PURPOSE: To investigate the degree of pulmonary and cardiovascular involvement and damage in patients with newly diagnosed eosinophilic granulomatosis with polyangiitis (EGPA), using a retrospective analysis of US administrative health insurance claims data (Merative™ MarketScan® databases).
METHODS: The inclusion criteria included patients with newly diagnosed EGPA (2017–2021) who had ≥12 months of continuous pre-diagnosis health plan enrolment, and ≥1 inpatient or ≥2 outpatient EGPA-related diagnoses (≥90 days apart, ICD-10-CM code M30.1). Follow-up was from first observed EGPA diagnosis (index date; ID) until health plan disenrollment or database end. The prevalence of pulmonary or cardiovascular involvement at any time on or before ID; the number of patients with ≥1 pulmonary or cardiovascular-related EGPA symptom ≤6 months before ID (‘existing symptoms’) and at any time after ID (‘new symptoms’), and the number of patients with persistent pulmonary and cardiovascular damage (caused by EGPA or another cause; assessed using components of the vasculitic damage index) at ID and 1 year after ID were assessed.
RESULTS: 236 patients with EGPA were identified (136 [57.6%] women; mean [SD] age, 50.4 [14.5] years; mean [SD] follow-up from index date [ID], 21.7 [14.6] months). Many patients had pulmonary manifestations or comorbidities including asthma (73.7%), throat or chest pain (46.2%), COPD (19.9%), obstructive sleep apnea (19.5%), and interstitial pulmonary disease (14.0%). Many patients had cardiovascular manifestations or comorbidities including arrhythmia (19.5%), ischemic heart disease (19.1%), deep vein thromboembolism (4.7%), and arterial thrombosis (1.3%). Most pulmonary-related symptoms occurred more often ≤6 months before ID than after ID, particularly respiratory failure (17.4% vs. 3.8%), lung nodules or cavities (32.6% vs. 13.1%), wheeze (8.5% vs. 7.6%) and pleural effusion or pleurisy/pleuritis (14.4% vs. 3.0%), hemoptysis or alveolar hemorrhage (5.9% vs 1.3%), but new events continued to occur after ID. Rates of endobronchial involvement did not change (1.7% before and after). Similarly, cardiovascular-related symptoms tended to occur more often before than after ID, particularly hypertension (33.9% vs. 15.7%) cardiomyopathy (6.4% vs. 3.4%), valvular heart disease (10.6% vs 9.3%), pericarditis (3.4% vs. 0.8%), and cerebrovascular accident (4.7% vs. 2.1%). However, new cardiovascular events continued to occur after ID, for example, rates of congestive heart failure rose from 5.9% to 7.2% and ischemic cardiovascular pain from 0.8% to 1.3%. Persistent pulmonary, cardiovascular, and peripheral vascular disease damage was reported across 82.2%, 42.8% and 5.5% of patients. Hypertension requiring anti-hypertensive therapy was the most reported cardiovascular damage at 33.5%. In the year before and after ID, 33.2% and 36.8% of patients identified, respectively, had ≥1 outpatient or office visit with a pulmonologist and 20.3% and 25.8% with a cardiologist; among these, the mean (SD) number of claims for pulmonologist and cardiologist visits were 3.4 (3.4) and 2.9 (3.3) in the year after ID, respectively.
CONCLUSIONS: Patients with EGPA had substantial pulmonary and cardiovascular involvement, recent and continuing pulmonary- and cardiovascular-related symptoms, and persistent pulmonary and cardiovascular damage.
