Long-Term Treatment With Anti-Interleukin 5 Antibodies in a Patient with Chronic Eosinophilic Pneumonia

Shimizu, Yoshiyuki; Kurosawa, Manabu; Sutoh, Y; Sutoh, E

doi:10.18176/jiaci.0468

“…In the case report by Shimizu et al, the initial treatment was mepolizumab, with a change to benralizumab. In their report, the patient relapsed after the monoclonal antibody was changed [19]. In the case report of Sarkis et al, management with mepolizumab was administered for 6 months, followed by management with reslizumab [20].…”

Section: Resultsmentioning

confidence: 98%

Monoclonal Antibodies in Idiopathic Chronic Eosinophilic Pneumonia: A Scoping Review

Murillo

¹

,

Castrillon

²

,

Serrano

³

et al. 2023

Preprint

0

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Background Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP. Methods A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers. Results 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events. Conclusion The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies.

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“…Two patients switched from mepolizumab to benralizumab and reslizumab respectively. The first switched because of relapse after 24 months on mepolizumab and achieved adequate control with benralizumab [ 32 ]. The second patient switched to mepolizumab due to anaphylaxis and had good tolerability and adequate disease control with reslizumab [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Severe asthma Significant improvement at 4 months with ACT in control range After relapse improvement, keeping ACT in control range None after start 1 relapse with onset Tolerated slow decline with suspension at 12 months. Tolerated descent and suspension after relapse Resolution at 4 months It had no alterations Improvement at 4 months It had no alterations Not described Not described No adverse events during handling No adverse events during handling Shimizu et al 2020 [ 32 ]. 100 mg every 4 weeks for 6 months, then Reslizumab 3 mg/kg every 4 weeks 1 14 months Female, 42 years old.…”

Section: Methodsmentioning

confidence: 99%

Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review

Murillo,

Castrillon,

Serrano

et al. 2024

BMC Pulm Med

2

0

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Background Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP. Methods A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers. Results 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events. Conclusion The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies.

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“…Indeed, in the present cases, all 4 ICEP patients with frequent recurrences were well controlled by anti-IL-5 agents, and no patients have developed relapses after the treatment, as supported by previous single-case reports. [32][33][34][35][36] Ricketti et al also reported that a patient with relapsing CEP was treated with benralizumab, and the safety of long-term treatment for over 30 months was found, with maintenance of its efficacy. 37 In addition, corticosteroid treatment was withdrawn or reduced in all 4 cases, which contributed to attenuation of corticosteroid-related adverse effects (Table 3).…”

Section: Dovepressmentioning

confidence: 97%

Anti-IL-5 Agents for the Treatment of Idiopathic Chronic Eosinophilic Pneumonia: A Case Series

Tashiro¹,

Takahashi²,

Kurihara³

et al. 2022

JAA

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Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare, chronic respiratory disease. Corticosteroid therapy is effective for ICEP, but relapse is frequent after its tapering, which leads to chronic use and corticosteroid-related adverse effects. Currently, biological agents targeting interleukin 5 (IL-5) are considered alternatives for treating ICEP patients with frequent relapse, but the detailed effects are not fully understood. Patients and Methods: The clinical characteristics of 30 patients with ICEP, especially 12 patients with ICEP who experienced relapse after corticosteroid dose tapering, were evaluated retrospectively. In addition, 4 ICEP patients with frequent relapse treated by IL-5-targeted biological agents were reviewed. Results: Of the 30 patients diagnosed with ICEP, 12 patients (40.0%) recurred after corticosteroid dose tapering, and 9 (30.0%) were treated with maintenance doses of corticosteroid. Of ICEP patients who experienced recurrence, 6 (50.0%) had frequent relapses (2 or more times). All 4 patients treated with anti-IL-5 agents had their corticosteroid dose reduced without any relapses; in 3 patients, corticosteroids were withdrawn. Conclusion: Anti-IL-5 agents might be alternatives for treating ICEP patients with frequent relapses.

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Long-Term Treatment With Anti-Interleukin 5 Antibodies in a Patient with Chronic Eosinophilic Pneumonia

Cited by 8 publications

References 0 publications

Monoclonal Antibodies in Idiopathic Chronic Eosinophilic Pneumonia: A Scoping Review

Monoclonal Antibodies in Idiopathic Chronic Eosinophilic Pneumonia: A Scoping Review

Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review

Anti-IL-5 Agents for the Treatment of Idiopathic Chronic Eosinophilic Pneumonia: A Case Series

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