Medicine, Procedures, Therapies

Successful Treatment of Eosinophilic Cystitis

Eosinophilic Cystitis (EoC) is a rare form of Interstitial Cystitis characterized by eosinophilic infiltration of the bladder wall.

Link to the article – [November 2020]

Eosinophilic Cystitis (EoC) is a rare form of Interstitial Cystitis. It can be chronic and debilitating due to urinary frequency, dysuria (painful urination), incontinence, and frequent urinary tract infections. Treatment of eosinophilic disorders has recently been improved with the use of monoclonal antibodies directed at interleukin 5. In a case study of Eosinophilic Cystitis treated with the interleukin 5 antagonist, Benralizumab, the patient had significant improvement in both quality of life measures and biopsy findings.

Benralizumab, sold under the brand name Fasenra, is a monoclonal antibody medication which is developed by MedImmune for the treatment of asthma. Nearly 7 out of 10 adults with asthma may have eosinophilic asthma. Everyone has eosinophils, but people living with eosinophilic asthma can have too many.

The etiology/cause of EoC is for the most part unknown, although some reports have been attributed to medications, infection, bladder trauma, or hypereosinophilic syndrome (medical condition caused by an overload of white blood cells called eosinophils). Due to the rarity of this condition, most of the literature is restricted to small case studies or single case reports.

The treatment of eosinophilic disorders has recently been revolutionized by the arrival of monoclonal antibodies (mAbs) directed at interleukin-5 (Il-5), a chemotactic cytokine for eosinophils.

The case study described the successful use of the Il-5 receptor antagonist, Benralizumab, in the patient with EoC. The patient had both improved quality of life (QoL) as measured by the UDI-6, symptomatic relief, and histologic resolution of her eosinophilic infiltration. It is believed this is the first report of the use of the biologic Benralizumab in this condition. The patient demonstrates the possibility that biologic intervention with Il-5 antagonists may be a new standard in the treatment of EoC, and one that should be further addressed in formal clinical trials.

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