Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence

Caminati, Marco; Micheletto, Claudio; Norelli, Francesca; Olivieri, Bianca; Ottaviano, Giancarlo; Padoan, Roberto; Piacentini, Giorgio; Schiappoli, Michele; Senna, Gianenrico; Menzella, Francesco

doi:10.1080/14712598.2024.2304556

Cited by 4 publications

(2 citation statements)

References 65 publications

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“…The available data confirms the safety profile of dupilumab. 65 Moreover, in terms of cost-to-benefit ratio, the benefits linked to the prescription of dupilumab must not be underestimated because patients eligible for biologic treatment are affected by difficult-to-treat pathologies that require high amounts of systemic steroids. Clinically significant hypereosinophilia related to dupilumab administration is rare, whilst systemic steroid damage is frequent and has a great impact on economic costs and patient health.…”

Section: Discussionmentioning

confidence: 99%

Severe hypereosinophilia in a patient treated with dupilumab and shift to mepolizumab: the importance of multidisciplinary management. A case report and literature review

Munari,

Ciotti,

Cestaro

et al. 2024

DIC

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Type 2 inflammation is a heterogeneous condition due to the complex activation of different immunological pathways. Rapid progress in research to evaluate the efficacy of biologics for chronic rhinosinusitis with nasal polyps and asthma has led to the availability of effective therapeutic options. These drugs are safe, but temporary iatrogenic hypereosinophilia may sometimes be associated with clinical symptoms or organ damage. Here, we describe a case of severe hypereosinophilia in a patient with chronic rhinosinusitis with nasal polyps and asthma treated with dupilumab and a subsequent therapeutic shift to mepolizumab that led to maintenance of symptom control and concomitant normalization of blood eosinophil count.

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Section: Discussionmentioning

confidence: 99%

Severe hypereosinophilia in a patient treated with dupilumab and shift to mepolizumab: the importance of multidisciplinary management. A case report and literature review

Munari,

Ciotti,

Cestaro

et al. 2024

DIC

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“…Однако необходимо отметить, что преходящее повышение эозинофилов обычно незначительно с клинической точки зрения и связано с механизмом действия лекарственного препарата. В ходе проводимых исследований и клинических наблюдений также сообщалось о редких случаях гиперэозинофилии, связанной с такими клиническими состояниями, как ЭГПА и гиперэозинофильный синдром, причем данные случаи связаны со стероидсберегающим эффектом препарата или естественным течением основного заболевания, а не с прямой причинно-следственной связью с терапией дупилумабом [10].…”

Section: Discussionunclassified

Blood eosinophilia in patients with severe bronchial asthma and chronic polypous rhinosinusitis treated with dupilumab: A review

Petukhova,

Gromov,

Solovyov

et al. 2024

Terapevticheskii arkhiv

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Bronchial asthma and chronic polypous rhinosinusitis are diseases associated with a T2-inflammatory immune response. These nosologies can be combined, creating the preconditions for a more severe course of multimorbidity, requiring the use of genetic engineering biological therapy. Dupilumab is a monoclonal antibody that can specifically bind to the alpha subunit of the interleukin-4 receptor and block the action of interleukins 4 and 13, which play a key role in the development of T2 inflammation. Numerous studies have demonstrated the high effectiveness of this medicament. The use of dupilumab in some cases may be accompanied by an increase in eosinophils in the blood. This article presents scientific base and our own experience in treating patients with dupilumab-associated eosinophilia, in addition we describe an algorithm for examining this group of patients for the purpose of timely diagnosis of diseases such as eosinophilic granulomatosis with polyangiitis, eosinophilic pneumonia, etc. It should be noted that in the most cases eosinophilia during targeted therapy with dupilumab is temporary and does not cause clinical manifestations.

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Dupilumab for refractory chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis

Padoan,

Davanzo,

Iorio

et al. 2024

Rheumatology

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Objectives Eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with refractory chronic rhinosinusitis with nasal polyps (CRSwNP), despite current treatments. Dupilumab demonstrated efficacy in the treatment of severe and uncontrolled CRSwNP, with improvements in patient-reported outcome measures and in objective measurements. This study aims to evaluate efficacy and safety of dupilumab in refractory CRSwNP in EGPA patients. Methods A prospective observational study was conducted on EGPA patients treated with dupilumab between 2021 and 2023. Patients in a phase of prolonged remission of vasculitis manifestations but still experiencing active CRSwNP were included. Clinical, biological, and rhinologic evaluations were performed, alongside with patient-reported outcomes measures (PROMs) and nasal cytology. Complete response was defined by Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone dose ≤ 4 mg/day, while partial response by BVAS = 0 and prednisone dose >4 mg/day. Results Nine EGPA patients were included. After 3 months, 55.6% achieved complete response, increasing to 83.3% at 12 months. Nasal symptoms and patient-reported outcomes improved significantly, with sustained efficacy over 12 months. An improvement in quality of life was also observed, with a significant reduction of the AAV-PRO score. Nasal cytology revealed reductions in eosinophils and neutrophils counts. Adverse events occurred in 44.4%, including hypereosinophilia in 2 cases, which led to dupilumab discontinuation. Conclusions Dupilumab is an effective treatment option for severe and refractory ENT manifestations in EGPA, as it improves symptoms, reduces inflammation, and leads to better a quality of life. However, careful patient selection and monitoring are necessary to minimize adverse events and optimize outcomes.

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Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence

Cited by 4 publications

References 65 publications

Severe hypereosinophilia in a patient treated with dupilumab and shift to mepolizumab: the importance of multidisciplinary management. A case report and literature review

Severe hypereosinophilia in a patient treated with dupilumab and shift to mepolizumab: the importance of multidisciplinary management. A case report and literature review

Blood eosinophilia in patients with severe bronchial asthma and chronic polypous rhinosinusitis treated with dupilumab: A review

Dupilumab for refractory chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis

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