Pelaia Corrado, Busceti Maria Teresa, Vatrella Alessandro, Ciriolo Marco, Garofalo Eugenio, Crimi Claudia, Terracciano Rosa, Lombardo Nicola, Pelaia Girolamo
Department of Medical and Surgical Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro, Italy.
Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy.
SAGE Open Med Case Rep. 2020 Feb 16;8:2050313X20906963. doi: 10.1177/2050313X20906963. eCollection 2020.
Severe allergic eosinophilic asthma can be characterized by inadequate control, despite the regular use of high dosages of inhaled corticosteroids/long-acting β-adrenergic agonists combinations, and the very frequent utilization of oral corticosteroids. Therefore, under these circumstances, an add-on biological treatment with monoclonal antibodies directed against suitable molecular targets, involved in the pathobiology of type-2 airway inflammation, is very useful. Within such a context, our case report refers to a 46-year-old woman with severe allergic eosinophilic asthma and relapsing nasal polyps, not eligible to add-on biological therapy with omalizumab because of her very high serum levels of immunoglobulins E (IgE). She is currently under treatment with the humanized monoclonal antibody benralizumab (30 mg subcutaneous injection, administered every 4 weeks for the first three doses, and every 8 weeks thereafter), an eosinophil-depleting anti-interleukin-5-receptor biologic. Our patient experienced relevant clinical and functional improvements already after the first dose, and subsequently striking changes were recorded after the second and third doses, including remarkable increases in asthma control test scores and forced expiratory volume in 1 s values, associated with a complete depletion of blood eosinophils and the interruption of oral corticosteroid intake, as well as with the concomitant disappearance of nasal polyps after the second dose. In conclusion, this case study suggests that benralizumab can exert a very rapid and effective therapeutic action in patients with severe eosinophilic asthma and nasal polyposis.
重度过敏性嗜酸性粒细胞性哮喘的特征可能是尽管规律使用高剂量吸入性糖皮质激素/长效β-肾上腺素能激动剂联合制剂，且频繁使用口服糖皮质激素，但病情仍控制不佳。因此，在这种情况下，添加针对参与2型气道炎症病理生物学的合适分子靶点的单克隆抗体进行生物治疗非常有用。在此背景下，我们的病例报告涉及一名46岁患有重度过敏性嗜酸性粒细胞性哮喘和复发性鼻息肉的女性，由于其血清免疫球蛋白E（IgE）水平极高，不符合使用奥马珠单抗进行添加生物治疗的条件。她目前正在接受人源化单克隆抗体贝那利珠单抗治疗（皮下注射30毫克，前3剂每4周给药一次，此后每8周给药一次），这是一种耗竭嗜酸性粒细胞的抗白细胞介素-5受体生物制剂。我们的患者在第一剂后就已经出现了相关的临床和功能改善，随后在第二剂和第三剂后记录到了显著变化，包括哮喘控制测试评分和第1秒用力呼气量值显著增加，同时血液嗜酸性粒细胞完全耗竭，口服糖皮质激素停用，并且在第二剂后鼻息肉也随之消失。总之，本病例研究表明，贝那利珠单抗对重度嗜酸性粒细胞性哮喘和鼻息肉患者可发挥非常快速且有效的治疗作用。
