Mepolizumab asthma treatment failure due to refractory airway eosinophilia, which responded to benralizumab

Alistair Cook; John Harrington; Jodie L Simpson; Peter Wark

doi:10.1002/rcr2.742

Mepolizumab asthma treatment failure due to refractory airway eosinophilia, which responded to benralizumab

Respirol Case Rep. 2021 Apr 1;9(5):e00743. doi: 10.1002/rcr2.742. eCollection 2021 May.

Authors

Alistair Cook^{1

2}, John Harrington², Jodie L Simpson¹, Peter Wark^{1

2}

Affiliations

¹ Centre for Healthy Lungs Hunter Medical Research Institute New Lambton NSW Australia.
² Department of Respiratory Medicine John Hunter Hospital Newcastle NSW Australia.

Abstract

Monoclonal antibodies directed against interleukin (IL)-5, such as mepolizumab and benralizumab, are an effective and established treatment for severe eosinophilic asthma. Here, we present a patient with eosinophilic asthma with a partial clinical response to mepolizumab initially, as measured by these biomarkers, who when investigated was found to have refractory airway eosinophilia. Escalation of the mepolizumab dose led to further but still only partial response. A treatment trial with benralizumab was more successful and led to suppression of airway eosinophilia. We review the literature, focusing on eosinophil biology at the tissues and the different mechanisms of action of the two agents.

Keywords: Asthma; benralizumab; eosinophil; mepolizumab.

Publication types

Case Reports