Anti-interleukin-5 therapy (mepolizumab) in life-threatening asthma attack: A case-based discussion

Abstract

We report about a case of a compassionate off-label use of the anti-interleukin-5-agent mepolizumab in a ventilated patient with life-threatening asthma attack in eosinophilic asthma. The patient suffered from severe eosinophilic asthma and was transmitted to our hospital with an asthma attack and a life-threatening respiratory state under ventilation. Since high dose steroids had not yielded a sufficient respiratory improvement mepolizumab was administered subcutaneously. After administration of mepolizumab respiratory state and ventilation parameter improved significantly. Two days after administration the patient was weaned could be extubated 8 days later and recovered completely from the asthma attack. The presented clinical case is suggestive of future clinical trials or registry studies to evaluate potential clinical benefits of anti-interleukin-5 treatment in patients with severe exacerbations of eosinophilic asthma.

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

“…All patients were known to have asthma. Atopy was found in 87% of the patients, and the diagnosis of asthma was made 21 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] years earlier. A quarter of the patients had a previous episode of ASA that required IMV.…”

“…The same applies to immunotherapy targeting hypereosinophilic asthma. While the latter seems promising for the treatment of severe chronic asthma [27,28], no data are available on its use in ICU except in case-reports [29]. We used this medication for a single patient only along with eosinophilic bronchoalveolar lavage, based on expert advice.…”

Will the asthma revolution fostered by biologics also benefit adult ICU patients?

“…Only one study was performed in an emergency department, but with the aim of preventing readmission successfully reached 102 . Intuitively, and because IL5 targeted‐treated patients present less frequent but also less severe exacerbations than those receiving placebo, both mepolizumab and benralizumab have been successfully used in some cases 65,103‐106 . Conversely, given their respective T2 targets, there is a strong rational for testing other biologics such as reslizumab obviously, but also dupilumab, in the ICU.…”

Compassionate Use of a Single Dose of Benralizumab in a Near-Fatal Asthma Exacerbation

“…Thus, absorption of mAbs after SC administration is a slow process, with an average time to peak concentration (Tmax) of 6-8 days [10], which nicely fits J Investig Allergol Clin Immunol 2021; Vol. 31 3© 2020 Esmon Publicidad doi: 10.18176/jiaci.0609 with the time period our patient started to show an improvement in his medical condition (4 days) and makes it difficult to understand the rapid response to benralizumab described by Ramakrishnan et al [9].…”

“…In fact, a patient with a severe asthma attack in whom systemic corticosteroids were contraindicated achieved clinically and functional significant improvement within 19 hours after SC injection of benralizumab 30 mg [8]. Besides, Tello et al published a case report on a patient who suffered a lifethreatening exacerbation and improved considerably after two days of one dose of SC mepolizumab [9]. Monoclonal antibodies (mAbs) are high molecular weight compounds, and for mAbs administered via the SC route, absorption into the systemic circulation first requires transport of the drug through the interstitial space into the lymphatic system.…”