Traitement de la fasciite éosinophilique : stratégies biologiques ciblées et adjuvantes
Contexte clinique
La fasciite éosinophilique est une maladie inflammatoire rare du fascia profond. Ce protocole de première ligne couvre l'ensemble des options thérapeutiques, y compris les cas sévères ou réfractaires au traitement conventionnel, ainsi que ceux présentant une éosinophilie périphérique persistante.
Approche thérapeutique Aperçu partiel
Le protocole intègre des thérapies biologiques ciblées — notamment les inhibiteurs de la voie IL-6, les agents anti-CD20 et les inhibiteurs JAK — ainsi que des modalités adjuvantes. Des options spécifiques sont disponibles pour les patients présentant une éosinophilie périphérique persistante. Les critères de sélection complets, la séquence thérapeutique et tous les paramètres thérapeutiques figurent dans le protocole complet.
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.
View source ↗