Tezepelumab treatment for allergic bronchopulmonary aspergillosis

Abstract

An 82‐year‐old man had been diagnosed with asthma. He experienced repeated exacerbations requiring treatment with a systemic corticosteroid despite being treated with medications including high‐dose fluticasone furoate/umeclidinium/vilanterol, montelukast sodium, and theophylline; treatment with mepolizumab was then initiated. The patient had been free from exacerbations for 15 months; however, he suffered from post‐obstructive pneumonia and atelectasis secondary to mucoid impaction in the right middle lobe of the lung, accompanied by a productive cough, wheezing, dyspnea, and right chest pain. In addition to the development of mucus plugs, the levels of serum IgE specific to Aspergillus spp. became positive; a definite diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was established. The patient underwent treatment with tezepelumab. Over 3 months, the mucus plugs and pulmonary opacities diminished gradually in parallel with the improvement in the control of asthmatic symptoms. Tezepelumab might provide a novel steroid‐sparing strategy for the management of ABPA, although further studies are required.

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

“…Omalizumab is a potential therapeutic approach since ABPA is associated with elevated IgE levels. Mepolizumab (anti-IL-5), benralizumab (anti-IL-5R), dupilumab (anti-IL-4Rα) and tezepelumab (anti-TSLP) have also been used in ABPA patients [ 135 , 142 , 162 – 165 ]. Most experience of biological agents in ABPA is with omalizumab.…”

Development of allergic bronchopulmonary aspergillosis in a patient with nontuberculous mycobacterial‐pulmonary disease successfully treated with dupilumab: A case report and literature review

“…Biologics are not currently available for ABPM cases. Case reports and series have reported that the use of biologics targeting IgE, 24 IL‐5, 25 IL‐4/IL‐13, 26 , 27 , 28 , 29 , 30 , 31 , 32 and TSLP 33 improves the disease status of ABPA complicated by severe asthma. Monoclonal antibodies against IgE have therapeutic efficacy in patients with ABPA and severe asthma, including 12 of the 25 patients with NTM‐PD.…”