Unsustained Response to Benralizumab in Eosinophilic Asthma After 3 Years of Therapy With Mepolizumab

Abstract

Eosinophilic asthma. Forced expiratory volume in 1 second. Palabras clave: Terapia anti-interleukina 5. Test de control del asma. Recuento de eosinófilos en sangre. Asma eosinofílica. FEV1. Eosinophils play pivotal roles in the inflammatory processes of asthma, and have been the target of new biologic treatments for eosinophilic asthma. Benralizumab is the monoclonal antibody (mAb) that targets chain of the interleukin 5(IL-5) receptor, and mepolizumab is the anti-IL-5 mAb. We herein present a patient with eosinophilic asthma who showed un-sustained response to benralizumab after 3-year mepolizumab administration. A 42-year-old woman, never smoker, visited the clinic because of increasing dyspnea on January 22, 2016. She was treated with pranlukast 450mg/day and fluticasone/formoterol 125µg/5µg inhaler 2 puffs/day. Because of unstable respiratory symptoms, she was given systemic steroids occasionally. On February 27, 2016, the patient was introduced to the hospital by the experienced pulmonologist. We confirmed the diagnosis of asthma using the Global Initiative for Asthma guidelines [1].Forced expiratory volume in 1 second (FEV 1) was 74.1 % of the predicted value with an increase of 14.1 % in FEV 1 after 180µgsalbutamolinhaler. She was a non-allergic asthma patient, diagnosed with serum total IgE level 94 IU/mL and negative results of specific IgE for common inhaled allergens including Dermatophagoides farinae and pteronyssinus. Her regimen was changed to budesonide/formoterol160g/4.5g inhaler 8 puffs/day and montelukast10 mg/day. She stopped using systemic steroids, and daily use of the inhaler was reduced to 6 puffs/day on April 15.