Treating Acute Severe Eosinophilic Asthma with IL-5 Inhibitors in ICU

Abstract

Introduction. About 10% of the 300 million people worldwide who suffer from asthma have a severe disease that is uncontrolled despite treatment with inhaled corticosteroids and long-acting beta agonists. The eosinophilic inflammation pathway in the respiratory tract and blood is involved and interleukin-5 (IL-5) has recently been identified as a major promotor of this pathway. The anti-IL-5 antibodies reduce the incidence of exacerbation and allowed steroid sparing in severe asthma patients but only two case reports have been published on their use in critical care. Case Presentation. This report describes the extraordinary clinical improvement of a young patient with steroid-refractory eosinophilic acute severe asthma who required mechanical ventilation, VV-ECMO followed by treatment with mepolizumab. The salient point in this case is the use of an anti-IL-5 monoclonal antibody for a critically ill patient whose condition was deteriorating despite mechanical ventilation and VV-ECMO. The usual steroid treatment failed to control the increase in blood eosinophils or his bronchial inflammation and constriction. Conclusion. Anti-IL-5 antibodies are now a standard treatment for severe eosinophilic asthma that can also be useful in an emergency to treat steroid-refractory eosinophilic acute severe asthma.

A Case Study Showing Benralizumab’s Effectiveness in Treating Uncontrolled Severe Eosinophilic Asthma that is Resistant to Omalizumab

“…[1] About 10% of the 300 million people worldwide suffer from asthma. [5] This case report demonstrated the efficacy of bendralizumab treatment in a patient with uncontrolled severe eosinophilic asthma refractory to omalizumab treatment and another study conducted by Adel H. Mansur et al reported the efficacy of bendralizumab treatment in a patient with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps refractory to mepolizumab treatment. [3] In the present study, treatment of uncontrolled severe eosinophilic asthma with bendralizumab appears to be feasible, rapid and safe.…”

The Determinants of Eosinophilia in Patients With Severe Asthma

“…Individuals with mild to moderate asthma with associated diseases whose pathogenesis consists of eosinophilia, such as rhinosinusitis with nasal polyps, allergic rhinitis, and allergic dermatitis, should be considered as possible candidates for monoclonal antibodies to decreased morbidity and mortality. One case report describing a 31-year-old male with allergic dermatitis and mild asthma controlled on demand with inhaled salbutamol was admitted for asthma exacerbation [ 15 ]. The hospital course was complicated by respiratory distress, despite methylprednisolone (2 mg/kg) and salbutamol nebulizers, with eventual orotracheal intubation and venovenous extracorporeal membrane oxygenation (VV-ECMO) placement.…”

“…One patient, with severe EA placed on VV-ECMO, was treated with IL-5 monoclonal antibody. And another patient with severe EA on IMV received mepolizumab with successful clinical improvement [ 11 , 15 ].…”

A bibliometric and scientific knowledge map study of the drug therapies for asthma-related study from 1982 to 2021

“…Studies showed that, omalizumab—a monoclonal antibody which targets immunoglobulin E—represents the first available humanized monoclonal anti-IgE for use in pediatric severe allergic asthma (approved for use in children ≥ 6 years of age), with an established efficacy and safety profile ( Licari et al, 2019 ). Mepolizumab—a monoclonal antibody against interleukin-5— is an effective and well-tolerated treatment that reduces the risk of asthma exacerbations in patients with severe eosinophilic asthma ( Pavord et al, 2012 ) and also be useful in an emergency to treat steroid-refractory eosinophilic acute severe asthma ( Barbarot et al, 2022 ). Phenotype-directed therapy with mepolizumab in urban children (aged 6–17 years) with exacerbation-prone eosinophilic asthma reduced the number of exacerbations ( Jackson et al, 2022 ).…”