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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 289-290

Treatment of eosinophilic myositis with mepolizumab


1 Department of Medicine, Sisters of Charity Hospital, Buffalo, NY, USA
2 Department of Medicine, Khyber Teaching Hospital, Peshawar, KPK, Pakistan

Date of Web Publication18-Nov-2018

Correspondence Address:
Dr. Saadia Waheed
Sisters of Charity Hospital, 2157 Main Street, Buffalo, NY 14214
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_105_18

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How to cite this article:
Waheed S, Zubair HM, Waheed F. Treatment of eosinophilic myositis with mepolizumab. Indian J Rheumatol 2018;13:289-90

How to cite this URL:
Waheed S, Zubair HM, Waheed F. Treatment of eosinophilic myositis with mepolizumab. Indian J Rheumatol [serial online] 2018 [cited 2019 Aug 19];13:289-90. Available from: http://www.indianjrheumatol.com/text.asp?2018/13/4/289/242257



Dear Editor,

Mepolizumab is a humanized interleukin-5 (IL) antagonist monoclonal antibody which was initially approved by Food and Drug Administration (FDA) for patients having severe asthma with frequent exacerbations despite being on high-dose steroids.[1],[2] Moreover, recently, the U. S. FDA expanded the approved use of mepolizumab to treat adult patients with eosinophilic granulomatosis with polyangiitis in December 2017. Since IL-5 appears to be a contributing factor in the pathogenesis and progression of the hypereosinophilic syndrome, inhibiting IL-5 is a logical therapeutic objective for patients with hypereosinophilic syndrome. We report a patient with eosinophilic myositis. His disease eventually responded to mepolizumab and it was possible to wean him off of the steroids.

A 42-year-old male with history of chronic sinusitis, asthma, nasal polyps, and intermittent swelling of lips presented with painless and a fluctuant right-sided neck swelling for 2 months with no systemic symptom of weakness, rash, pain, and joint swelling without any skin changes indicative of fasciitis. His initial investigations revealed eosinophilia with antineutrophil cytoplasmic antibodies panel negative for vasculitis. Magnetic resonance imaging (MRI) of the neck was notable for extensive area of edema within the right paraspinal muscles and MRI of left thigh [Figure 1] showed marked edema and enhancement within the medial and posterior thigh compartment with near entire involvement of the adductor magnus muscle and less prominent involvement also seen within the semimembranosus, semitendinosus, and biceps femoris muscles. Electromyography was found to be nonsignificant and muscle biopsy demonstrated eosinophilic infiltrate without any evidence of infection. The patient was initially started on prednisone in a tapering dose of 60 mg for 5 days then decreased to 40 mg for 5 days and then 20 mg × 5 days for neck swelling; he responded adequately and swelling shrunk moderately in size. As the patient had come off of the prednisone, he developed a new soft-tissue swelling on the inner aspect of the right thigh. He was restarted on prednisone 40 mg daily for 5 days then 30 mg for 5 days and then to remain on 20 mg daily, an appropriate response to this treatment was achieved again. It became problematic to wean him off prednisone as every time it resulted in recurrence of soft-tissue swelling. He was then started on mepolizumab, a subcutaneous injection of 100 mg once every 4 weeks for a total duration of about 7 months during which he was off of the steroids and remarkable subjective and objective improvements were noted in terms of recurrent soft-tissue swelling, eosinophilia, and pulmonary function test.
Figure 1: Magnetic resonance imaging left thigh demonstrating notable edema in the medial and posterior thigh compartment

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Consistent with prior published work, our this case shows that administration of anti-IL-5 antibodies, an eosinophil-specific and targeted therapy, has a potential clinical benefit.[3] Mepolizumab durably reduces eosinophil counts along with marked clinical improvement. Furthermore, recent experiments with younger patients encourage redirecting therapeutic strategies toward therapy with lower side effects. Further researches in this regard will help broaden the FDA approved indications for this drug.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014;371:1198-207.  Back to cited text no. 1
    
2.
McCracken JL, Veeranki SP, Ameredes BT, Calhoun WJ. Diagnosis and management of asthma in adults: A review. JAMA 2017;318:279-90.  Back to cited text no. 2
    
3.
Plötz SG, Simon HU, Darsow U, Simon D, Vassina E, Yousefi S, et al. Use of an anti-interleukin-5 antibody in the hypereosinophilic syndrome with eosinophilic dermatitis. N Engl J Med 2003;349:2334-9.  Back to cited text no. 3
    


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