Allergic bronchopulmonary aspergillosis successfully treated with benralizumab

Soeda, Seiko; Kono, Yuta; Tsuzuki, Ryuta; Yamawaki, Satoshi; Katsube, Otohiro; To, Masako; To, Yasuo

doi:10.1016/j.jaip.2018.11.024

Cited by 40 publications

(31 citation statements)

References 10 publications

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“…After discontinuation of benralizumab there was no change in symptoms underlining that the patient did not benefit from this treatment. Soeda et al reported a case of asthma and ABPA with similar eosinophilia that responded well to benralizumab [11]. In contrast to our patient, that patient had less advanced disease without bronchiectasis and much lower total IgE of 537 IU/ml.…”

Section: Discussioncontrasting

confidence: 79%

“…Clinical management involves oral corticosteroids and systemic therapy with azoles. In recent years, several studies and case reports showed efficacy for anti-IgE antibody and IL5/IL5-Rα antibodies in the treatment of ABPA [7][8][9][10][11]. Dupilumab is a novel IL4-Rα-antibody that has been approved for the treatment of atopic dermatitis, severe asthma and chronic rhinosinusitis with nasal polyps.…”

Section: Introductionmentioning

confidence: 99%

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Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Mümmler

Kemmerich²,

Behr

et al. 2020

Allergy Asthma Clin Immunol

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Background Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma. Case presentation Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced. Conclusion Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Mümmler

Kemmerich²,

Behr

et al. 2020

Allergy Asthma Clin Immunol

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“…In addition, 48% were receiving or had received antifungal therapy; 106 patients (69.7%) had baseline eosinophil counts >500 cells/µL. 10 , 12 , 13 , 16 – 33 55 patients (36%) had baseline IgE serum values >1000 IU/mL. 10 – 12 , 14 , 15 , 17 – 19 , 21 , 23 – 28 , 30 – 32 , 34 , 35 …”

Section: Resultsmentioning

confidence: 99%

“…In both cases there was a clinical improvement, IgE levels decreased 22% after 1 month of treatment, which is too soon to draw any conclusions. 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review

Eraso

Sangiovanni

Morales

et al. 2020

Ther Adv Respir Dis

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Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction (HR) mediated by antigens to Aspergillus fumigatus. It is estimated that 2–15% of patients with cystic fibrosis (CF) and between 1% and 5% of asthmatics develop ABPA, affecting approximately 4.8 million people worldwide. The goals of treatment are controlling inflammation, reducing the number of exacerbations and limiting the progression of lung damage. Systemic steroids are therefore used as the mainstay therapy, along with antifungal medications. However, many patients do not respond or develop side effects to treatment. In this scenario, biological drugs such as Omalizumab, Mepolizumab, Benralizumab and Dupilumab have been implemented in clinical practice, even though there is a lack of scientific evidence to support their use. We performed a literature review of the studies carried out which analyzed biologics for the management of ABPA in adult populations with asthma and CF. To our knowledge this is the first literature review that included all biologics. We included a total of 32 studies, all but one were descriptive studies, and the vast majority evaluated the use of Omalizumab. Biologics appeared to have more benefit for patients with ABPA and asthma than CF, specifically at decreasing the frequency of acute exacerbations and by having a steroid-sparing effect. Although a decrease in serum IgE level is considered a measure of therapy success, values may not decline as expected in the context of a significant clinical improvement, highlighting the importance of measuring patient-oriented outcomes. As evidence comes mainly from case series and case reports, randomized controlled trials are needed to evaluate further the safety and efficacy of biologics in ABPA. The reviews of this paper are available via the supplemental material section.

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“…Anti-Th2 therapies : ABPA is characterized by an intense Th2 inflammation associated with excessive production of Th2 cytokines IL-4 and IL-5, which suggests a role for anti-IL-5 therapies 116 . There are reports on the efficacy of mepolizumab, a monoclonal antibody against IL-5 (100 mg subcutaneous every 4 wk) and benralizumab, a monoclonal antibody against IL-5Rα (30 mg subcutaneous every 4 wk for the first three doses, then every 8 wk) in patients with ABPA 141 142 . More studies are required to define the place of anti-Th2 therapies in ABPA.…”

Section: Treatment Of Abpamentioning

confidence: 99%

Allergic bronchopulmonary aspergillosis

et al. 2020

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Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease caused by immunologic reactions initiated against Aspergillus fumigatus colonizing the airways of patients with asthma and cystic fibrosis. The common manifestations include treatment-resistant asthma, transient and fleeting pulmonary opacities and bronchiectasis. It is believed that globally there are about five million cases of ABPA, with India alone accounting for about 1.4 million cases. The occurrence of ABPA among asthmatic patients in special clinics may be as high as 13 per cent. Thus, a high degree of suspicion for ABPA should be entertained while treating a patient with bronchial asthma, particularly in specialized clinics. Early diagnosis and appropriate treatment can delay (or even prevent) the onset of bronchiectasis, which suggests that all patients of bronchial asthma should be screened for ABPA, especially in chest clinics. The current review summarizes the recent advances in the pathogenesis, diagnosis and management of ABPA.

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Allergic bronchopulmonary aspergillosis successfully treated with benralizumab

Cited by 40 publications

References 10 publications

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review

Allergic bronchopulmonary aspergillosis

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