The changes of eosinophil counts in patients after treatment of Dupilumab: A systematic review and meta‐analysis

Abstract

To the Editor, The type 2 immune response is mediated by Th2 and ILC2s cells, through the production of type 2 cytokines such as IL-4, IL-13, and IL-5. Multiple cells, including eosinophils, are active by these cytokines. In healthy individuals, eosinophils account for 1%-5% of peripheral blood leukocytes. The type 2 inflammatory diseases include a series of allergic, immune diseases, such as atopic dermatitis, asthma, allergic rhinitis and eosinophilic esophagitis. 1,2 Dupilumab is a fully human monoclonal antibody, which blocks IL-4/13. Clinical studies have shown optimistic efficacy of Dupilumab, while some studies found that Dupilumab could induce an increase in blood eosinophils. 3 Clinicians may be concerned about whether changes in eosinophils may limit the continued use of Dupilumab. 4 In this study, we evaluated the changes in eosinophil counts after Dupilumab treatment through meta-analysis. Data from different studies were merged, and at different weeks, comprehensive results were obtained.We searched five databases up to December 31, 2021, to select eligible publications. For included studies, quality was assessed.For randomized studies, the risk of bias tool was applied. For observational studies, Newcastle-Ottawa Scale was applied. The standardized mean difference (SMD) was used to evaluate the change.According to the between-study heterogeneity, fixed or random effect model was selected. The detail of selection and study quality were in Figure S1.Ten studies were included. Three diseases were included and analyzed through meta-analysis. The detail was in Table 1. At weeks 8, 16, 48, 100, and 148, eosinophil counts showed significant decrease (P < .05), which were SMD = −0.18 (95%CI: −0.31, −0.05); −0.17

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

“…Although hypereosinophilic syndrome emerging during dupilumab treatment is rare, it constitutes a clinical and diagnostic challenge and should not be disregarded 73–78 . Increased eosinophil levels generally arise and return back to normal within the first half year of dupilumab treatment 79,80 . Standardized and selectively vigilant clinical follow‐up including regular eosinophil level determination is advised, and responsive (interim) dosing adjustments and/or short OCS courses can be employed to overcome (transient) hypereosinophilia (protocol in our center published before) 40 .…”

“…[73][74][75][76][77][78] Increased eosinophil levels generally arise and return back to normal within the first half year of dupilumab treatment. 79,80 dupilumab could be continued. 81,82 The strength of this study lies in the real-life context, reporting on a prospective observational cohort with standardized indication criteria, treatment regimen, and follow-up schedule.…”