Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the treatment of eosinophilic otitis media
Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the treatment of eosinophilic otitis media
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DOI：
10.1016/j.anl.2018.07.011
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发表时间：
2019-04-01
影响因子：
1.7
通讯作者：
Kikuchi, Saori
中科院分区：
文献类型：
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作者：
Iino, Yukiko;Takahashi, Eli;Kikuchi, Saori
目的：嗜酸性中耳炎（EOM）是一种顽固性中耳炎，其特征是含有嗜酸性粒细胞的高度粘稠的渗出液，并且大多与支气管哮喘相关。最近，使用美泊利单抗的抗IL-5治疗已被报道对重度和难治性嗜酸性支气管哮喘患者有效。EOM显示嗜酸性粒细胞在中耳积液中的积聚，并且大多数EOM患者具有高数量的外周血嗜酸性粒细胞。因此，我们进行了一项回顾性研究，以确定是否抗IL-5治疗也是有效的治疗EOM.Patients和方法：9例EOM相关的支气管哮喘患者接受抗IL-5剂美泊利单抗作为添加治疗至少6个月（美泊利单抗组）。在接受抗IL-5治疗前后，通过EOM严重程度评分、症状评分、骨导听力水平和替代标志物进行评估。13例未接受抗LL-5治疗的支气管哮喘EOM患者作为对照组（control group）。结果：美泊利珠单抗组大多数患者的严重程度评分在开始治疗后3个月显著降低，随着治疗的继续，评分进一步降低至显著低于基线水平。然而，两名肉芽型眼外肌患者显示治疗后的改善极小。对照组患者的严重程度评分在研究期间没有显着变化。在两组中均未观察到骨导听力水平的显著恶化。外周血嗜酸性粒细胞的数量显着减少，和嗜酸性粒细胞几乎没有观察到中耳积液和中耳mucosal after the mepolizumab therapeutic.Conclusions：抗IL-5治疗使用mepolizumab是有效的抑制嗜酸性粒细胞募集到中耳炎患者。然而，这种疗法对肉芽型眼外膜患者的影响很小。因此，这种疗法可能是一种可行的治疗选择难治性眼外膜没有严重的粘膜变化。(C)2019爱思唯尔B. V.保留所有权利。
Objective: Eosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion containing eosinophils, and it is mostly associated with bronchial asthma. Recently, anti-IL-5 therapy using mepolizumab has been reported to be effective for patients with severe and refractory eosinophilic bronchial asthma. EOM shows accumulation of eiosinophils in the middle ear effusion and most EOM patients have high numbers of peripheral blood eosinophils. Therefore, we carried out a retrospective study to determine whether anti-IL-5 therapy is also effective in the treatment of EOM.Patients and methods: Nine patients with EOM associated with bronchial asthma received the anti-IL-5 agent mepoliumab as an add-on therapy for at least 6 months (mepolizumab group). They were evaluated by EOM severity scores, symptom scores, bone conduction hearing levels, and surrogate markers before and after receiving the anti-IL-5 therapy. Thirteen EOM patients associated with bronchial asthma who did not receive the anti-LL-5 therapy were also included as controls (control group).Results: The severity scores of most patients in the mepolizumab group were dramatically reduced at 3 months after the initiation of this therapy and, as therapy continued, they further decreased to levels significantly lower than the baseline. However, two patients with a granulation type of EOM showed minimal improvement from the therapy. The severity scores of control patients showed no significant changes during the study period. Significant deterioration of the bone conduction hearing levels was not observed in either group. The number of peripheral blood eosinophils was significantly reduced, and eosinophils were scarcely observed in the middle ear effusion and middle ear mucosa after the mepolizumab therapy.Conclusions: Anti-IL-5 therapy using mepolizumab was effective at inhibiting eosinophilic recruitment to the middle ear in patients with EOM. However, this therapy showed minimal effect on patients with the granulation type of EOM. Therefore, this therapy may be a viable treatment option for refractory EOM without severe mucosal change. (C) 2019 Elsevier B.V. All rights reserved.