Biologics and Hypereosinophilic Syndromes: Knowledge Gaps and Controversies

Fei Li Kuang*, Paneez Khoury, Peter F. Weller, Michael E. Wechsler, Amy D. Klion

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Hypereosinophilic syndromes (HES) are a heterogeneous group of disorders defined by blood and/or tissue hypereosinophilia and clinical manifestations attributable to the eosinophilia. Although various clinical subtypes of HES have been described, the general approach to therapy in all subtypes has focused on the reduction of blood and tissue eosinophilia to improve symptoms and halt disease progression. Until recently, this typically involved the use of corticosteroids and/or other immunosuppressive or cytotoxic drugs with significant toxicity. Whereas imatinib, the first targeted therapy approved for treatment of HES, has dramatically changed the prognosis of patients with primary (myeloid) forms of HES, it is ineffective in patients with other HES subtypes. For these nonmyeloid patients with HES, the development of eosinophil-targeting biologics (most notably, mepolizumab, the first biologic approved for the treatment of HES) has been transformative. Nevertheless, important issues remain with respect to the efficacy and safety of these biologics in the treatment of the varied subtypes of HES. Moreover, with the increasing number of commercially available biologics with direct or indirect effects on eosinophils, questions related to the choice of initial biologic, potential reasons for biologic failure, and treatment options in the setting of incomplete response are becoming increasingly common.

Original languageEnglish (US)
Pages (from-to)2666-2671
Number of pages6
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume11
Issue number9
DOIs
StatePublished - Sep 2023

Funding

This work was funded in part by the Division of Intramural Research, National Institute for Allergy and Infectious Diseases ( NIAID), National Institutes of Health h ( NIH ).

Keywords

  • Benralizumab
  • Dupilumab
  • Eosinophil
  • Mepolizumab
  • Reslizumab
  • Targeted therapy

ASJC Scopus subject areas

  • Immunology and Allergy

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