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Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?
Allergy, Asthma & Clinical Immunology ( IF 2.7 ) Pub Date : 2020-06-26 , DOI: 10.1186/s13223-020-00454-w
Carlo Mümmler 1, 2 , Bernd Kemmerich 3 , Jürgen Behr 1, 2 , Nikolaus Kneidinger 1, 2 , Katrin Milger 1, 2
Affiliation  

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.

中文翻译:

严重哮喘和 ABPA 患者对生物制剂的不同反应:dupilumab 的作用?

过敏性支气管肺曲霉病 (ABPA) 是对定植于哮喘或囊性纤维化患者气道的曲霉菌的严重超敏反应。包括抗 IgE 和抗 IL5 抗体在内的生物制剂极大地改变了重症哮喘患者的治疗方法,并且部分报道其对 ABPA 的治疗有效。最近,一种抑制 Th2 细胞因子 IL4 和 IL13 信号传导的抗 IL4-Rα 抗体 dupilumab 已被批准用于治疗严重哮喘。在这里,我们报告了一名患有严重哮喘和 ABPA 的 49 岁女性的病例,尽管进行了最大程度的吸入治疗、抗 IL5-Rα 抗体和连续口服类固醇治疗,但仍未得到控制。此外,伊曲康唑和奥马珠单抗的试验显示疗效不足。肺功能显示外周阻塞。FeNO 和 IgE 增加,嗜酸性粒细胞在治疗下受到抑制,而先前已记录显着增加。改用 dupilumab 导致肺部症状的完全消退、恶化的消退和口服类固醇的完全停药。注意到肺功能显着改善,FEV1 增加近 1 升。FeNO 被归一化,IgE 强烈降低。我们的案例强调,患者可能对目前可用的哮喘生物制剂表现出不同的治疗反应,如果结果不足,则建议更换治疗。dupilumab 在 ABPA 治疗中的潜在作用值得未来研究。缓解恶化和完全停止口服类固醇。注意到肺功能显着改善,FEV1 增加近 1 升。FeNO 被归一化,IgE 强烈降低。我们的案例强调,患者可能对目前可用的哮喘生物制剂表现出不同的治疗反应,如果结果不足,则建议更换治疗。dupilumab 在 ABPA 治疗中的潜在作用值得未来研究。缓解恶化和完全停止口服类固醇。注意到肺功能显着改善,FEV1 增加近 1 升。FeNO 被归一化,IgE 强烈降低。我们的案例强调,患者可能对目前可用的哮喘生物制剂表现出不同的治疗反应,如果结果不足,则建议更换治疗。dupilumab 在 ABPA 治疗中的潜在作用值得未来研究。
更新日期:2020-06-26
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