Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS).

Gschwend, Anna; Helbling, Arthur; Feldmeyer, Laurence; Mani-Weber, Ulrich; Meincke, Cordula; Heidemeyer, Kristine; Bossart, Simon; Jörg, Lukas (2022). Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS). (In Press). Allergo journal international, pp. 1-8. Springer 10.1007/s40629-022-00224-7

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Purpose

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed drug hypersensitivity reaction with exanthema, eosinophilia, and organ manifestations. After culprit drug withdrawal, systemic corticosteroids (CS) are the most widely used treatment, often requiring high doses for months. Blocking the IL-5/IL‑5 receptor axis with mepolizumab, reslizumab, and benralizumab is a promising targeted treatment with a good safety profile and no immunosuppressive effect. The aim of this study is to summarize current experience with the anti-IL5/IL-5-receptor therapy in DRESS.

Methods

A retrospective analysis of all patients diagnosed with DRESS and treated with mepolizumab, reslizumab, or benralizumab in DRESS was performed. In addition, a PubMed-Medline search for publications on DRESS with anti-IL-5/IL‑5 receptor treatment was performed.

Results

Of the 14 cases identified, 6 patients were treated with mepolizumab, 6 with benralizumab, 1 patient with reslizumab, and 1 patient was switched from benralizumab to mepolizumab. The main indication for an IL‑5 blockade was a therapy-refractory course (7/14 [50.0%]), recurrent relapses (3/14 [21.4%]), and severe organ dysfunction (2/14 [14.3%]). In 13/14 (93%) cases, a rapid clinical improvement with suppression of eosinophilia and reduction of CS could be achieved. In all but two cases under mepolizumab (dose 100-600 mg) or reslizumab (dose according to body weight), two or more doses were necessary until resolution of DRESS. In 4/7 cases under benralizumab, a single 30 mg dose was sufficient.

Conclusion

Blockade of the IL-5/IL‑5 receptor axis appears to be a promising treatment in DRESS with fast clinical improvement, which may allow more rapid reduction of CS, and a good safety profile. In addition, a summary of recommendations on when to use blockade of the IL-5/IL‑5 receptor axis in DRESS treatment is provided.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology and Immunology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology

UniBE Contributor:

Gschwend, Anna, Helbling, Arthur, Feldmeyer, Laurence, Meincke, Cordula, Heidemeyer, Kristine, Bossart, Simon, Jörg, Lukas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2197-0378

Publisher:

Springer

Language:

English

Submitter:

Pubmed Import

Date Deposited:

30 Aug 2022 16:03

Last Modified:

05 Dec 2022 16:23

Publisher DOI:

10.1007/s40629-022-00224-7

PubMed ID:

36035809

Uncontrolled Keywords:

Benralizumab Drug hypersensitivity Eosinophilia Mepolizumab Reslizumab

BORIS DOI:

10.48350/172483

URI:

https://boris.unibe.ch/id/eprint/172483

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