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Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Authors
  • Mümmler, Carlo1, 2
  • Kemmerich, Bernd3
  • Behr, Jürgen1, 2
  • Kneidinger, Nikolaus1, 2
  • Milger, Katrin1, 2
  • 1 Ludwig-Maximilians-University of Munich (LMU), Marchioninistr.15, Munich, 81377, Germany , Munich (Germany)
  • 2 Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany , Munich (Germany)
  • 3 Pneumologie an der Münchner Freiheit, Munich, Germany , Munich (Germany)
Type
Published Article
Journal
Allergy, Asthma & Clinical Immunology
Publisher
BioMed Central
Publication Date
Jun 26, 2020
Volume
16
Issue
1
Identifiers
DOI: 10.1186/s13223-020-00454-w
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma.Case presentationHere, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced.ConclusionOur case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

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