Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?
ABPA
Aspergillosis
Asthma
Dupilumab
IL13
IL4
Journal
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
ISSN: 1710-1484
Titre abrégé: Allergy Asthma Clin Immunol
Pays: England
ID NLM: 101244313
Informations de publication
Date de publication:
2020
2020
Historique:
received:
30
04
2020
accepted:
22
06
2020
entrez:
18
9
2020
pubmed:
19
9
2020
medline:
19
9
2020
Statut:
epublish
Résumé
Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma. Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced. Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.
Sections du résumé
BACKGROUND
BACKGROUND
Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma.
CASE PRESENTATION
METHODS
Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced.
CONCLUSION
CONCLUSIONS
Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.
Identifiants
pubmed: 32944023
doi: 10.1186/s13223-020-00454-w
pii: 454
pmc: PMC7491355
doi:
Types de publication
Case Reports
Langues
eng
Pagination
55Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
Références
N Engl J Med. 2018 Jun 28;378(26):2486-2496
pubmed: 29782217
Clin Immunol. 2001 Aug;100(2):228-35
pubmed: 11465952
BMC Pulm Med. 2018 Mar 27;18(1):53
pubmed: 29587693
Eur Radiol. 2003 Aug;13(8):1786-800
pubmed: 12783174
Respir Med. 2017 Jan;122:33-42
pubmed: 27993289
Am J Respir Crit Care Med. 1994 Oct;150(4):1038-48
pubmed: 7921434
J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):192-9
pubmed: 25640470
J Allergy Clin Immunol Pract. 2019 May - Jun;7(5):1633-1635
pubmed: 30513359
Thorax. 2007 Mar;62(3):276-7
pubmed: 17329558
N Engl J Med. 2018 Jun 28;378(26):2475-2485
pubmed: 29782224
Pediatr Pulmonol. 1999 Feb;27(2):74-9
pubmed: 10088929
Eur J Immunol. 2020 Jul;50(7):1044-1056
pubmed: 32108934
Clin Exp Allergy. 2013 Aug;43(8):850-73
pubmed: 23889240