Duo biologic therapy using mepolizumab and omalizumab in refractory ABPA: two cases

Background Allergic bronchopulmonary aspergillosis (ABPA) presents with a wide range of symptom severity, with severe disease manifestations being harder to control through conventional inhalers. While corticosteroids remain a standard treatment option, their use is often hindered by significant adverse side effects. This case series discusses a novel treatment of duo-administration of monoclonal antibodies for two patients that reduced their exacerbations, spared the use of steroids, and improved their quality of life. Case presentation Both patients were diagnosed with ABPA. Before the administration of treatment, they experienced almost monthly exacerbations and infections requiring constant systemic oral corticosteroids and antibiotics. After the implementation of successive concomitant monoclonal antibody treatments, absolute eosinophil levels were brought down to normal levels, and the monthly exacerbations were eliminated. Conclusion This case series describes a novel approach for ABPA therapy that holds potential in improving patient outcomes for those with severe ABPA. Duo biologic therapy may improve disease control and reduce corticosteroid reliance in patients with refractory ABPA by targeting multiple mechanistic pathways of inflammation. Mepolizumab with Omalizumab offers a potential treatment strategy to reduce exacerbation frequency and severity and has minimal adverse effects.