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Combination of monoclonal antibodies targeting type 2 inflammation for severe asthma and eosinophilic granulomatosis with polyangiitis.
- Source :
-
Autoimmunity reviews [Autoimmun Rev] 2024 Mar; Vol. 23 (3), pp. 103503. Date of Electronic Publication: 2023 Dec 13. - Publication Year :
- 2024
-
Abstract
- Monoclonal antibodies targeting type 2 inflammation are promising treatments for eosinophilic-associated diseases. There is growing interest in the potential benefits of combining two biologics to treat patients with poorly controlled conditions. We present a case of a 54-year-old female patient affected with a relapsing-refractory ANCA myeloperoxidase positive eosinophilic granulomatosis with polyangiitis (EGPA), presenting with difficult-to-treat asthma and rhino-sinusitis manifestations. She failed several biologics, including omalizumab 300 mg, mepolizumab 100 mg, and benralizumab 30 mg every 8 weeks. A switch to dupilumab led to significant eosinophilia (7.69 × 10 <superscript>9</superscript> /L) as well as systemic symptoms, and a deterioration of asthma control. Therefore, a combination of dupilumab-benralizumab was started, leading to better nasal and ear outcomes, asthma control and decrease in blood eosinophils. During the 12-month treatment, no adverse effects were observed. We conducted an extensive literature search in MEDLINE for original articles published until August 1st, 2023 reporting the combination of anti-type 2 biologics. A total of 51 cases were retrieved from the literature. Omalizumab was the most frequently combined drugs (34 cases). Combination therapy led to reduction of asthma exacerbations and glucocorticoid intake, though was ineffective only for one EGPA patient. Only one patient on omalizumab-mepolizumab therapy reported a mild adverse reaction. Combination biologic therapies for conditions which share pathogenic pathways appears to be both safe and effective. This approach may benefit patients with uncontrolled conditions and counter side effects of biologics, like dupilumab-related hypereosinophilia.<br />Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2023 Elsevier B.V. All rights reserved.)
- Subjects :
- Humans
Middle Aged
Female
Drug Therapy, Combination
Antibodies, Monoclonal therapeutic use
Antibodies, Monoclonal administration & dosage
Inflammation drug therapy
Inflammation immunology
Asthma drug therapy
Asthma immunology
Granulomatosis with Polyangiitis drug therapy
Granulomatosis with Polyangiitis immunology
Granulomatosis with Polyangiitis diagnosis
Antibodies, Monoclonal, Humanized therapeutic use
Antibodies, Monoclonal, Humanized administration & dosage
Antibodies, Monoclonal, Humanized adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1873-0183
- Volume :
- 23
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Autoimmunity reviews
- Publication Type :
- Review
- Accession number :
- 38101691
- Full Text :
- https://doi.org/10.1016/j.autrev.2023.103503