Heart failure & cardiomyopathies
Monoclonal antibodies targeting IL-5/5R or IL-4/13 pathways in eosinophilic myocarditis: a single-centre experience and systematic literature review
Authors' conclusion
In EM within eosinophilic disease, anti-IL-5/5R and anti-IL-4/13 mAbs showed steroid-sparing effects and favourable safety, suggesting potential benefit for disease control.
Study context
- Population
- Patients with eosinophilic myocarditis (EM) treated with mepolizumab, benralizumab, or dupilumab in combination with glucocorticoids and/or immunosuppressantsEM patients included · contemporary cohort 19 · from the literature 18
- Participants
- 37 patients
- Exposure
- mAb group vs EM patients managed with conventional immunosuppressants alone
- Outcome
- Biologic treatments
Methodological detailscomparison with a contemporary cohort, historical cohort treated without monoclonal antibodies (mAbs)
- Comparison with a contemporary cohort
- Historical cohort treated without mAbs
Main finding
As reported in the abstract
- Mepolizumab
- 81%
- Benralizumab
- 14%
- Dupilumab
- 5%
- Median time to mAb initiation
- 2.5 months
- Treatment duration
- 24 months
Observational data: associations, not effects.
Further findings
Myocarditis relapses and follow-up eosinophil counts
Myocarditis relapses
Follow-up eosinophil counts mAb group 0.04 × 109/L · conventional immunosuppressants alone 0.85 × 109/L
EM relapses, deaths, or heart transplantations
- No EM relapses, deaths, or heart transplantations occurred
Glucocorticoids tapered and withdrawn
- Glucocorticoids were tapered and withdrawn
- 89%
LVEF, TnI normalization, eosinophil reduction (contemporary cohort)
- Improved LVEF
- 47%-55%, P = 0.004
- TnI normalization
- 95%-12%, P < 0.001
- Eosinophil reduction
- 95%-11%, P < 0.001
- In the contemporary cohort
Safety
- No mAb discontinuations due to adverse events
Original publication
Monoclonal antibodies targeting IL-5/5R or IL-4/13 pathways in eosinophilic myocarditis: a single-centre experience and systematic literature review. Eur Heart J Cardiovasc Pharmacother. Published 21 April 2026. doi:10.
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