Profiling blood hypereosinophilia in patients on dupilumab treatment for respiratory conditions: a real-life snapshot.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-02-14 DOI:10.1016/j.jaip.2025.01.040

Marco Caminati, Matteo Maule, Diego Bagnasco, Bianca Beghè, Fulvio Braido, Luisa Brussino, Paolo Cameli, Maria Giulia Candeliere, Giovanna Elisiana Carpagnano, Giulia Costanzo, Claudia Crimi, Mariella D'Amato, Stefano Del Giacco, Gabriella Guarnieri, Mona-Rita Yacoub, Claudio Micheletto, Filippo Moletta, Stefania Nicola, Bianca Olivieri, Laura Pini, Michele Schiappoli, Elena Scarpieri, Rachele Vaia, Andrea Vianello, Dina Visca, Antonio Spanevello, Gianenrico Senna, Roberto Benoni

{"title":"Profiling blood hypereosinophilia in patients on dupilumab treatment for respiratory conditions: a real-life snapshot.","authors":"Marco Caminati, Matteo Maule, Diego Bagnasco, Bianca Beghè, Fulvio Braido, Luisa Brussino, Paolo Cameli, Maria Giulia Candeliere, Giovanna Elisiana Carpagnano, Giulia Costanzo, Claudia Crimi, Mariella D'Amato, Stefano Del Giacco, Gabriella Guarnieri, Mona-Rita Yacoub, Claudio Micheletto, Filippo Moletta, Stefania Nicola, Bianca Olivieri, Laura Pini, Michele Schiappoli, Elena Scarpieri, Rachele Vaia, Andrea Vianello, Dina Visca, Antonio Spanevello, Gianenrico Senna, Roberto Benoni","doi":"10.1016/j.jaip.2025.01.040","DOIUrl":null,"url":null,"abstract":"Background: Transient and usually asymptomatic increase in blood eosinophil count (BEC) associated with dupilumab treatment has been described. Predicting factors related to BEC increase and symptoms occurrence are still poorly investigated.Objective: To investigate frequency, timing, duration, clinical relevance and potential predictors of BEC increase in a real-life multicentre cohort of patients affected by asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab.Methods: BEC and clinical conditions at baseline and every 3 months after dupilumab treatment start were assessed. Any adverse drug reaction was also recorded. Remission of dupilumab-associated eosinophilia was defined by follow-up BEC values < 0.5 x10ˆ9 cells/L.Results: Overall, 108 out of 195 (55%) patients experienced an increased BEC after dupilumab initiation but only 29 out of 195 (14.9%) showed hypereosinophilia. BEC peak occurred 6 months after the treatment start and resolved after 9 months (median time). Probability of developing hypereosinophilia was 3.3 times higher in patients with baseline BEC between 0.5 and 1.5 cells x 109L. Symptoms occurrence during BEC peak was higher in patients with comorbidities and in patients showing any increase of BEC.Conclusions: In a real-life setting dupilumab treatment in asthma and/or CRSwNP patients was often associated with transient BEC increase but hypereosinophilia rarely occurred. Onset of symptoms co-occurring with BEC peak was observed in a minority of subjects. BEC should not preclude itself dupilumab initiation or continuation but deserves to be monitored for at least 8 months after the treatment start, particularly in the case of baseline eosinophilia/hypereosinophilia and/or comorbidities.","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2000,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaip.2025.01.040","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Transient and usually asymptomatic increase in blood eosinophil count (BEC) associated with dupilumab treatment has been described. Predicting factors related to BEC increase and symptoms occurrence are still poorly investigated.

Objective: To investigate frequency, timing, duration, clinical relevance and potential predictors of BEC increase in a real-life multicentre cohort of patients affected by asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab.

Methods: BEC and clinical conditions at baseline and every 3 months after dupilumab treatment start were assessed. Any adverse drug reaction was also recorded. Remission of dupilumab-associated eosinophilia was defined by follow-up BEC values < 0.5 x10ˆ9 cells/L.

Results: Overall, 108 out of 195 (55%) patients experienced an increased BEC after dupilumab initiation but only 29 out of 195 (14.9%) showed hypereosinophilia. BEC peak occurred 6 months after the treatment start and resolved after 9 months (median time). Probability of developing hypereosinophilia was 3.3 times higher in patients with baseline BEC between 0.5 and 1.5 cells x 10⁹L. Symptoms occurrence during BEC peak was higher in patients with comorbidities and in patients showing any increase of BEC.

Conclusions: In a real-life setting dupilumab treatment in asthma and/or CRSwNP patients was often associated with transient BEC increase but hypereosinophilia rarely occurred. Onset of symptoms co-occurring with BEC peak was observed in a minority of subjects. BEC should not preclude itself dupilumab initiation or continuation but deserves to be monitored for at least 8 months after the treatment start, particularly in the case of baseline eosinophilia/hypereosinophilia and/or comorbidities.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.