Format

Send to

Choose Destination
Ther Clin Risk Manag. 2017 Nov 8;13:1489-1493. doi: 10.2147/TCRM.S149775. eCollection 2017.

Near-fatal asthma responsive to mepolizumab after failure of omalizumab and bronchial thermoplasty.

Author information

1
Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia.
2
Unit of Respiratory Rehabilitation, Azienda USL di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy.

Abstract

Severe asthma affects between 5% and 10% of patients with asthma worldwide and requires best standard therapies at maximal doses, but there is a subgroup of patients refractory to all treatments. We share a case report of a 53-year-old woman with a history of severe allergic asthma that progressively worsened over the years despite the best therapy. She had been hospitalized 35 times, including nine admissions to the respiratory intensive care unit due to severe exacerbations. To rule out other possible diagnoses, several investigations were performed, such as computed tomography scan of the chest and neck, fiberoptic laryngoscopy, antineutrophil cytoplasmic antibodies, and complete blood cell count. The patient was first treated with omalizumab, which was completely ineffective, and then with bronchial thermoplasty (BT), again without clinical benefit. The situation remained critical for about 3 months during the last hospitalization, but in February 2017, the Italian Medicines Agency approved the treatment of severe refractory eosinophilic asthma with mepolizumab (Nucala®). Given a blood eosinophil count of 300 cells/μL, our patient was started on 100 mg mepolizumab treatment. After the second administration, symptoms improved progressively, with a reduction in the number and severity of exacerbations, so the patient could finally be discharged from hospital. At follow-up, it was possible to reduce and then suspend oral corticosteroids by continuing only with inhaled corticosteroids/long-acting beta-agonists and montelukast. No further asthmatic exacerbations occurred; symptom control and quality of life improved significantly. To our knowledge, this is the first case of a patient unresponsive to omalizumab and BT but with excellent clinical response to mepolizumab. She is also the first patient to be treated with an anti-IL5 agent in Italy in a real-life clinical setting. The availability of new effective biological agents will allow many patients to resume as normal a life as possible, with a positive outcome also from a social and economic point of view.

KEYWORDS:

bronchial thermoplasty; eosinophilia; exacerbation; mepolizumab; omalizumab; severe asthma

Conflict of interest statement

Disclosure Francesco Menzella participated in contracted research and clinical trials for Novartis and Sanofi, and has received lecture fees and advisory board fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, and Novartis. Nicola Facciolongo served as a consultant for Boston Scientific and has received lecture fees from Astra-Zeneca and Chiesi. The other authors report no conflicts of interest in this work.

Supplemental Content

Full text links

Icon for Dove Medical Press Icon for PubMed Central
Loading ...
Support Center