Treatment of Eosinophilic Fasciitis: Targeted Biologic and Adjuvant Strategies
Clinical Context
Eosinophilic fasciitis is a rare inflammatory disorder of the deep fascia. This first-line protocol addresses the full range of therapeutic options, including cases that are severe or refractory to conventional treatment, and those presenting with sustained peripheral eosinophilia.
Treatment Approach Partial Preview
The protocol incorporates targeted biologic therapies — including IL-6 pathway inhibitors, anti-CD20 agents, and JAK inhibitors — alongside adjuvant modalities. Specific options are available for patients with sustained peripheral eosinophilia. Full selection criteria, sequencing, and all therapeutic parameters are in the complete protocol.
References
DOI: 10.1007/s40674-024-00222-6
- IL-6 blocking by a humanized monoclonal antibody, tocilizumab, recently has gained interest in the treatment of EF when other more conventional agents such as methotrexate or mycophenolate mofetil are not working as a second-line glucocorticoid-sparing agents.
- A total of 8 cases of patients with refractory EF have been reported who successfully respond to rituximab. Thus, this biological therapy could be a therapeutical option in severe and refractory cases of EF.
- Patients with EF refractory to conventional therapy have been reported with a successful response to any one of the JAK inhibitors, baricitinib or tofacitinib.
- It is well-known that IL-5 plays a role in the maturation, recruitment, and proliferation of eosinophils, thus it seems logical that monoclonal antibodies directed to the cytokine (mepolizumab or reslizumab, human monoclonal antibodies against IL-5) or to their receptor (benralizumab) may be useful in some cases that do not respond to the usual therapy with prednisone or immunosuppressive drugs.
- At least in those patients with sustained peripheral eosinophilia.
- UVA-1 phototherapy or irradiation (90 J/cm, for 40 consecutive sessions, 3–4 times a week) is an alternative therapy for difficult cases of EF.
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