Dupilumab is a humanised monoclonal antibody that targets type 2 inflammation by blocking IL-4 and IL-13 signalling. Reported adverse events from its use include injection site erythema, conjunctivitis, arthralgia and hypereosinophilia. The potential for more severe eosinophilic-related complications such as hypereosinophlic syndrome, eosinophilic granulomatosis with polyangiitis (EGPA) or other eosinophil-induced organ damage has led to clinical protocols to monitor blood eosinophil count (BEC) during dupilumab therapy. This study was a systematic review of all reported eosinophilic complications that developed during dupilumab therapy for the most frequent indications (CRSwNP, asthma, atopic dermatitis and eosinophilic oesophagitis). Thirty-five studies met inclusion criteria (17 case reports, six RCTs, seven case series, five observational cohort studies). Fifty-three patients were included (median age 56 years; 73% female, 27% male; in 27 patients for asthma, in 12 for uncontrolled asthma and CRSwNP, in 10 for only CRSwNP, in four for atopic dermatitis). EGPA occurred in 24 patients, eosinophilic pneumonia in 15 and hypereosinophilic syndrome in six. There were isolated reports of eosinophilic myopericarditis, eosinophilic pleuritis, myositis, eosinophilic vasculitis (non-EGPA), atrial fibrillation, stroke and anaphylaxis. These complications developed after a median of nine weeks. Eighty-five of the complications occurred within six months of dupilumab therapy. Median BEC at diagnosis of the complication was 6.38X109 cells/L. There were no reported deaths from the eosinophilic complications. Dupilumab therapy was discontinued in 89% of patients. The authors conclude that the occurrence of eosinophilic complications during dupilumab therapy are extremely rare and occur in the first months of therapy, challenging the need for prolonged BEC monitoring.
Eosinophilic complications during dupilumab therapy
Reviewed by Richard (Wei Chern) Gan
Eosinophilic complications during dupilumab therapy for type 2 diseases: a systematic review.
CONTRIBUTOR
Richard (Wei Chern) Gan
Hull University Teaching Hospitals NHS Trust, UK.
View Full Profile
