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EGPA Treatment: A new Era with the E-MERGE trial?

Brian Jaros, MD Nov 08, 2026

Eosinophilic granulomatosis with polyangiitis (EGPA) is the rarest of the ANCA-associated vasculitides. Compared to GPA and MPA, EGPA carries a mechanistically unique pathophysiology involving eosinophil-mediated inflammation.

AI advice in clinical decision support still needs checking. In 60 rheum scenarios, 5 platforms had hallucination rates of 3.8-18.1%. Dosing, treatment-selection and screening errors occurred across platforms, even those with high guideline concordance. #0869 @Rheumnow #ACR26

Research from my own group! Similar treatment patterns by age, but 5-year mortality diverges by age: 7.6% at age <65 31.6% at >=75 As usual, age is the #1 risk factor @RheumNow #ACR26 Ab#0192 https://t.co/KuofRSjTH9

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Retro cohort study of combi anti-CD20 + eculizumab for SLE-aHUS: 4-month overall survival & renal survival was higher in the combi grp vs. control Combi grp improved survival vs. conv IS AEs comparable, infexns more common @RheumNow #ACR26 ABS0873 https://t.co/LREeqI0e4R

Beyond CD19 CAR-T in SLE: γδ T, NK, iNKT: allo, MHC-independent, less GVHD CAAR-T hits only autoreactive B cells, but SLE has too many autoantigens CAR-Treg: non-depleting, no B-cell aplasia, low CRS Anca Askanase @RheumNow #ACR26 https://t.co/kh412q9Pnh

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Should we use subQ IG in myositis? Awaiting results of completed RECLAIIM trial to help answer this. @docrota considers SQIG for maintenance in myositis pts who’ve done well on IVIG and suggests this may be attractive in dominant skin disease in his experience. #AC26 @RheumNow https://t.co/qeYdQxdSQ0

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Does IL-5 therapy work for EGPA vasculitic manifestations? Abst0214 details EGPA pts based on hx vasculitic disease and use of IL-5 alone vs. with other IS Comparable vasculitic recurrence in those with hx Higher new-onset vasculitic disease in IL-5 only #ACR26 @RheumNow https://t.co/0lW6eqy3sb

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Medscape overview of Fibromyalgia Therapies. Only four FDA approved FM drugs in the USA - pregabalin (2007), duloxetine (2008), milnacipran (2009) & sublingual cyclobenzaprine (2025) but none approved by the EMA in Europe. https://t.co/QHFSmcozT0 https://t.co/lGCRl3opkY

Four Fibromyalgia Drugs Are Approved in the US, None in Europe. What Are Regula…

Even PET & ultrasound remission does not protect against GCA flare when tx is stopped Abst0186: GCA pt on toci avg 2 years, confirmed imaging remission stopped therapy 55% pt flared during 72 week follow-up We still struggle who & when to stop therapy... @RheumNow #ACR26 https://t.co/yEiidlR1Jc

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Normal CRP does NOT exclude GCA Abst0172 compares low & high CRP GCA patients Low CRP pt: - less systemic symptoms - less PMR - MORE vision sx and stroke - lower relapse risk We are in desperate need of better GCA biomarkers, especially with vision risk @RheumNow #ACR26 https://t.co/83hE0tbpvG

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14-3-3eta a new biomarker for axSpA? Abstr0378 evaluated a bead-based assay targeting five immunogenic peptide regions of 14-3-3eta to determine its ability to distinguish axSpA from other conditions. The groups were 30 patients with axSpA, 60 healthy controls, and 61 disease

Is HLA-B*52 the most frequent risk allele for TAK in non-Asian populations? Abst #0005 mono-center cross-sectional analysis of 76 Brazilian TAK patients HLA-B*52 retains greatest odds ratio for TAK B*41 and B*44 were novel HLA risk arrangements! @RheumNow #ACR26

Yr in Rvw #ACR26 Secukinumab for PMR Stone NEJM Previously failed GCA, + result for PMR P3RCT, 12 wk remission, sustain until wk 52 Sustained reduction, annual GC use + study, but 50% did require rescue tx Approved in Europe @RheumNow https://t.co/9ahHC5SpJi

RheumNow’s expanded coverage of the #ACR26 Annual Meeting is sponsored by Eli Lilly and Company. All coverage content is independently selected by RheumNow and its faculty.

YIR: Why does RA affect PIPs and not DIPs? This study demonstrates that Joint-specific susceptibility is established embryonically: PIP jts - larger synovial vol & PI16+ fibroblasts Implications? Provides developmental exp why particular jts are affected @RheumNow #ACR26 https://t.co/easfYOl5Ee

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#CHAI has #AI that is the largest not for profit organization in #healthcare #keynote @ACRheum #ACR26 Example of #artificial #intelligence involves targets for #CAR-T #CD19, #CD20, #CD22 and #BCMA @RheumNow https://t.co/ZCENzmnNTN

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Treatment for ICI-IrAEs: •Early immunosuppression/high doses of steroids (first 2 months) associated with worse survival. •ICI-IA: TNFi and IL-6Ri mostly used •ICI-PMR: steroids/IL6Ri •ICI-myositis: steroids/IVIG mostly used. •Little data on effects of long-term

Importance of genetics in rheumatic diseases #ACR26 #ReviewCourse @RheumNow https://t.co/weDtEQH0Cb

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Emergence of systemic autoimmune rheumatic diseases can occur in menopause and difficult to differentiate from "MS syndrome of Menopause" HRT: Safe in Non-SLE autoimmune disease/SLE with negative APL+ use with caution/Not recommended in APL+/APS #ACR26 @RheumNow https://t.co/6al61n1ck3

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Nice RWE study of UPA in GCA Refractory cohort w/multiple prior biologics; 22/34 evaluable pts had clinical remission at 6 months; 7/63 stopped for severe adverse events. Useful real-world signal, overall corroborates SELECT-GCA @RheumNow #ACR26 Ab#0184 https://t.co/hGRFAoV6B4

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EGPA Treatment: A new Era with the E-MERGE trial?

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