction of tezepelumab led to marked improvement in EOM and upper and lower airway symptoms. To sustain remission, we employed a bi-monthly alternating regimen of tezepelumab and mepolizumab, achieving long-term control without dual biologic use or systemic corticosteroid escalation. This case highlights a personalized and steroid-sparing strategy for managing complex type 2 inflammation in EGPA.

Keywords: Eosinophilic granulomatosis with polyangiitis, EGPA, Mepolizumab, Tezepelumab, Eosinophilic otitis media, Steroid-sparing, biologics, TSLP

Received: 07 Jul 2025; Accepted: 07 Oct 2025.

Copyright: © 2025 Matsuno, Kawamoto, Wibowo, Ishida and Ogata. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Osamu Matsuno, matsunoo@ra.opho.jp

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