Successful Treatment of Mepolizumab- and Prednisolone-resistant Allergic Bronchopulmonary Aspergillosis with Dupilumab

• Published in: Internal Medicine Vol. 60; no. 17; pp. 2839 - 2842
• Main Authors: Mikura, Sunao, Saraya, Takeshi, Yoshida, Yuki, Oda, Miku, Ishida, Manabu, Honda, Kojiro, Nakamoto, Keitaro, Tamura, Masaki, Takata, Saori, Shimoyamada, Hiroaki, Fujiwara, Masachika, Ishii, Haruyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.09.2021; Japan Science and Technology Agency
• Subjects: Allergic bronchopulmonary aspergillosis; Aspergillosis; Case Report; Corticosteroids; dupilumab; Injection; Interleukin 13; Interleukin 4; Interleukin 5; Internal medicine; Itraconazole; mepolizumab; Prednisolone; prednisolone; allergic bronchopulmonary aspergillosis; mepolizumab; dupilumab
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.6679-20

A 45-year-old man with allergic bronchopulmonary aspergillosis (ABPA) was treated with oral prednisolone (PSL) (30 mg/day), inhaled corticosteroids, and long-acting beta2-agonists. After confirmation of a PSL-dependent status (8 mg/day), subcutaneous injection with anti-interleukin (IL)-5 antibody (mepolizumab, 100 mg/month) was performed, and the PSL dose was tapered to 5 mg/day. However, ABPA recurred and proved refractory to oral itraconazole (200 mg/day). Alternative subcutaneous injection therapy with dupilumab (induction dose of 600 mg followed by a maintenance dose of 300 mg/2 weeks) enabled the successful withdrawal of oral PSL without clinical deterioration. This case demonstrates the potential utility of dupilumab for steroid-dependent ABPA via the synergistic suppression of IL-4 and IL-13 compared to monotherapy with anti-IL-5 antibody.