COVID-19 in two severe asthmatics receiving benralizumab: busting the eosinophilia myth

Renner, Andreas; Marth, Katharina; Patocka, Karin; Idzko, Marco; Pohl, Wolfgang

doi:10.1183/23120541.00457-2020

Cited by 19 publications

(19 citation statements)

References 14 publications

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“…Finally, only one patient died, but he had obesity and diabetes, known comorbidities for fatal outcome (Eger et al, 2020). Other case reports do not indicate a worse clinical course in COVID-19 patients exposed to anti-IgE omalizumab (Lommatzsch et al, 2020) and, anti-IL-5R benralizumab (Renner et al, 2020a;Renner et al, 2020b). Although only a few cases were reported, it can be speculated that biological inhibitors of type 2 response can have a possible impact on aberrant immune response, and thus can protect infected subjects from severe complications of COVID-19.…”

Section: Severe Asthma In Covid-19 Patients: a Case-studymentioning

confidence: 96%

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Pala

Pistis

2021

Front. Pharmacol.

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SARS-CoV-2 infection stimulates a complex activation of the immune system. Eosinophils belong to the host’s defense equipment against respiratory viruses. In the first phase of the infection, eosinophils contribution is probably appropriate and beneficial, as they facilitate the suppression of the viral replication. However, in severe COVID-19 patients, during the second and third phases of the disease, eosinophils may participate in a maladaptive immune response and directly contribute to immunopathology. In fact, in severe patients, the immune response is prevalently T helper 1 type, but T helper 2 is also present. Eosinophils’ expansion and activation are stimulated by Type 2 cytokines, especially IL-5. Moreover, bronchial asthma, in which eosinophils play a central role, seems not to be a major risk factor for severe COVID-19. Among possible explanations, asthmatic patients are often treated with corticosteroids, which have been demonstrated to reduce the progression to critical COVID-19 in hospitalized patients. In addition to steroids, severe asthmatic patients are currently treated with biological drugs that target Type 2 immune response. Because IL-5 is necessary for the growth, survival, and activation of eosinophils, IL-5 inhibitors, such as mepolizumab, decrease the peripheral blood count of eosinophils, but do not influence eosinophils activation in the airway. In severe COVID-19 patients, the blockade of eosinophils’ activation might contrast harmful immunity.

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Section: Severe Asthma In Covid-19 Patients: a Case-studymentioning

confidence: 96%

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Pala

Pistis

2021

Front. Pharmacol.

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“…Similarly, although some preclinical studies have provided convincing experimental evidence that eosinophils have potential antiviral activity, there is no evidence that patients with eosinopenia induced by recently approved anti-eosinophil therapies have an increased susceptibility to viruses. There are reports of patients treated with anti-eosinophil drugs such as benralizumab with concomitant COVID-19 who have had a very mild disease course [ 23 ]. It has not yet been proven with certainty whether COVID-19-associated acquired eosinopenia contributes directly to the course of the disease, but it should be noted that pulmonary eosinophilia is not part of the secondary lung disease due to SARS-CoV-2 infection [ 22 ].…”

Section: Immune Response To Respiratory Viruses and Sars-cov-2mentioning

confidence: 99%

“…Numerous and recent studies showed that eosinopenia was present in patients with severe COVID-19 phenotypes and in many cases with fatal evolution [ 21 , 22 , 23 , 24 ].…”

Section: Immune Response To Respiratory Viruses and Sars-cov-2mentioning

confidence: 99%

Immunological Aspects Related to Viral Infections in Severe Asthma and the Role of Omalizumab

et al. 2021

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Viral respiratory infections are recognized risk factors for the loss of control of allergic asthma and the induction of exacerbations, both in adults and children. Severe asthma is more susceptible to virus-induced asthma exacerbations, especially in the presence of high IgE levels. In the course of immune responses to viruses, an initial activation of innate immunity typically occurs and the production of type I and III interferons is essential in the control of viral spread. However, the Th2 inflammatory environment still appears to be protective against viral infections in general and in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections as well. As for now, literature data, although extremely limited and preliminary, show that severe asthma patients treated with biologics don’t have an increased risk of SARS-CoV-2 infection or progression to severe forms compared to the non-asthmatic population. Omalizumab, an anti-IgE monoclonal antibody, exerts a profound cellular effect, which can stabilize the effector cells, and is becoming much more efficient from the point of view of innate immunity in contrasting respiratory viral infections. In addition to the antiviral effect, clinical efficacy and safety of this biological allow a great improvement in the management of asthma.

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“…continuation of biological treatment during the COVID-19 pandemic, but also highlighted the lack of evidence on the subject. 4 5 Renner et al 6 described the consideration concerning biological treatment for eosinophilic asthma during the COVID-19 pandemic and reports two benralizumab-treated severe asthma patients with COVID-19 infection. The COVID-19 infection was very mild in the described cases, as opposed to our case, which described a severe COVID-19 infection.…”

Section: Case Reportmentioning

confidence: 99%

Administration of benralizumab in a patient with severe asthma admitted to the intensive care unit with COVID-19 pneumonia: case report

et al. 2021

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A patient with severe asthma on benralizumab therapy was admitted to the intensive care unit (ICU) for a coronavirus disease 2019 (COVID-19) infection. At the end of the 8 week benralizumab dosing interval, discussion arose as to whether benralizumab should be administered or if treatment should be discontinued, due to the lack of experience with benralizumab in this situation. Severe broncho-obstruction developed, and the next injection of benralizumab was administered during ICU admission without detrimental symptoms. With this case report, we would like to share our experience with the safe administration of benralizumab during COVID-19 pneumonia, guiding doctors in future decision making.

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COVID-19 in two severe asthmatics receiving benralizumab: busting the eosinophilia myth

Cited by 19 publications

References 14 publications

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Immunological Aspects Related to Viral Infections in Severe Asthma and the Role of Omalizumab

Administration of benralizumab in a patient with severe asthma admitted to the intensive care unit with COVID-19 pneumonia: case report

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