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The following is a summary of “Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review,” published in the February 2024 issue of Pulmonology by Murillo et al.
Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare condition characterized by pulmonary radiological changes, peripheral eosinophilia, and pulmonary eosinophilia. While oral steroids (OSs) are the standard treatment, relapses occur in up to 50% of patients upon tapering or discontinuation of steroids, necessitating treatment reinitiation and exposing patients to associated adverse events. Monoclonal antibodies have been proposed as an alternative management approach to control the disease and mitigate treatment-related complications. This review aims to elucidate the extent and nature of evidence regarding the use of monoclonal antibodies in treating ICEP.
A comprehensive literature review encompassed observational and experimental studies involving pediatric and adult populations managed for recurrent ICEP with monoclonal antibodies. Two reviewers independently performed data search, selection, and extraction.
A total of 937 studies were identified initially. After rigorous application of inclusion and exclusion criteria, 37 titles were retained for final analysis, including one retrospective observational study, two case series publications, and 34 case reports published in academic posters and letters to the editor. Overall, findings suggest that monoclonal antibodies approved for severe asthma, mainly targeting IL-5 and IgE (e.g., omalizumab), may promise to control ICEP, yielding positive clinical and radiological outcomes. Biological agents are a safer option for managing ICEP relapses, facilitating OS tapering or discontinuation, and potentially substituting for patients intolerant to steroids or with significant comorbidities.
Although the evidence supporting the use of monoclonal antibodies for ICEP management is limited, particularly for agents like dupilumab, it shows promise in patients experiencing frequent relapses, corticosteroid dependence, or contraindications to steroid use. Future studies with improved design and structure are warranted to evaluate long-term outcomes and quality of life during a well-defined follow-up period. This scoping review represents the first comprehensive analysis of the literature regarding the use of monoclonal antibodies in managing ICEP, shedding light on its potential efficacy and areas for further investigation.
Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-02868-3