The pitfalls of genetically engineered biological therapy: case report

The pitfalls of genetically engineered biological therapy: case report

N.A. Kuzubova¹, O.N. Titova², D.B. Sklyarova¹, V.A. Volchkov³ 

¹City Multidisciplinary Hospital No. 2, St. Petersburg

²Pavlov First Saint-Petersburg State Medical University, St. Petersburg

³St. Petersburg State University, St. Petersburg 

Asthma is a major health problem worldwide, characterized by high morbidity, mortality and a heavy economic burden. 5–10% of patients have severe asthma, insufficiently controlled by high doses of inhaled glucocorticoids (GCs), and commonly dependent on oral GCs. Currently, exposure to specific mediators involved in the inflammatory cascade with the help of highly selective biological drugs opens up the possibility of achieving optimal disease control in severe type 2 inflammation of asthma. Several monoclonal antibodies, including benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab, have been approved as additional maintenance therapy in severe uncontrolled eosinophilic asthma. These biological drugs are highly effective, help to reduce the number of asthma exacerbations, improve disease control and reduce the need for systemic GCs. In general, biologic drugs are well tolerated by patients. However, an expanding number of studies of real clinical practice show that there is an increased risk of adverse events associated with the use of targeted therapy for asthma, including allergic ones. The article presents a clinical case of a female patient with severe asthma, who was diagnosed with the development of adverse events in the form of redness and swelling (by the urticaria type) of the upper half of the trunk and face after the fifth injection of dupilumab. Awareness concerning the risks of allergic reactions and conditions potentially life-threatening to the patient and associated with the use of monoclonal antibodies is necessary for their proper and safe use.

Keywords: severe asthma, eosinophilic phenotype, genetically engineered biological therapy, targeted therapy, monoclonal antibodies, type 2 immune response, adverse events, allergic reactions, angioedema.

For citation: Kuzubova N.A., Titova O.N., Sklyarova D.B., Volchkov V.A. The pitfalls of genetically engineered biological therapy: case report. RMJ. 2024;1:30–33.