From the Research
The primary treatment for eosinophilic pneumonia is corticosteroid therapy, with oral prednisone typically prescribed at 0.5-1 mg/kg/day for acute cases, but recent evidence suggests that mepolizumab at a dose of 100 mg administered every 4 weeks may be a promising alternative for preventing relapses in chronic eosinophilic pneumonia. The treatment regimen usually continues for 2-4 weeks before gradually tapering over 2-3 months 1. For severe cases requiring hospitalization, intravenous methylprednisolone at 60-125 mg every 6 hours may be initiated until clinical improvement occurs. Most patients respond dramatically to steroids within 24-48 hours. For chronic eosinophilic pneumonia, longer treatment courses of 6-12 months are often necessary to prevent relapse, but a study found that a dose regimen of 100 mg of mepolizumab administered every 4 weeks emerges as a promising and well-tolerated therapeutic approach for averting relapses of idiopathic chronic eosinophilic pneumonia 2. In steroid-resistant cases, alternative immunosuppressants like azathioprine (2-3 mg/kg/day) or mycophenolate mofetil (1000-1500 mg twice daily) may be considered. If the condition is secondary to medication use, discontinuation of the offending drug is essential. Supportive care including oxygen therapy and respiratory support may be needed during the acute phase. Corticosteroids are effective because they suppress the inflammatory response by inhibiting eosinophil activation and recruitment to the lungs, reducing the release of inflammatory mediators that cause lung damage. However, recent studies have shown that benralizumab, an IL-5Rα antagonist, may also be a reasonable therapy choice for patients with chronic eosinophilic pneumonia, especially those who are dependent on or resistant to corticosteroids 3.
Some key points to consider in the treatment of eosinophilic pneumonia include:
- The use of corticosteroids as the primary treatment, with oral prednisone being a common choice
- The potential for relapse in chronic eosinophilic pneumonia, and the need for longer treatment courses to prevent this
- The emergence of alternative treatments, such as mepolizumab and benralizumab, which may be useful in steroid-resistant cases or for preventing relapses
- The importance of supportive care, including oxygen therapy and respiratory support, during the acute phase of the illness.
It's worth noting that the evidence for the use of inhaled corticosteroids in eosinophilic pneumonia is limited, and a study found that inhaled corticosteroids may not be effective when given as monotherapy in patients with chronic eosinophilic pneumonia 4. Therefore, the use of oral corticosteroids or alternative treatments like mepolizumab or benralizumab is generally recommended.