Matsumoto-Sasaki Machiko, Shimizu Kaoruko, Suzuki Masanobu, Suzuki Masaru, Nakamaru Yuji, Konno Satoshi
Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.
Arerugi. 2020;69(8):678-682. doi: 10.15036/arerugi.69.678.
We report the case of a 66-year-old patient with severe asthma complicated by eosinophilic chronic rhinosinusitis (ECRS). The patient was initially treated with benralizumab, which resulted in marked improvement of asthma symptoms and reduced the peripheral blood eosinophil count to 0/μL. Additionally, oral steroids were discontinued. After 7 months of benralizumab administration, the asthma symptoms worsened and peripheral blood eosinophil count increased to 813/μL. The neutralizing antibodies to benralizumab may have resulted in the recurrence of symptoms due to eosinophilic inflammation. The nasal symptoms, on which benralizumab had an unremarkable effect, improved when treatment was switched to mepolizumab. However, the difference in effects of biologics on ECRS has not been elucidated and warrants further investigation. To the best of our knowledge, this is the first report of a case of severe asthma in which mepolizumab administration reversed the clinical deterioration of asthma, which was possibly caused by neutralizing antibodies to benralizumab.
我们报告了一例66岁患有严重哮喘并伴有嗜酸性粒细胞性慢性鼻-鼻窦炎（ECRS）的患者。该患者最初接受了贝那利珠单抗治疗，哮喘症状显著改善，外周血嗜酸性粒细胞计数降至0/μL。此外，口服类固醇药物停用。在使用贝那利珠单抗7个月后，哮喘症状恶化，外周血嗜酸性粒细胞计数增至813/μL。针对贝那利珠单抗的中和抗体可能导致了嗜酸性粒细胞炎症引起的症状复发。贝那利珠单抗对鼻症状效果不明显，改用美泊利珠单抗治疗后鼻症状改善。然而，生物制剂对ECRS的疗效差异尚未阐明，值得进一步研究。据我们所知，这是首例美泊利珠单抗治疗逆转了可能由贝那利珠单抗中和抗体引起的哮喘临床恶化的严重哮喘病例报告。
