Biologics are now established treatment options, particularly for severe courses of the disease. However, there is little data on the the efficacy and safety of simultaneous administration of several biologics for concomitant disease entities. Until now, there has been little knowledge about the combination of mepolizumab and ixekizumab – researchers from Freiburg (Germany) have now investigated this in an individual case.
(red) Andreas Hoheisel from the Department of Pulmonology at the University Medical Center Freiburg (D) reported a case of severe eosinophilic asthma treated with mepolizumab (anti-interleukin-5) and concomitant severe psoriasis treated with ixekizumab (anti-interleukin-17) [1]. The 34-year-old ex-smoker under 4-weekly administration of ixekizumab (80 mg s.c.) presented for the first time in mid-2022 after severe, hospitalized exacerbation of asthma known since childhood with multiple allergies (including HSM I/II, grasses, rye, ragweed). The man was 185 cm tall and weighed 145 kg, which caused him great suffering.
Most recently, oral corticosteroids (prednisolone) had to be administered monthly. The patient developed obesity (BMI 42 kg/m²), sleep apnea and arterial hypertension. He was first diagnosed with psoriasis in 2009 and has been receiving Ixekizumab since May 2022. The initial pre-BD FEV1 was 52%SW, in the Asthma Control Test (ACT) the man scored only 8 out of 25 points, the blood eosinophils were 0.5 Gpt/l after OCS break, the NO was 88 ppb. Despite maximum inhalation therapy with high-dose ICS, LABA and LAMA, the patient remained markedly symptomatic and had no improvement in lung function.
In consensus with the treating dermatologists, it was therefore decided to additionally administer mepolizumab 100 mg s.c. from 12/2022. The decisive factors for the decision were the severity of the asthma, the young age of the patient and the side effects due to repeated OCS administration. The therapy with Ixekizumab, which had been in place for a year at the time, had so far led to an almost complete remission of the psoriasis.
Rapid improvement in FEV1
Within 4 months, the patient’s FEV1 value gradually increased from 52% to 84% (Fig. 1). He was symptom-free and achieved a score of 20/25 points on the ACT. Prednisolone was no longer necessary after starting mepolizumab. It is administered every 14 days as an injection in a pen, which the patient applies himself and is very satisfied with. In addition, the man has lost 17 kg in body weight since starting treatment with the second biologic and the associated discontinuation of OCS, which is of great importance to him, as the pulmonologist explained.
This case thus confirms the efficacy of the administration of mepolizumab in severe eosinophilic asthma and the tolerability of simultaneous administration of ixekizumab, summarized Andreas Hoheisel. However, the simultaneous administration of biologics for different disease entities must always remain a case-by-case decision, which must be made after careful consideration of the pros and cons and with the involvement of the specialist disciplines involved.
Congress: DGP 2024
Source:
- Hoheisel A: Combination of mepolizumab and ixekizumab in severe eosinophilic asthma and psoriasis – case report. 64th Congress of the German Society for Pneumology and Respiratory Medicine e.V., 20-24.03.2024, Mannheim (D); Po 205.
InFo PNEUMOLOGIE & ALLERGOLOGIE 2024; 6(2): 25 (published on 30.5.24, ahead of print)
