Eosinophilic granulomatosis with polyangiitis: sequential use of mepolizumab following rituximab for inadequate asthma control despite vasculitis remission.

We report the case of a 54-year-old woman with antineutrophilic cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis presenting with mononeuritis multiplex, intestinal hemorrhage, cardiomyopathy, fever, and worsening asthma symptoms. She was initially treated with steroids and cyclophosphamide but eventually required rituximab to control a vasculitis flare. However, her asthmatic symptoms did not improve, despite attaining vasculitis remission. Symptoms abated only after the treatment transition to mepolizumab. After a 1-year interval, there were no further episodes of asthma exacerbation and no requirement for systemic steroid therapy. This report reinforces the use of rituximab for induction and maintenance of remission in patients with eosinophilic granulomatosis with polyangiitis and predominant vasculitic manifestations, whereas mepolizumab demonstrated better control of the persistent eosinophilic manifestations, ensuing sustained remission and improved quality of life.

Pharmacodynamics and toxicology of fenflumizole, a new non-steroidal anti-inflammatory imidazole derivative.

Fenflumizole, (2-(2,4-difluorophenyl)-4,5-bis(4-methoxyphenyl) imidazole), a new non-steroidal anti-inflammatory agent, was investigated for anti-inflammatory, analgesic and anti-pyretic activity in experimental animals. Comparison was made to other non-steroidal anti-phlogistics. Furthermore, general pharmacodynamics and toxicity of fenflumizole was studied. Fenflumizole was comparable to or weaker than indomethacin in models of acute inflammation (carrageenin paw oedema and pleurisy, rats, ultraviolet erythema, guinea-pigs) and stronger than indomethacin as an analgesic (writhing, mice). As an antipyretic agent (arachidonic acid pyresis, rats) fenflumizole was 3 times weaker than indomethacin. The acute gastro-ulcerogenicity and toxicity of fenflumizole was low as compared to reference drugs. No untoward activity of fenflumizole on respiratory and circulatory systems was observed in rabbits and dogs. Fenflumizole is a potential new therapeutic agent with anti-inflammatory, analgesic and anti-pyretic activities comparable to other anti-phlogistics but with reduced side effects.

Fenflumizole: interactions with the arachidonic acid cascade.

Fenflumizole (2-(2,4-difluorophenyl)-4,5-bis(4-methoxyphenyl)imidazole), a new non-steroidal anti-inflammatory agent, was investigated for interference with cyclo-oxygenase activity in vivo, ex vivo and in vitro in comparison with indomethacin (and aspirin). Fenflumizole was comparable to indomethacin ex vivo in inhibition of thromboxane (TX)A2 production in rabbit platelets and inhibition of prostaglandin (PG)I2 (approximately prostacyclin) generation in rabbit mesenteric arteries and in vivo as an inhibitor of PGE2 formation in inflammatory exudates in rats. Fenflumizole was 18 times less active than indomethacin in inhibition of PGE2 synthesis in vitro and 170 times weaker as an inhibitor of PGI2 generation in the rat stomach mucosa ex vivo. Fenflumizole was 20-50 times more potent than indomethacin in vivo in inhibition of arachidonic acid induced bronchoconstriction in guinea-pigs, in inhibition of platelet aggregation on tendons superfused with blood from rabbits and in vitro in inhibition of aggregation of human and rabbit platelets. Neither fenflumizole nor indomethacin inhibited TXA2-synthetase in vitro. Aspirin-when tested-was less potent than fenflumizole and indomethacin. It is concluded that fenflumizole is a potent cyclo-oxygenase inhibitor. The very potent activity of fenflumizole against platelet aggregation and bronchoconstriction suggests a selectivity in the mode of action. The weak inhibition of gastric PGI2 generation may account for the previously observed weak gastro-ulcerogenicity of fenflumizole.

Release of prostacyclin (PGI2) by the layers of corpus of rat stomach.

Release of PGI2 by slices of muscularis and mucosa layers of rat corpus stomach was investigated. An anti-aggregatory substance that was released by slices of muscularis was identified as PGI2 in various bioassay systems including anti-serum against PGI2 as well as by stimulation of its generation with AA or PGH2 and by inhibition of this generation with indomethacin or tranylcypromine, respectively. PGI2 was the major PGs released from slices of muscularis. The release of PGI2 from muscularis surpasses a similar release of PGI2 from mucosa by a factor of 10. On the other hand, degradation of exogenous PGI2 was 4 times faster by mucosa than by muscularis slices. Our conclusion is that in the stomach corpus wall of rats, muscularis is the main source of PGI2, which may play a role in regulation of mucosal blood flow.