Development of vasculitis in a case with severe asthma treated with benralizumab and low-dose corticosteroid

Umezawa, Natsuka; Sasaki, Hirokazu; Furusawa, Haruhiko; Kawata, Daisuke; Hata, Chiina; Yasuda, Shinsuke

doi:10.1016/j.alit.2022.08.004

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…We found no reports of BP patients under treatment with eosinophil‐suppressing biologics, but a case of vasculitis under benralizumab treatment was reported 14 . The authors considered that eosinophilic granulomatosis with polyangiitis‐like vasculitis might be caused by a vasculitic process rather than by eosinophil infiltration because the case did not demonstrate eosinophilia or eosinophil infiltration.…”

Section: Discussionmentioning

confidence: 95%

“…We found no reports of BP patients under treatment with eosinophil-suppressing biologics, but a case of vasculitis under benralizumab treatment was reported. 14 The authors considered that eosinophilic granulomatosis with polyangiitis-like vasculitis might be caused by a vasculitic process rather than by eosinophil infiltration because the case did not demonstrate eosinophilia or eosinophil infiltration. Since our patient was also treated with benralizumab for bronchial asthma, both her peripheral eosinophils and basophils were 0%, and almost no eosinophils were histologically observed in the skin.…”

Section: Discussionmentioning

confidence: 99%

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A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma

Tanaka

Fujimura

Fuke

et al. 2023

The Journal of Dermatology

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Bullous pemphigoid (BP) is an autoimmune disease characterized by itchy erythema and tense blisters on the whole body. Recent reports have unveiled the pathogenic roles of eosinophils in BP (e.g., dermal‐epidermal separation, generation of pruritus). Thus, eosinophils are considered a therapeutic target. Benralizumab is an anti‐IL‐5 receptor alpha (IL‐5Rα) monoclonal antibody (mAb) that is widely used to treat severe eosinophilic asthma. By affecting IL‐5Rα, benralizumab depletes eosinophils and basophils due to apoptosis through antibody‐dependent cell‐mediated cytotoxicity. The efficacies of benralizumab and other biologics, including bertilimumab (anti‐eotaxin‐1 mAb) and mepolizumab (anti‐IL‐5 mAb), were evaluated in several clinical trials. Also, reslizumab, an anti‐IL‐5 mAb, was reported as a successful treatment option in a case of BP. We present a case of severe asthma treated with benralizumab at 8‐week intervals for 3 years before BP developed. Histologically, subepidermal blisters without eosinophilic infiltration were observed. Methylprednisolone pulse therapy followed by 40 mg/day (1 mg/kg/day) of oral prednisolone (PSL) was initiated, but the skin lesions worsened. Additional intravenous immunoglobulin and oral azathioprine enabled the oral PSL to be tapered. The benralizumab was discontinued after the onset of BP because the asthma did not worsen. To the best of our knowledge, there have been no reports of BP developing during anti‐eosinophil therapy. BP may occur paradoxically via various pathways during treatment with drugs that are typically effective against BP.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma

Tanaka

Fujimura

Fuke

et al. 2023

The Journal of Dermatology

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“…Thus, targeting eosinophils alone likely is not sufficient for controlling all aspects of the inflammatory process, and cases of new-onset vasculitis during ongoing anti-eosinophilic therapies have been described. 44 , 45 This might provide a rationale for continuing low-dose OCS and/or other steroid-sparing immunosuppressants after remission induction even with ongoing anti-eosinophilic treatments. However, it is unknown whether this is actually necessary in all patients, eg those with ANCA-negative phenotype, and for how long.…”

Section: Discussionmentioning

confidence: 99%

Benralizumab Reduces Respiratory Exacerbations and Oral Glucocorticosteroid Dose in Patients with Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis

Mümmler,

Mertsch,

Barnikel

et al. 2024

JAA

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Ten clinical conundrums in the management of eosinophilic granulomatosis with polyangiitis

Rua–Figueroa,

Solans–Laqué,

Blanco–Aparicio

et al. 2024

Expert Review of Clinical Immunology

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Development of vasculitis in a case with severe asthma treated with benralizumab and low-dose corticosteroid

Cited by 4 publications

References 10 publications

A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma

A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma

Benralizumab Reduces Respiratory Exacerbations and Oral Glucocorticosteroid Dose in Patients with Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis

Ten clinical conundrums in the management of eosinophilic granulomatosis with polyangiitis

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