Benralizumab for Life-threatening Exacerbations of Eosinophilic Asthma: A Case Series
Notice bibliographique
Résumé
Abstract Introduction Benralizumab, an anti-interleukin-5 receptor-α monoclonal antibody, is approved for maintenance therapy in severe eosinophilic asthma. Few reports have described benralizumab use in acute eosinophilic exacerbations. We present two patients with life-threatening exacerbations who experienced striking clinical improvement with benralizumab. Case description Patient 1 is a 31-year-old man known for mild asthma on as-needed fluticasone and salbutamol. His symptoms had markedly worsened following sustained occupational diisocyanate spray paint exposure, culminating in him presenting in respiratory distress following a viral illness. He was tachycardic (118/min), hypoxemic (SpO2 88%), and hypercapnic (pCO2 47.1 mmHg). Spirometry revealed forced expiratory volume in one second (FEV1) 1.69 L (36% predicted) and peak expiratory flow (PEF) 2.92 L/s (30% predicted). Blood eosinophil count (BEC) was 520 cells/μL. Patient 2 is a 37-year-old pregnant woman who presented at 27 weeks gestation in respiratory distress. She was known for severe, oral corticosteroid-dependent eosinophilic asthma with multiple exacerbations annually despite triple inhaled therapy, prednisone 10 mg daily, and montelukast. She was hypoxemic (SpO2 89%) with FEV1 1.09 L (31% predicted) and PEF 3.43 L/s (47% predicted). Investigations revealed BEC 430 cells/μL, pCO2 27.9 mmHg, and lactate 2.5 mmol/L. Despite short-acting bronchodilators, intravenous methylprednisolone, and magnesium sulfate, both patients remained dyspneic at rest and required 5 L/min supplemental oxygen to maintain SpO2 >90%. They both tested positive for rhinovirus. Imaging revealed no pneumonia or pulmonary embolus. Given elevated BEC suggesting that eosinophil-mediated inflammation was driving their exacerbations, benralizumab was administered. Within 24 hours, both patients were weaned off oxygen and reported significant symptomatic improvement. Patient 1's repeat spirometry confirmed markedly increased PEF and FEV1 (Figure 1). Both patients were discharged five days following benralizumab with near-normal spirometry. Discussion These patients with life-threatening eosinophilic asthma exacerbations experienced prompt and dramatic improvement in symptoms, oxygenation, and lung function following single-dose benralizumab. Benralizumab generates antibody-dependent cellular cytotoxicity against eosinophils, causing rapid and near-complete depletion of blood and tissue levels. This process is hypothesized to explain the brisk clinical response in patients with eosinophil-mediated exacerbations. Our case series adds to the growing literature, including a recently presented randomized trial, demonstrating the positive effects of benralizumab in the treatment of acute eosinophilic respiratory exacerbations in reducing treatment failure. We emphasize that our patients had rapid clinical improvement despite near-fatal exacerbations refractory to usual management, suggesting that benralizumab could have an important role as rescue and potentially first-line therapy in this population.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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