Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jan;13(1):167-175.e6.
doi: 10.1016/j.jaip.2024.10.036. Epub 2024 Nov 6.

Dupilumab Use in Patients With Hypereosinophilic Syndromes: A Multicenter Case Series and Review of the Literature

Ejiofor A D Ezekwe Jr  1 , Andrew L Weskamp  2 , Rodaba Rahim  1 , Michelle A Makiya  1 , Lauren Wetzler  1 , JeanAnne M Ware  1 , Celeste Nelson  1 , Perla Adames Castillo  1 , Charles A Riley  3 , Thomas Brown  1 , Lori Penrod  1 , Gregory M Constantine  1 , Paneez Khoury  1 , Nathan A Boggs  4 , Amy D Klion  5
Affiliations
Review

Dupilumab Use in Patients With Hypereosinophilic Syndromes: A Multicenter Case Series and Review of the Literature

Ejiofor A D Ezekwe Jr et al. J Allergy Clin Immunol Pract. 2025 Jan.

Abstract

Background: Hypereosinophilic syndromes (HES) are defined as hypereosinophilia with eosinophil-related clinical manifestations, some of which overlap in presentation with asthma, atopic dermatitis, eosinophilic esophagitis, and/or chronic rhinosinusitis with nasal polyps. Dupilumab is approved to treat these conditions but can induce a transient rise in the absolute eosinophil count and rare eosinophil-related complications.

Objective: To determine whether eosinophil-related complications of dupilumab are increased in HES.

Methods: Retrospective chart review of patients with HES treated with dupilumab enrolled on an institutional review board-approved research protocol at the National Institutes of Health (NCT00001406) or receiving care at Walter Reed National Military Medical Center. Clinical response and treatment-emergent adverse events were recorded. Serum mediators were assessed in a subset of patients before and after dupilumab using stored samples.

Results: Among the 28 patients (15 male, 13 female; median age 41.5 y), the most common prescribing indication for dupilumab was chronic rhinosinusitis with nasal polyps (n = 11). Twenty-three patients (82%) showed significant clinical improvement on dupilumab. Hypereosinophilia (absolute eosinophil count > 1.5 × 109/L) recurred or worsened in 9 of 20 patients on dupilumab monotherapy. Moreover, 4 of 20 (20%) patients developed an eosinophil-related complication with dupilumab discontinuation and/or addition of eosinophil-lowering therapy. None of the 8 patients who received dupilumab while in hematological remission on an eosinophil-lowering biologic developed hypereosinophilia or an eosinophil-related complication. Serum immunoglobulin E and eotaxin levels decreased on dupilumab therapy.

Conclusions: These data suggest that dupilumab is effective in treating residual symptoms in HES patients but that the incidence of eosinophil-related complications is increased. Concomitant eosinophil-lowering therapy may reduce the risk of eosinophil-related complications during dupilumab therapy in patients with HES.

Keywords: Benralizumab; Biologic therapy; Dupilumab; Eosinophil; Hypereosinophilia; Hypereosinophilic syndrome; Mepolizumab; Reslizumab.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors report no conflicts of interest to disclose.

References

    1. Oykhman P, Paramo FA, Bousquet J, Kennedy DW, Brignardello-Petersen R, Chu DK. Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis. J Allergy Clin Immunol. 2022. Apr;149(4):1286–95. - PubMed
    1. Wechsler ME, Klion AD, Paggiaro P, Nair P, Staumont-Salle D, Radwan A, et al. Effect of dupilumab on blood eosinophil counts in patients with asthma, chronic rhinosinusitis with nasal polyps, atopic dermatitis, or eosinophilic esophagitis. J Allergy Clin Immunol Pract. 2022. Oct;10(10):2695–709. - PubMed
    1. Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med. 2018. Jun 28;378(26):2486–96. - PubMed
    1. Caminati M, Olivieri B, Dama A, Micheletto C, Paggiaro P, Pinter P, et al. Dupilumab-induced hypereosinophilia: review of the literature and algorithm proposal for clinical management. Expert Rev Respir Med. 2022. Jul;16(7):713–21. - PubMed
    1. Briegel I, Felicio-Briegel A, Mertsch P, Kneidinger N, Haubner F, Milger K. Hypereosinophilia with systemic manifestations under dupilumab and possibility of dual benralizumab and dupilumab therapy in patients with asthma and CRSwNP. J Allergy Clin Immunol Pract. 2021. Dec;9(12):4477–9. - PubMed

MeSH terms

Substances

LinkOut - more resources