Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance

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Abstract

A 55-year-old woman with cough-variant asthma presented for 1 month of worsening wheezing, cough, and dyspnea refractory to treatment. Initial laboratory findings revealed profound peripheral eosinophilia, and a chest computed tomography showed bi-apical consolidation. Bronchio-alveolar lavage demonstrated alveolar eosinophilia. She was diagnosed with idiopathic chronic eosinophilic pneumonia (ICEP). Her peripheral eosinophilia and respiratory symptoms improved rapidly with high-dose systemic corticosteroid therapy. However, she was intolerant to corticosteroid monotherapy due to non-compliance and psychological adverse effects. Mepolizumab was initiated as a steroid-sparing agent, resulting in successful therapy for 2 years without relapse or adverse effects. Mepolizumab is an interleukin-5 (IL-5) antagonist monoclonal antibody, which is a targeted therapy for diseases mediated by eosinophil activity and eosinophil proliferation. Mepolizumab is typically used in ICEP refractory to steroids, but this case supports its use in cases of glucocorticoid intolerance. Further study of IL-5 antagonist therapies for ICEP may identify an alternative treatment modality for patients in whom the adverse effects of corticosteroids pose a challenge.

Keywords: complementary therapies, glucocorticoids, humanized monoclonal antibodies, mepolizumab, pulmonary eosinophilia.

Citation: Kisling A, Jones J, Hixson C, Hostler D, Hostler J. Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance. Drugs in Context 2020; 9: 2020-5-3. DOI: 10.7573/dic.2020-5-3

Contributions: Study conception and design: Jordanna Hostler and Adam Kisling. Acquisition of data: Adam Kisling and Jason Jones. Analysis and interpretation of data: Adam Kisling, Jason Jones, David Hostler, and Jordanna Hostler. Drafting of manuscript: Adam Kisling, Jason Jones, Caleb Hixson, David Hostler, and Jordanna Hostler. Critical revision: Adam Kisling, Jason Jones, Caleb Hixson, David Hostler, and Jordanna Hostler MD. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/06/dic.2020-5-3-COI.pdf

Acknowledgements: The primary author is a military service member or employee of the US Government. This work was prepared as part of official duties. Title 17, USC §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, USC §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. The views expressed are solely those of the authors and do not necessarily reflect the official policy or position of Tripler Army Medical Center, the Department of the Army, the Department of Defense, nor the US Government.

Funding declaration: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Kisling A, Jones J, Hixson C, Hostler D, Hostler J. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Kisling A, Jones J, Hixson C, Hostler D, Hostler J. https://doi.org/10.7573/dic.2020-5-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/mepolizumab:-an-alternative-therapy-for-idiopathic-chronic-eosinophilic-pneumonia-with-glucocorticoid-intolerance

Correspondence: Adam Kisling, Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, Hawaii, 96859, USA. adam.j.kisling.mil@mail.mil

Provenance: submitted; externally peer reviewed.

Submitted: 6 May 2020; Peer review comments to author: 26 May 2020; Revised manuscript received: 17 June 2020; Accepted: 17 June 2020; Publication date: 18 August 2020.

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