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Dupilumab suppresses relapsing chronic eosinophilic pneumonia with severe asthma

Masumoto, Nami Oshikata, Chiyako Nakadegawa, Ryo Motobayashi, Yuto Osada, Reeko Manabe, Saki Kaneko, Takeshi Tsurikisawa, Naomi 名古屋大学

2023.11

概要

Dupilumab is one of five biologics licensed in Japan for the treatment of severe asthma.
Dupilumab blocks type 2 inflammation by targeting the IL-4/IL-13 pathway.1 IL-4 and IL-13 are
key mediators of type 2 immune responses in which allergens act as the main antigen drivers. The
aberrant expression and secretion of IL-4 and IL-13 have been implicated in the pathophysiology
of allergic diseases, including asthma.2 Dupilumab has been reported to be effective in severe
asthma with baseline blood eosinophil count >150 cells/µL, FeNO >25 ppb, or both.3
In patients with severe asthma and a baseline peripheral blood eosinophil count ≥500 cells/µL,
dupilumab suppresses asthma exacerbations and improves forced expiratory volume in one second
(FEV1).4 Hypereosinophilia, with counts of 1500/µL or greater, is attributed to reduced eosinophil
migration via IL-4/IL-13 pathway blockade1; it has been observed at least once during followup in some patients receiving dupilumab.5 An association between dupilumab-induced elevated
peripheral blood eosinophil counts and chronic eosinophilic pneumonia (CEP),6 eosinophilic
granulomatosis with polyangiitis (EGPA),7,8 and eosinophilic gastroenteritis9 has been reported,
but these three diseases are likely to coexist with severe asthma, and the role of dupilumab in
their pathogenesis remains unclear.
Here we report the case of a woman with recurrent, severe asthma and multiple relapses of
CEP who developed peripheral blood eosinophilia during treatment with dupilumab, but whose
asthma and CEP were well controlled. ...

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参考文献

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References End

Nagoya J. Med. Sci. 85. 857–865, 2023

865

doi:10.18999/nagjms.85.4.857

...

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