Huang Ivan H, Dang Kenneth N, Kashyap Saarang, Clair Noah St, Sweidan Alexander J
Department of Physiological Science, University of California, 986 N Center Street, Orange, Los Angeles, CA, 90095, USA.
Department of Bioengineering, University of California, Los Angeles, CA, 90095, USA.
Allergy Asthma Clin Immunol. 2025 Sep 2;21(1):39. doi: 10.1186/s13223-025-00985-0.
Allergic bronchopulmonary aspergillosis (ABPA) presents with a wide range of symptom severity, with severe disease manifestations being harder to control through conventional inhalers. While corticosteroids remain a standard treatment option, their use is often hindered by significant adverse side effects. This case series discusses a novel treatment of duo-administration of monoclonal antibodies for two patients that reduced their exacerbations, spared the use of steroids, and improved their quality of life.
Both patients were diagnosed with ABPA. Before the administration of treatment, they experienced almost monthly exacerbations and infections requiring constant systemic oral corticosteroids and antibiotics. After the implementation of successive concomitant monoclonal antibody treatments, absolute eosinophil levels were brought down to normal levels, and the monthly exacerbations were eliminated.
This case series describes a novel approach for ABPA therapy that holds potential in improving patient outcomes for those with severe ABPA. Duo biologic therapy may improve disease control and reduce corticosteroid reliance in patients with refractory ABPA by targeting multiple mechanistic pathways of inflammation. Mepolizumab with Omalizumab offers a potential treatment strategy to reduce exacerbation frequency and severity and has minimal adverse effects.
变应性支气管肺曲霉病（ABPA）症状严重程度范围广泛，严重的疾病表现难以通过传统吸入器控制。虽然皮质类固醇仍然是标准治疗选择，但其使用常常受到显著不良副作用的阻碍。本病例系列讨论了一种针对两名患者的单克隆抗体联合给药的新疗法，该疗法减少了他们的病情加重次数，避免了类固醇的使用，并改善了他们的生活质量。
两名患者均被诊断为ABPA。在进行治疗之前，他们几乎每月都会病情加重并感染，需要持续使用全身性口服皮质类固醇和抗生素。在连续进行联合单克隆抗体治疗后，嗜酸性粒细胞绝对水平降至正常水平，每月的病情加重情况也消除了。
本病例系列描述了一种ABPA治疗的新方法，对改善重度ABPA患者的治疗效果具有潜力。双生物疗法通过针对多种炎症机制途径，可能改善难治性ABPA患者的疾病控制并减少对皮质类固醇的依赖。美泊利单抗与奥马珠单抗联合使用提供了一种潜在的治疗策略，可降低病情加重的频率和严重程度，且副作用最小。
