Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

Abstract

A 55-year-old woman with cough-variant asthma presented for 1 month of worsening wheezing, cough, and dyspnea refractory to treatment. Initial laboratory findings revealed profound peripheral eosinophilia, and a chest computed tomography showed bi-apical consolidation. Bronchio-alveolar lavage demonstrated alveolar eosinophilia. She was diagnosed with idiopathic chronic eosinophilic pneumonia (ICEP). Her peripheral eosinophilia and respiratory symptoms improved rapidly with high-dose systemic corticosteroid therapy. However, she was intolerant to corticosteroid monotherapy due to non-compliance and psychological adverse effects. Mepolizumab was initiated as a steroid-sparing agent, resulting in successful therapy for 2 years without relapse or adverse effects. Mepolizumab is an interleukin-5 (IL-5) antagonist monoclonal antibody, which is a targeted therapy for diseases mediated by eosinophil activity and eosinophil proliferation. Mepolizumab is typically used in ICEP refractory to steroids, but this case supports its use in cases of glucocorticoid intolerance. Further study of IL-5 antagonist therapies for ICEP may identify an alternative treatment modality for patients in whom the adverse effects of corticosteroids pose a challenge.

A case of chronic eosinophilic pneumonia associated with rheumatoid arthritis in glucocorticoid-free remission with JAK inhibitor: A case report

“…However, it is not only ineffective for RA but also an anti-IL-5 agent that sometimes develops arthritis by reducing the concomitant glucocorticoid dose. [ 12 ] Similarly, anti-IgE antibodies can also reduce glucocorticoid doses, but their effects are limited to cases with high IgE levels. [ 13 ]…”

“…However, it is not only ineffective for RA but also an anti-IL-5 agent that sometimes develops arthritis by reducing the concomitant glucocorticoid dose. [12] Similarly, anti-IgE antibodies can also reduce glucocorticoid doses, but their effects are limited to cases with high IgE levels. [13] Baricitinib, originally developed for the treatment of RA, inhibits cytokine signaling, including IL-6, IL-12, IL-20, IL-22, IL-23, and IFN-γ, but also exerts regulatory effects on the Th2 cytokines such as IL-4, IL-5, and IL-13.…”

Mepolizumab and dupilumab as a replacement to systemic glucocorticoids for the treatment of Chronic Eosinophilic Pneumonia and Allergic Bronchopulmonary Aspergillosis - Case series, Almoosa specialist hospital

“…Allen and Wert conducted an open-label, retrospective study of the treatment of CEP with mepolizumab and found that treatment with mepolizumab was associated with a reduction in disease episodes, steroid use, and improvement in pulmonary infiltrates on imaging [ 25 ]. Mepolizumab and dupilumab have been reported to improve symptoms and reduce relapse rates and have a corticosteroid-sparing effect (CEP) [ 26 ]. Patients treated for asthma with dupilumab may develop serious systemic eosinophilia, such as eosinophilic pneumonia or vasculitis in the sense of EGPA.…”

Anti-IL-5 Agents for the Treatment of Idiopathic Chronic Eosinophilic Pneumonia: A Case Series

“…Indeed, in the present cases, all 4 ICEP patients with frequent recurrences were well controlled by anti-IL-5 agents, and no patients have developed relapses after the treatment, as supported by previous single-case reports. [32][33][34][35][36] Ricketti et al also reported that a patient with relapsing CEP was treated with benralizumab, and the safety of long-term treatment for over 30 months was found, with maintenance of its efficacy. 37 In addition, corticosteroid treatment was withdrawn or reduced in all 4 cases, which contributed to attenuation of corticosteroid-related adverse effects (Table 3).…”