Use of Biologic Drugs for Treatment of Allergic Bronchopulmonary Aspergillosis
Author:
Saeed Albogami
Date: 11 October 2021
Abstract:
Allergic bronchopulmonary aspergillosis (ABPA) is an allergic fungal infection that induces immunoglobulin E (IgE) production and eosinophils
proliferation and affect mostly asthmatic and cystic fibrosis patients. The mainstay treatment for ABPA is systemic steroid and antifungal treatment
which have increasing rates of treatment failure and side effects. Because of their mechanism of action in suppressing IgE or eosinophils, biologic
drugs were expected to play an important role in the treatment of ABPA, however, their use in this issue was off label and lack the evidence. In
this comprehensive and comparative review, 59 full text articles (228 patients) were selected. The outcomes were analyzed and the percentages
of posttreatment change for each variable in each study were collected then the overall median percentages were calculated for each variable for
each biologic drug. Comparative discussion of these outcomes was done in terms of clinical and functional response, reduction of exacerbation
events, reduction of IgE level and eosinophils count, prevention of complications and patient’s ability to reduce steroid dose or discontinue it.
The review shows that the use of biologic drugs for treatment of ABPA is associated with a significant clinical and functional improvement and
reduction of exacerbation rates up to 90%. There is more reduction in post-treatment IgE level with mepolizumab and marked reduction in post-
treatment eosinophils count with benralizumab. Mepolizumab has the better steroid-sparing effect. Changing from one biologic drug to another
with different target in case of treatment failure is advisable. More stronger studies and randomized control trials are needed to figure out the
use of biologic drugs for ABPA treatment.
Keywords: Allergic bronchopulmonary aspergillosis; Anti-IgE; Benralizumab; Dupilumab; Mepolizumab
Abbreviations: ABPA: Allergic Bronchopulmonary Aspergillosis; IgE: Immunoglobulin E; ISHAM: International Society for Human and Animal
Mycology; IL-5R: Interleukin-5 Receptor; IL-4: Interleukin-4; IL-13: Interleukin-13; ACT: Asthma Control Test
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