成功使用度普利尤单抗治疗美泊利珠单抗和泼尼松龙耐药性变应性支气管肺曲霉病。
Successful Treatment of Mepolizumab- and Prednisolone-resistant Allergic Bronchopulmonary Aspergillosis with Dupilumab.
机构信息
Department of Respiratory Medicine, Kyorin University School of Medicine, Japan.
Department of Pathology, Kyorin University School of Medicine, Japan.
出版信息
Intern Med. 2021 Sep 1;60(17):2839-2842. doi: 10.2169/internalmedicine.6679-20. Epub 2021 Mar 1.
A 45-year-old man with allergic bronchopulmonary aspergillosis (ABPA) was treated with oral prednisolone (PSL) (30 mg/day), inhaled corticosteroids, and long-acting beta2-agonists. After confirmation of a PSL-dependent status (8 mg/day), subcutaneous injection with anti-interleukin (IL)-5 antibody (mepolizumab, 100 mg/month) was performed, and the PSL dose was tapered to 5 mg/day. However, ABPA recurred and proved refractory to oral itraconazole (200 mg/day). Alternative subcutaneous injection therapy with dupilumab (induction dose of 600 mg followed by a maintenance dose of 300 mg/2 weeks) enabled the successful withdrawal of oral PSL without clinical deterioration. This case demonstrates the potential utility of dupilumab for steroid-dependent ABPA via the synergistic suppression of IL-4 and IL-13 compared to monotherapy with anti-IL-5 antibody.
一位 45 岁的变应性支气管肺曲霉病（ABPA）患者接受了口服泼尼松龙（PSL）（30 mg/天）、吸入皮质类固醇和长效β2-激动剂治疗。在确认 PSL 依赖性状态（8 mg/天）后，进行了皮下注射抗白细胞介素（IL）-5 抗体（美泊利珠单抗，每月 100 mg），并将 PSL 剂量逐渐减少至 5 mg/天。然而，ABPA 复发且对口服伊曲康唑（200 mg/天）难治。与抗 IL-5 抗体单药治疗相比，使用度普利尤单抗（起始剂量 600 mg，维持剂量 300 mg/2 周）进行替代皮下注射治疗可成功停用口服 PSL，且无临床恶化。该病例表明，与抗 IL-5 抗体单药治疗相比，度普利尤单抗通过协同抑制 IL-4 和 IL-13，可能对 PSL 依赖性 ABPA 有效。
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