Case Report: Severe Eosinophilic Asthma Associated With ANCA-Negative EGPA in a Young Adult Successfully Treated With Benralizumab

Ricciardi, Luisa; Soler, Daniel Griscti; Bennici, Alessandra; Brunetto, Silvia; Pioggia, Giovanni; Gangemi, Sebastiano

doi:10.3389/fphar.2022.858344

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…There is still little evidence regarding the efficacy of benralizumab in reducing ANCA titers in patients with MPO-ANCA positivity [ 49 – 51 ]. Moreover, benralizumab was also effective in an ANCA-negative patient with EGPA [ 52 ].…”

Section: Resultsmentioning

confidence: 99%

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

2023

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Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, mostly affecting small-sized arteries and usually occurring in patients with an allergic background. Eosinophils seem to play a significant role in the pathogenesis of the disease and, therefore, biologics targeting interleukin 5 (IL5), a cytokine tightly linked to eosinophils, have emerged as a promising therapeutic tool. A systematic review of Medline was conducted from 2007 to 2022 to search for data regarding the use of anti-IL5 therapies in patients with EGPA. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. The efficacy and safety of mepolizumab, an anti-IL5 monoclonal antibody (mAb), was confirmed by a randomized controlled trial (RCT), although a significant proportion of patients did not respond to this treatment. Other studies showed that both doses of 100 mg and 300 mg of mepolizumab are almost equally effective in EGPA. Benralizumab, an anti-IL5 receptor mAb has preliminary promising results and an RCT is planned to be conducted. Apart from their clinical efficacy in EGPA, anti-IL5 therapies may have steroid-sparing properties. Anti-IL5 therapies seem to be effective and safe in patients with refractory/relapsing EGPA and can be used as a steroid-sparing treatment. Nevertheless, more research is needed to clarify the pathophysiology of the disease; this may potentially lead to the identification of biomarkers to pinpoint patients most likely to respond to anti-IL5-blockade.

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Section: Resultsmentioning

confidence: 99%

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

2023

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“…It was approved by the FDA in 2017 as an add-on therapy for patients with severe eosinophilic asthma aged 12 years old or above. 108 Table 1 summarizes the clinical outcomes of benralizumab.…”

Section: Benralizumabmentioning

confidence: 99%

“…Benralizumab is another class of humanized mAb that targets IL‐5Rα subunit expressed mainly on eosinophils. It was approved by the FDA in 2017 as an add‐on therapy for patients with severe eosinophilic asthma aged 12 years old or above 108 . Table 1 summarizes the clinical outcomes of benralizumab.…”

Section: Il‐5 Targeted Therapeutic Advances In Asthmamentioning

confidence: 99%

Role of IL‐5 in asthma and airway remodelling

AbuJabal,

Ramakrishnan,

Bajbouj

et al. 2024

Clin Experimental Allergy

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Asthma is a common and burdensome chronic inflammatory airway disease that affects both children and adults. One of the main concerns with asthma is the manifestation of irreversible tissue remodelling of the airways due to the chronic inflammatory environment that eventually disrupts the whole structure of the airways. Most people with troublesome asthma are treated with inhaled corticosteroids. However, the development of steroid resistance is a commonly encountered issue, necessitating other treatment options for these patients. Biological therapies are a promising therapeutic approach for people with steroid‐resistant asthma. Interleukin 5 is recently gaining a lot of attention as a biological target relevant to the tissue remodelling process. Since IL‐5‐neutralizing monoclonal antibodies (mepolizumab, reslizumab and benralizumab) are currently available for clinical use, this review aims to revisit the role of IL‐5 in asthma pathogenesis at large and airway remodelling in particular, in addition to exploring its role as a target for biological treatments.

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“…SEA is considered to be a prodromal phase of EGPA for some patients (see the case report). With initial respiratory tract symptoms affecting the upper and lower airways, patients then develop organ involvement due to eosinophilic tissue infiltration and vasculitis [ 43 ]. Due to the similarity in the pathogenesis of the two conditions, driven by hyper-eosinophilia, similar treatments have been and continue to be trialled and tested.…”

Section: Classification Of Egpamentioning

confidence: 99%

Eosinophilic granulomatosis with polyangiitis: case report and literature review

Alam

Nanzer

2022

Breathe

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Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg–Strauss syndrome, is a multisystem disorder characterised by asthma, blood and tissue eosinophilia and small-vessel vasculitis. Eosinophilic tissue infiltration and extravascular granuloma formation can lead to damage in any organ, but it is classically seen to cause pulmonary infiltrates, sino-nasal disease, peripheral neuropathy, renal and cardiac involvement, and rashes.EGPA is part of the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis syndromes, with the antibody being detected in ∼30–40% of cases and mostly against myeloperoxidase. Two genetically and clinically distinct phenotypes, defined by the presence or absence of ANCA have been identified. Treatment for EGPA focuses on inducing and maintaining disease remission. To date, oral corticosteroids remain first-line agents whilst second-line treatments include immunosuppressants such as cyclophosphamide, azathioprine, methotrexate, rituximab and mycophenolate mofetil. However, long-term steroid usage results in multiple and well-known adverse health effects and new insights into the pathophysiology of EGPA have allowed for the development of targeted biologic therapies, like the anti-eosinophilic, anti-interleukin-5 monoclonal antibodies.

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Case Report: Severe Eosinophilic Asthma Associated With ANCA-Negative EGPA in a Young Adult Successfully Treated With Benralizumab

Cited by 4 publications

References 20 publications

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

The role of anti-eosinophilic therapies in eosinophilic granulomatosis with polyangiitis: a systematic review

Role of IL‐5 in asthma and airway remodelling

Eosinophilic granulomatosis with polyangiitis: case report and literature review

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