TOPLINE

Patients with drug reaction with eosinophilia and systemic symptoms (DRESS) who received interleukin-5 inhibitor (IL-5i) with corticosteroids tapered and discontinued steroids and cleared eosinophilia faster than those who received corticosteroids alone. 

METHODOLOGY

• Researchers conducted a retrospective cohort study of 73 adults hospitalized with DRESS (53% women) at three Boston hospitals from January to October 2025.
• Patients had a European Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) score of four or greater. Ten received an IL-5i with corticosteroids (mepolizumab or benralizumab; median age, 58 years) at a median of 4 days after diagnosis, and 63 received corticosteroids alone (median age, 57 years).
• Study outcomes were time to taper to a prednisone-equivalent dose of 0.5 mg/kg per day or less, time to corticosteroid discontinuation, and time to eosinophilia resolution.

TAKEAWAY

• IL-5i recipients stopped corticosteroids sooner than controls (hazard ratio [HR], 2.39; P = .01) and reported faster tapering to a dose of 0.5 mg/kg per day or less (HR, 2.67; P = .006). Eosinophilia resolution was also faster with IL-5i (HR, 3.23; P = .005). 
• Median total corticosteroid exposure was lower with IL-5i (20.9 vs 28.4 mg/kg).
• Rebound symptoms with rising eosinophilia occurred in 10% of IL-5i recipients vs 25% of those who received corticosteroids only. Among corticosteroid-only recipients, steroids were escalated or restarted in 75% of those with rebound and readmission for DRESS complications occurred in 13%; none of the IL-5i recipients were readmitted.
• Researchers identified no serious adverse events with IL-5i.

IN PRACTICE

"Our findings may help expand options for steroid-sparing DRESS treatments while recognizing that cost and access remain barriers to widespread IL-5i use," the authors wrote.

SOURCE

The study was led by Beatrix B. Thompson, BA, Department of Dermatology, Massachusetts General Hospital, Boston. It was published online on October 21 in JAMA Dermatology.

LIMITATIONS

The study was limited by its retrospective design, small sample size, and selection bias, and the differences between outpatient and inpatient management were not accounted for.

DISCLOSURES

No funding source was reported. Nambudiri disclosed grant support from the American Academy of Dermatology and the American Board of Medical Specialties, plus honoraria from Merck, Elsevier, and McGraw-Hill. Imadojemu disclosed research funding from Priovant Therapeutics. DeWane disclosed owning shares in Veradermics, and Chen disclosed personal fees from AbbVie. All disclosures were outside the submitted work. Full disclosures are reported in the original source article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.