Complications of switching from anti–IL-5 or anti–IL-5R to dupilumab in corticosteroid-dependent severe asthma
[...]on rare occasions, anti–IL-4/13 biologics such as dupilumab may induce hypereosinophilia, with sudden deterioration of asthma, tissue infiltration by eosinophils, and EGPA-like symptoms such as thromboembolic events. [...]our current strategy is to stop dupilumab and (re)start anti–IL-5 therapy...
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| Veröffentlicht in: | The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2021-07, Vol.9 (7), p.2913-2915 |
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| container_title | The journal of allergy and clinical immunology in practice (Cambridge, MA) |
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| creator | Eger, Katrien Pet, Lodewijk Weersink, Els J.M. Bel, Elisabeth H. |
| description | [...]on rare occasions, anti–IL-4/13 biologics such as dupilumab may induce hypereosinophilia, with sudden deterioration of asthma, tissue infiltration by eosinophils, and EGPA-like symptoms such as thromboembolic events. [...]our current strategy is to stop dupilumab and (re)start anti–IL-5 therapy if eosinophils rise to more than 1000 cells/L and asthma symptoms worsen. [...]eosinophilic complications may occur after switching from an anti–IL-5 to an anti–IL-4/13 monoclonal despite an initial favorable response. Outcome Patient 1 Patient 2 Patient 3 Patient 4 Age (y) 59 35 48 63 Sex (F/M) F M F F Before anti–IL-5 treatment Asthma exacerbations (n/y) “Frequent” >10 “Frequent” “Frequent” ACQ score >4 >4 >2 >3 Prednisolone (mg/d) 15 40 40 32.5 FEV1 (% predicted) 58% 38% 54% 68% Blood eosinophils (cells/μL)∗ 1190 1670 2200 760 Feno (ppb)∗ 159 >300 221 NA Total IgE (IU/L) 1663 753 366 96 Specific IgE to aspergillus (IU/L) |
| doi_str_mv | 10.1016/j.jaip.2021.02.042 |
| format | Article |
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[...]our current strategy is to stop dupilumab and (re)start anti–IL-5 therapy if eosinophils rise to more than 1000 cells/L and asthma symptoms worsen. [...]eosinophilic complications may occur after switching from an anti–IL-5 to an anti–IL-4/13 monoclonal despite an initial favorable response. Outcome Patient 1 Patient 2 Patient 3 Patient 4 Age (y) 59 35 48 63 Sex (F/M) F M F F Before anti–IL-5 treatment Asthma exacerbations (n/y) “Frequent” >10 “Frequent” “Frequent” ACQ score >4 >4 >2 >3 Prednisolone (mg/d) 15 40 40 32.5 FEV1 (% predicted) 58% 38% 54% 68% Blood eosinophils (cells/μL)∗ 1190 1670 2200 760 Feno (ppb)∗ 159 >300 221 NA Total IgE (IU/L) 1663 753 366 96 Specific IgE to aspergillus (IU/L) <0.35 1.63 0.37 0.61 ANCA IFT screening Negative Negative Negative Negative Successive biologic treatments Mepolizumab Mepolizumab Mepolizumab Mepolizumab Benralizumab Reslizumab Reslizumab Reslizumab Benralizumab Benralizumab Before dupilumab† Asthma exacerbations (n/y) 1 2 3 2 ACQ score 2.00 4.17 2.83 1.17 Prednisolone (mg/d) 5 0 7.5 32.5 FEV1 (% predicted) 84% 35% 30% 43% Blood eosinophils (cells/μL) 100 500 90 60 Feno (ppb) 39 112 64 205 After dupilumab‡ Asthma exacerbations No No No No ACQ score 2.50 1.33 0.17 0.00 Prednisolone (mg/d) 10-20 0 5 22.5 FEV1 (% predicted) NA NA NA 71% Blood eosinophils (cells/μL) 5080 4864 1010 3956 Feno (ppb) NA NA NA 19 Complications and acute therapies Rapid asthma worsening Yes Yes Yes No Cardiovascular events Yes No No Yes Pulmonary infiltrates Yes NA NA Yes Prednisolone (mg/d) 60 30 20 30 Anti–IL-5 therapy No Reslizumab Benralizumab Mepolizumab§ Table I Asthma outcome parameters before anti–IL-5 treatment and before and after initiation of dupilumab</description><identifier>ISSN: 2213-2198</identifier><identifier>EISSN: 2213-2201</identifier><identifier>DOI: 10.1016/j.jaip.2021.02.042</identifier><identifier>PMID: 33676050</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Antineutrophil cytoplasmic antibodies ; Asthma ; Asymptomatic ; Biological products ; Blood ; Corticosteroids ; Dyspnea ; Immunoglobulin E ; Interleukin 4 ; Interleukin 5 ; Interleukin 5 receptors ; Leukocytes (eosinophilic) ; Monoclonal antibodies ; Patients ; Prednisolone ; Thromboembolism</subject><ispartof>The journal of allergy and clinical immunology in practice (Cambridge, MA), 2021-07, Vol.9 (7), p.2913-2915</ispartof><rights>2021 The Authors</rights><rights>2021. 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[...]our current strategy is to stop dupilumab and (re)start anti–IL-5 therapy if eosinophils rise to more than 1000 cells/L and asthma symptoms worsen. [...]eosinophilic complications may occur after switching from an anti–IL-5 to an anti–IL-4/13 monoclonal despite an initial favorable response. Outcome Patient 1 Patient 2 Patient 3 Patient 4 Age (y) 59 35 48 63 Sex (F/M) F M F F Before anti–IL-5 treatment Asthma exacerbations (n/y) “Frequent” >10 “Frequent” “Frequent” ACQ score >4 >4 >2 >3 Prednisolone (mg/d) 15 40 40 32.5 FEV1 (% predicted) 58% 38% 54% 68% Blood eosinophils (cells/μL)∗ 1190 1670 2200 760 Feno (ppb)∗ 159 >300 221 NA Total IgE (IU/L) 1663 753 366 96 Specific IgE to aspergillus (IU/L) <0.35 1.63 0.37 0.61 ANCA IFT screening Negative Negative Negative Negative Successive biologic treatments Mepolizumab Mepolizumab Mepolizumab Mepolizumab Benralizumab Reslizumab Reslizumab Reslizumab Benralizumab Benralizumab Before dupilumab† Asthma exacerbations (n/y) 1 2 3 2 ACQ score 2.00 4.17 2.83 1.17 Prednisolone (mg/d) 5 0 7.5 32.5 FEV1 (% predicted) 84% 35% 30% 43% Blood eosinophils (cells/μL) 100 500 90 60 Feno (ppb) 39 112 64 205 After dupilumab‡ Asthma exacerbations No No No No ACQ score 2.50 1.33 0.17 0.00 Prednisolone (mg/d) 10-20 0 5 22.5 FEV1 (% predicted) NA NA NA 71% Blood eosinophils (cells/μL) 5080 4864 1010 3956 Feno (ppb) NA NA NA 19 Complications and acute therapies Rapid asthma worsening Yes Yes Yes No Cardiovascular events Yes No No Yes Pulmonary infiltrates Yes NA NA Yes Prednisolone (mg/d) 60 30 20 30 Anti–IL-5 therapy No Reslizumab Benralizumab Mepolizumab§ Table I Asthma outcome parameters before anti–IL-5 treatment and before and after initiation of dupilumab</description><subject>Antineutrophil cytoplasmic antibodies</subject><subject>Asthma</subject><subject>Asymptomatic</subject><subject>Biological products</subject><subject>Blood</subject><subject>Corticosteroids</subject><subject>Dyspnea</subject><subject>Immunoglobulin E</subject><subject>Interleukin 4</subject><subject>Interleukin 5</subject><subject>Interleukin 5 receptors</subject><subject>Leukocytes (eosinophilic)</subject><subject>Monoclonal antibodies</subject><subject>Patients</subject><subject>Prednisolone</subject><subject>Thromboembolism</subject><issn>2213-2198</issn><issn>2213-2201</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kcFqFTEUhoMotrR9ARcScONmxiSTzEzAjVyqFi4IRdchyZyxGWaSMclU3PUdfMM-SXO5rYgLszk58J2fw_kQekVJTQlt3031pN1aM8JoTVhNOHuGThmjTcUYoc-f_lT2J-gipYmU19OOcPISnTRN27VEkFMUd2FZZ2d1dsEnHEacfrpsb5z_jscYFqx9dvd3v6_2lcAh_t1e4xzwsK1u3hZtsPPYhpidDSlDDG6oBljBD-AzTnALEbBO-WbR5-jFqOcEF4_1DH37ePl197naf_l0tfuwryyXPFfQd61hktuubYQcetNLzik1tCWNNZ2hEkgrODV6FNIIYqzVmg6cwAiNEdCcobfH3DWGHxukrBaXLMyz9hC2pBiXvaCSiLagb_5Bp7BFX7ZTTPBeNqxcq1DsSNkYUoowqjW6RcdfihJ1kKImdZCiDlIUYapIKUOvH6M3s8DwZ-RJQQHeHwEot7h1EFWyDryFwUWwWQ3B_S__AXyXnvU</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Eger, Katrien</creator><creator>Pet, Lodewijk</creator><creator>Weersink, Els J.M.</creator><creator>Bel, Elisabeth H.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9628-2174</orcidid></search><sort><creationdate>20210701</creationdate><title>Complications of switching from anti–IL-5 or anti–IL-5R to dupilumab in corticosteroid-dependent severe asthma</title><author>Eger, Katrien ; Pet, Lodewijk ; Weersink, Els J.M. ; Bel, Elisabeth H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-e876b294c76359d8b894411b1603cb7b19e06541baf59b50bccaa1d40efe3b5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antineutrophil cytoplasmic antibodies</topic><topic>Asthma</topic><topic>Asymptomatic</topic><topic>Biological products</topic><topic>Blood</topic><topic>Corticosteroids</topic><topic>Dyspnea</topic><topic>Immunoglobulin E</topic><topic>Interleukin 4</topic><topic>Interleukin 5</topic><topic>Interleukin 5 receptors</topic><topic>Leukocytes (eosinophilic)</topic><topic>Monoclonal antibodies</topic><topic>Patients</topic><topic>Prednisolone</topic><topic>Thromboembolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eger, Katrien</creatorcontrib><creatorcontrib>Pet, Lodewijk</creatorcontrib><creatorcontrib>Weersink, Els J.M.</creatorcontrib><creatorcontrib>Bel, Elisabeth H.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eger, Katrien</au><au>Pet, Lodewijk</au><au>Weersink, Els J.M.</au><au>Bel, Elisabeth H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications of switching from anti–IL-5 or anti–IL-5R to dupilumab in corticosteroid-dependent severe asthma</atitle><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle><addtitle>J Allergy Clin Immunol Pract</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>9</volume><issue>7</issue><spage>2913</spage><epage>2915</epage><pages>2913-2915</pages><issn>2213-2198</issn><eissn>2213-2201</eissn><abstract>[...]on rare occasions, anti–IL-4/13 biologics such as dupilumab may induce hypereosinophilia, with sudden deterioration of asthma, tissue infiltration by eosinophils, and EGPA-like symptoms such as thromboembolic events. [...]our current strategy is to stop dupilumab and (re)start anti–IL-5 therapy if eosinophils rise to more than 1000 cells/L and asthma symptoms worsen. [...]eosinophilic complications may occur after switching from an anti–IL-5 to an anti–IL-4/13 monoclonal despite an initial favorable response. Outcome Patient 1 Patient 2 Patient 3 Patient 4 Age (y) 59 35 48 63 Sex (F/M) F M F F Before anti–IL-5 treatment Asthma exacerbations (n/y) “Frequent” >10 “Frequent” “Frequent” ACQ score >4 >4 >2 >3 Prednisolone (mg/d) 15 40 40 32.5 FEV1 (% predicted) 58% 38% 54% 68% Blood eosinophils (cells/μL)∗ 1190 1670 2200 760 Feno (ppb)∗ 159 >300 221 NA Total IgE (IU/L) 1663 753 366 96 Specific IgE to aspergillus (IU/L) <0.35 1.63 0.37 0.61 ANCA IFT screening Negative Negative Negative Negative Successive biologic treatments Mepolizumab Mepolizumab Mepolizumab Mepolizumab Benralizumab Reslizumab Reslizumab Reslizumab Benralizumab Benralizumab Before dupilumab† Asthma exacerbations (n/y) 1 2 3 2 ACQ score 2.00 4.17 2.83 1.17 Prednisolone (mg/d) 5 0 7.5 32.5 FEV1 (% predicted) 84% 35% 30% 43% Blood eosinophils (cells/μL) 100 500 90 60 Feno (ppb) 39 112 64 205 After dupilumab‡ Asthma exacerbations No No No No ACQ score 2.50 1.33 0.17 0.00 Prednisolone (mg/d) 10-20 0 5 22.5 FEV1 (% predicted) NA NA NA 71% Blood eosinophils (cells/μL) 5080 4864 1010 3956 Feno (ppb) NA NA NA 19 Complications and acute therapies Rapid asthma worsening Yes Yes Yes No Cardiovascular events Yes No No Yes Pulmonary infiltrates Yes NA NA Yes Prednisolone (mg/d) 60 30 20 30 Anti–IL-5 therapy No Reslizumab Benralizumab Mepolizumab§ Table I Asthma outcome parameters before anti–IL-5 treatment and before and after initiation of dupilumab</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33676050</pmid><doi>10.1016/j.jaip.2021.02.042</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0002-9628-2174</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Antineutrophil cytoplasmic antibodies Asthma Asymptomatic Biological products Blood Corticosteroids Dyspnea Immunoglobulin E Interleukin 4 Interleukin 5 Interleukin 5 receptors Leukocytes (eosinophilic) Monoclonal antibodies Patients Prednisolone Thromboembolism |
| title | Complications of switching from anti–IL-5 or anti–IL-5R to dupilumab in corticosteroid-dependent severe asthma |
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