IL-5 Inhibitors May Be Steroid Alternative For Rx of DRESS

TOPLINE:

A retrospective case series found that treatment with an interleukin (IL)-5 inhibitor reduced eosinophil levels and improved clinical outcomes in patients with drug reaction with eosinophilia and systemic symptoms (DRESS), with no adverse events or long-term autoimmune sequelae.

METHODOLOGY:

• Researchers conducted a retrospective case series of 16 patients treated with IL-5 inhibitors across the Mass General Brigham system, of whom five (two women, five men) met criteria for possible DRESS (Registry of Severe Cutaneous Adverse Reactions score ≥ 3).
• The mean peak absolute eosinophil count was 5200 (range, 1800-10,000) cells/μL.
• The patients required IL-5 inhibitors (mepolizumab or benralizumab) because of contraindications to or failure of oral, intravenous, or ocular steroid treatment or various immunomodulators.
• Clinical response was defined as resolution of cutaneous symptoms and sustained recovery of organ involvement.

TAKEAWAY:

• Researchers reported a dramatic reduction in eosinophilia within 1-3 days for all patients, with a mean time to eosinophil resolution of 1.4 days.
• The mean time to clinical response was 16 days, sustained resolution observed in follow-up periods ranging from 57 to 793 days.
• One patient relapsed after 13 days on mepolizumab but responded well to benralizumab, achieving a sustained reduction in eosinophil levels.
• No adverse events or long-term autoimmune sequelae were reported.

IN PRACTICE:

“Our work highlights a potentially safe and effective alternative to mainline steroid-sparing immunomodulators in reducing eosinophil levels and providing sustained clinical relief” for DRESS, the authors wrote; they called for larger prospective studies to validate the findings.

SOURCE:

The study was led by Baraa Hijaz, Harvard Medical School, Boston. It was published online on April 16 in JAMA Dermatology.

LIMITATIONS:

Study limitations included the retrospective design and a small sample size. Short follow-up was reported in two patients.

DISCLOSURES:

The authors did not disclose any funding source. One author reported receiving royalties from McGraw Hill outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.