A case of chronic eosinophilic pneumonia successfully treated with mepolizumab

To, Masako; Kono, Yuta; Yamawaki, Satoshi; Soeda, Seiko; Katsube, Otohiro; Kishi, Hirohisa; To, Yasuo

doi:10.1016/j.jaip.2018.06.017

Cited by 29 publications

(27 citation statements)

References 10 publications

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“…ICEP shares similar pathophysiology with these conditions and mepolizumab has demonstrated efficacy in inducing sustained corticosteroid-free remission. 7 The physiologic mechanism of action of mepolizumab directly guided our therapy selection for this ICEP patient with relative steroid intolerance. In addition to mepolizumab, there are other monoclonal antibodies, such as reslizumab and benralizumab, which reduce the production and survival of eosinophils by inhibiting IL-5.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 5 Several recent reports indicate a role for novel biologic agents in the treatment of a variety of eosinophil-driven disease processes, including ICEP. 6 , 7 Mepolizumab has previously been shown to reduce symptoms and relapse rate and to have corticosteroid-sparing potential in ICEP. 7 , 8 We present a case of ICEP in which mepolizumab was used as a steroid-sparing agent, resulting in improvement in markers of disease activity and corticosteroid requirement.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 Mepolizumab has previously been shown to reduce symptoms and relapse rate and to have corticosteroid-sparing potential in ICEP. 7 , 8 We present a case of ICEP in which mepolizumab was used as a steroid-sparing agent, resulting in improvement in markers of disease activity and corticosteroid requirement.…”

Section: Introductionmentioning

confidence: 99%

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Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

Kisling¹,

Jones²,

Hixson³

et al. 2020

DIC

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A 55-year-old woman with cough-variant asthma presented for 1 month of worsening wheezing, cough, and dyspnea refractory to treatment. Initial laboratory findings revealed profound peripheral eosinophilia, and a chest computed tomography showed bi-apical consolidation. Bronchio-alveolar lavage demonstrated alveolar eosinophilia. She was diagnosed with idiopathic chronic eosinophilic pneumonia (ICEP). Her peripheral eosinophilia and respiratory symptoms improved rapidly with high-dose systemic corticosteroid therapy. However, she was intolerant to corticosteroid monotherapy due to non-compliance and psychological adverse effects. Mepolizumab was initiated as a steroid-sparing agent, resulting in successful therapy for 2 years without relapse or adverse effects. Mepolizumab is an interleukin-5 (IL-5) antagonist monoclonal antibody, which is a targeted therapy for diseases mediated by eosinophil activity and eosinophil proliferation. Mepolizumab is typically used in ICEP refractory to steroids, but this case supports its use in cases of glucocorticoid intolerance. Further study of IL-5 antagonist therapies for ICEP may identify an alternative treatment modality for patients in whom the adverse effects of corticosteroids pose a challenge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

Kisling¹,

Jones²,

Hixson³

et al. 2020

DIC

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“…But, it has been reported that blood IL‐5 and BALF IL‐5 levels are elevated in EP and IL‐5 seems play an important role in the pathogenesis of EP . Therefore, it is reasonable that mepolizumab suppresses levels of IL‐5 and infiltration of eosinophils, resulting in the resolution of CT findings and decreased eosinophilia and symptoms . Although mepolizumab has not been approved for treating EP, it may be a treatment option for patients with severe asthmatic symptoms and difficulty in using corticosteroid owing to their side effect.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of mepolizumab for eosinophilic pneumonia following bronchial thermoplasty

Otoshi

Baba

Komatsu

et al. 2019

Respirology Case Reports

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A 57-year-old woman with poorly controlled diabetes was admitted to our hospital for additional treatment of severe asthma. Although bronchial thermoplasty was performed in the both upper lobes, cough and dyspnoea gradually appeared 2 weeks later. High-resolution computed tomography revealed thickness of intralobular septa and a diffuse ground-glass attenuation in the lung fields. Laboratory examination revealed elevated levels of serum eosinophils and total immunoglobulin E. Bronchoalveolar lavage fluid showed a remarkable increase of eosinophils as high as 48.5%, then eosinophilic pneumonia was diagnosed. Although treatment with steroids resulted in an improvement of eosinophilic pneumonia, the treatment was discontinued after 4 days because it worsened her diabetic condition. Since eosinophilic pneumonia recurred after discontinuing steroid, mepolizumab was administered, which subsequently improved her disease condition. Clinicians should be aware that bronchial thermoplasty can lead to eosinophilic pneumonia and mepolizumab might be an effective treatment in this setting.

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“…The concentration of IL-5 is increased in the BALF of EP patients, as described above. In this context, several case reports have suggested a positive effect for mepolizumab (anti-IL-5 mAb) on remission and the reduction of glucocorticoid use in CEP [26,27].…”

Section: Mechanisms For the Development Of Eosinophilic Airway Inflammentioning

confidence: 99%

Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia

Nakagome

Nagata

2020

Biomolecules

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Eosinophilic pneumonia (EP), including acute EP and chronic EP, is characterized by the massive pulmonary infiltration of eosinophils into the lung. However, the mechanisms underlying the selective accumulation of eosinophils in EP have not yet been fully elucidated. We reported that bronchoalveolar lavage fluid (BALF) from EP patients induced the transmigration of eosinophils across endothelial cells in vitro. The concentrations of eotaxin-2 (CCL24) and monocyte chemotactic protein (MCP)-4 (CCL13), which are CC chemokine receptor (CCR) 3 ligands, were elevated in the BALF of EP patients, and anti-CCR3 monoclonal antibody inhibited the eosinophil transmigration induced by the BALF of EP patients. The concentration of macrophage inflammatory protein 1β (CCL4), a CCR5 ligand that induces eosinophil migration, was increased in the BALF of EP patients. Furthermore, the concentration of interleukin (IL) 5 was increased in the BALF of EP patients, and it has been reported that anti-IL-5 antibody treatment resulted in remission and the reduction of glucocorticoid use in some cases of chronic EP. The concentrations of lipid mediators, such as leukotriene (LT) B 4 , damage-associated molecular pattern molecules (DAMPs), such as uric acid, or extracellular matrix proteins, such as periostin, were also increased in the BALF of EP patients. These findings suggest that chemokines, such as CCR3/CCR5 ligands, cytokines, such as IL-5, lipid mediators, such as LTB 4 , DAMPs, and extracellular matrix proteins may play roles in the accumulation or activation of eosinophils in EP.Biomolecules 2020, 10, 638 2 of 12 mechanisms of eosinophil accumulation in the airway of EP patients are discussed. The aim of this review is to better understand the mechanisms of eosinophil accumulation and activation in EP. AEP and CEPAEP is characterized by acute febrile illness with diffuse pulmonary infiltrates, severe hypoxemia, and increased eosinophils in bronchoalveolar lavage fluid (BALF) [3]. AEP is diagnosed based on the following: acute onset of respiratory failure, diffuse pulmonary infiltrates on chest roentgenogram, and increased numbers of eosinophils in BALF (more than 25% of total cells) [3]. Although the mechanisms of AEP have not yet been fully established, inhaled agents, such as cigarette smoke or chemical agents, are known causes of AEP [1,2,[5][6][7][8][9]. For example, a relationship was observed between the recent onset of cigarette smoking and the development of AEP [5][6][7]. Even short-term passive smoking can induce AEP [7]. The collapse of the World Trade Center towers [8] and the desert of the Middle East [9] have also been reported to induce AEP.

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A case of chronic eosinophilic pneumonia successfully treated with mepolizumab

Cited by 29 publications

References 10 publications

Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

Effectiveness of mepolizumab for eosinophilic pneumonia following bronchial thermoplasty

Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia

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