Dual biologic therapy with mepolizumab a novel solution to dupilumab-induced conjunctivitis
Bibliographic record
Abstract
Introduction: Dupilumab is an interleukin-4 (IL-4) receptor alpha antagonist antibody used to treat severe eosinophilic asthma (SEA) and atopic dermatitis (AD). Mepolizumab is an IL-5 antagonist antibody also used to treat SEA. Adverse effects associated with dupilumab include an elevation in peripheral blood eosinophils and severe conjunctivitis, the mechanism of which is unknown. Current medical management of dupilumab-induced conjunctivitis is topical steroids or cessation of therapy. Case description: A 28-year-old male with established severe AD and SEA refractory to standard medical therapy was started on dupilumab for his AD with significant clinical improvements; his SEA clinically improved but he remained symptomatic. Within four weeks he developed severe bilateral conjunctivitis and his peripheral blood eosinophil count rose from 0 to 5.5 10 E9/L. Mepolizumab was initiated in addition to dupilumab. Three days after his first injection his peripheral eosinophil count dropped to zero, the conjunctivitis resolved, and there was marked improvement in his Asthma Control Questionnaire score. The patient remains on combination therapy, and has had no asthma exacerbations. Case implications: Blocking three T2 cytokine pathways (IL-4, 5 and 13) by administration of concurrent mepolizumab and dupilumab can alleviate dupilumab-associated conjunctivitis and provide additive improvement in asthma control. This case study postulates that the conjunctivitis is associated with disarrangement of the T2 inflammatory pathway. More data is needed on the indications, efficacy and safety of combination biologic therapy in severe asthma; in the interim case reports provide valuable information.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".