Scientific Letter
Severe Eosinophilic Asthma and Severe Mixed Polyneuropathy: A Case of Eosinophilic Granulomatous Vasculitis With Polyangiitis and New Therapeutic Perspectives
Asma eosinofílica grave y polineuropatía mixta severa. Un nuevo caso de vasculitis granulomatosa eosinofílica con poliangeítis (GEPA). Nuevas perspectivas terapéuticas
Read
544
Timeswas read the article
129
Total PDF
415
Total HTML
Share statistics
array:23 [ "pii" => "S2659663624000158" "issn" => "26596636" "doi" => "10.1016/j.opresp.2024.100312" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "100312" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Open Respir Arch. 2024;6:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2659663624000195" "issn" => "26596636" "doi" => "10.1016/j.opresp.2024.100316" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "100316" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Open Respir Arch. 2024;6:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "High-flow Nasal Oxygen Therapy Yields a Favorable Outcome in Patient Presenting With Kussmaul Breathing" "tienePdf" => "en" "tieneTextoCompleto" => "en" "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La oxigenoterapia nasal de alto flujo produce un resultado favorable en pacientes que presentan respiración de Kussmaul" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "René Agustín Flores-Franco, Carlos Mauricio González-Ponce, Victor Irigoyen-Monroy" "autores" => array:3 [ 0 => array:2 [ "nombre" => "René Agustín" "apellidos" => "Flores-Franco" ] 1 => array:2 [ "nombre" => "Carlos Mauricio" "apellidos" => "González-Ponce" ] 2 => array:2 [ "nombre" => "Victor" "apellidos" => "Irigoyen-Monroy" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663624000195?idApp=UINPBA00004N" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663624000195/v1_202406140703/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2659663623000826" "issn" => "26596636" "doi" => "10.1016/j.opresp.2023.100296" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "100296" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Open Respir Arch. 2024;6:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Primary Pulmonary Ewing's Sarcoma: A Surprise Diagnosis in a 52-Year-Old Active Smoker" "tienePdf" => "en" "tieneTextoCompleto" => "en" "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma de Ewing pulmonar primario: una sorpresa diagnóstica en un fumador activo de 52 años" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1532 "Ancho" => 1725 "Tamanyo" => 401927 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Computed tomography chest images showing a large, relatively well-defined, heterogenous pulmonary mass in the right upper lobe, measuring 24<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>cm. (C) Histopathology shows large sheets of small round cells with perivascular arrangement (HEA50 ×4). (D) Scattered pyknotic cells corresponding to apoptotic cells (HEA50 ×25). (E) Immunohistochemistry photomicrograph showing tumor cells positive for CD99.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "El Ghoul Jamel, Ksouri Chiraz, Walha Marwa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "El Ghoul" "apellidos" => "Jamel" ] 1 => array:2 [ "nombre" => "Ksouri" "apellidos" => "Chiraz" ] 2 => array:2 [ "nombre" => "Walha" "apellidos" => "Marwa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663623000826?idApp=UINPBA00004N" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663623000826/v1_202406140703/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Severe Eosinophilic Asthma and Severe Mixed Polyneuropathy: A Case of Eosinophilic Granulomatous Vasculitis With Polyangiitis and New Therapeutic Perspectives" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María del Carmen Lorenzo Martínez, Ángela Hidalgo Herranz, Ana María Ochoa Ruiz, Bárbara Gutierrez Ruano, Raúl Ruiz Esteban, Sergio Campos Téllez, José Javier Jareño Esteban" "autores" => array:7 [ 0 => array:3 [ "nombre" => "María del Carmen" "apellidos" => "Lorenzo Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Ángela" "apellidos" => "Hidalgo Herranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ana María" "apellidos" => "Ochoa Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Bárbara" "apellidos" => "Gutierrez Ruano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Raúl" "apellidos" => "Ruiz Esteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Sergio" "apellidos" => "Campos Téllez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:4 [ "nombre" => "José Javier" "apellidos" => "Jareño Esteban" "email" => array:1 [ 0 => "jjjarenoesteban@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Respiratory Medicine Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Neurology Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Internal Medicine Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asma eosinofílica grave y polineuropatía mixta severa. Un nuevo caso de vasculitis granulomatosa eosinofílica con poliangeítis (GEPA). Nuevas perspectivas terapéuticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 46-year-old woman, non-smoker with a history of severe uncontrolled asthma. Since the age of 30, she has presented symptoms of arthralgia and myalgia, and 2 years ago she developed distal paraesthesia. Physical examination revealed diffuse bilateral wheezing on pulmonary auscultation. Neurological findings included right-sided peripheral hypoesthesia. Laboratory values of note included haemoglobin 11.3<span class="elsevierStyleHsp" style=""></span>g/dl, haematocrit 37.2%, and eosinophils 485 (6.9%). Kidney function, ionogram and thyroid hormones were normal. Antineutrophil cytoplasmic antibody (ANCA) testing, an immunological study for connective tissue diseases and serologies were all negative. Chest computed tomography showed pulmonary opacities in the left upper lobe. Sural nerve biopsy led to a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). The Birmingham activity score was 10 points. Treatment began with corticosteroids and cyclophosphamide that, due to adverse effects, were switched to azathioprine. At follow-up, paraesthesia had progressed so we changed treatment to rituximab and continued with prednisone. In the following months, worsening asthma control (Asthma Control Test<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>15, reduced forced expiratory volume in 1 second, elevated fractional exhaled nitric oxide) and progression of neurological symptoms were observed. In view of this situation, inhaled therapy and systemic corticosteroids were optimised. We also started mepolizumab at 100<span class="elsevierStyleHsp" style=""></span>mg that was progressively increased to 300<span class="elsevierStyleHsp" style=""></span>mg to achieve greater control of EGPA activity, asthma, and improve pulmonary function and neurological symptoms (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Subsequently, we were able to reduce corticosteroid dosage.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">EGPA is characterised by eosinophilic tissue infiltration associated with vasculitis and the presence of granulomas. Clinical manifestations are varied, and diagnostic criteria include asthma, rhinosinusitis, peripheral blood eosinophilia, extravascular eosinophilia, evanescent pulmonary infiltrates, and peripheral neuropathy. Only 40% of patients are ANCA-positive. The Birmingham activity score (≥4) is currently used to assess the degree of activity and remission.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The survival of patients with vasculitis has increased in recent decades due to the use of immunomodulators and corticosteroids, but these treatments are not exempt from toxicity or risk of infections. In recent years, new treatments such as rituximab and mepolizumab have appeared and have demonstrated their efficacy in inducing remission.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Rituximab is an anti-CD20 monoclonal antibody that depletes B-lymphocytes and has shown efficacy in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). Experience in EGPA is scant but growing, with the recent publication of several series in EGPA patients in which rituximab demonstrated efficacy in controlling disease activity and possibly reducing maintenance doses of corticosteroids.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our patient, refractory vasculitis and mononeuritis multiplex improved partially with rituximab treatment. However, persistent neurological symptoms and poor asthma control prompted the initiation of mepolizumab associated with corticosteroids as an alternative to other treatments (methotrexate, azathioprine and mycophenolate mofetil, etc.). Recent multicentre studies in Europe have confirmed the efficacy and safety of this combination. It is well tolerated and is associated few adverse effects and a low risk of infections, allowing a progressive reduction of the corticosteroid dose.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Several European studies show that a 100<span class="elsevierStyleHsp" style=""></span>mg dose of mepolizumab is as effective as the 300<span class="elsevierStyleHsp" style=""></span>mg dose recommended by the US Food and Drug Administration.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patient and/or subjects referred to in the article. This document is held by the corresponding author.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No external financing was needed for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors have contributed substantially to each of the following aspects: (1) data acquisition, data analysis and interpretation, (2) drafting of the article, and (3) final approval of the version presented.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Informed consent" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors’ contributions" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interests" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ACT: asthma control test; FEV<span class="elsevierStyleInf">1</span>: forced expiratory volume in 1 second; FVC: forced vital capacity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Without mepolizumab treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">With mepolizumab treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Asthma exacerbation</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 per year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ACT</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Spirometry</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3040<span class="elsevierStyleHsp" style=""></span>mL (128%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2240<span class="elsevierStyleHsp" style=""></span>mL (99%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1280<span class="elsevierStyleHsp" style=""></span>mL (64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1720<span class="elsevierStyleHsp" style=""></span>mL (91%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>/FVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Prednisone dose</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3568360.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and functional comparison before and after starting mepolizumab treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 American College of Rheumatology/Vasculitis Foundation Guideline for the management of antineutrophil cytoplasmic antibody – associated vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Chung" 1 => "C.A. Langford" 2 => "M. Maz" 3 => "A. Abril" 4 => "M. Gorelik" 5 => "G. Guyarr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.41773" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2021" "volumen" => "73" "paginaInicial" => "1088" "paginaFinal" => "1105" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scheduled rituximab maintenance reduces relapse rate in eosinophilic granulomatosis with polyangiitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Emmi" 1 => "G.M. Rossi" 2 => "L.M. Urban" 3 => "E. Silvestri" 4 => "D. Prisco" 5 => "M. Goldoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2017-211897" "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2018" "volumen" => "77" "paginaInicial" => "952" "paginaFinal" => "954" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety or rituximab in the treatment of eosinophilic granulomatosis with polyangitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Teixeira" 1 => "A.J. Mohammad" 2 => "R.B. Jones" 3 => "R. Smith" 4 => "D. Jayne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/rmdopen-2019-000905" "Revista" => array:5 [ "tituloSerie" => "RMD Open" "fecha" => "2019" "volumen" => "5" "paginaInicial" => "e000905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31245051" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and effectiveness of mepolizumab therapy in remission induction therapy for eosinophilic granulomatosis with polyangiitis: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Ueno" 1 => "I. Miyagawa" 2 => "T. Aeitomi" 3 => "K. Kimura" 4 => "S. Iwata" 5 => "K. Hanami" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-022-02845-3" "Revista" => array:3 [ "tituloSerie" => "Arthritis Res Therapy" "fecha" => "2022" "paginaInicial" => "159" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low dose mepolizumab effectiveness in patients suffering from eosinophilic granulomatosis with polyangiitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Vultaggio" 1 => "F. Nencini" 2 => "S. Bormioli" 3 => "E. Vivarelli" 4 => "L. Dies" 5 => "O. Rossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4168/aair.2020.12.5.885" "Revista" => array:5 [ "tituloSerie" => "Allergy Asmthma Immunol Res" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "885" "paginaFinal" => "893" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663624000158/v1_202406140703/en/main.assets" "Apartado" => array:4 [ "identificador" => "85987" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/26596636/0000000600000002/v1_202406140703/S2659663624000158/v1_202406140703/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663624000158?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 23 | 6 | 29 |
| 2024 September | 36 | 10 | 46 |
| 2024 August | 36 | 5 | 41 |
| 2024 July | 48 | 14 | 62 |
| 2024 June | 53 | 20 | 73 |
| 2024 May | 31 | 7 | 38 |
| 2024 April | 95 | 22 | 117 |
| 2024 March | 90 | 44 | 134 |
