# Case Report: Sequential use of tezepelumab and mepolizumab for eosinophilic otitis media in EGPA: a steroid-sparing strategy

## TL;DR

A patient with EGPA showed improved symptoms using a combination of tezepelumab and mepolizumab, reducing the need for steroids.

## Contribution

A steroid-sparing strategy using alternating biologics for managing EGPA-related inflammation is presented.

## Key findings

- Tezepelumab improved EOM and airway symptoms after mepolizumab failed.
- Alternating biologics achieved long-term control without corticosteroid escalation.
- The regimen offers a personalized approach for complex type 2 inflammation in EGPA.

## Abstract

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.