根据血清游离IgE水平可以指导减少奥马珠单抗的剂量：一个病例报告
2017/11/20
摘要
背景：奥马珠单抗是一种人产生的对抗IgE的IgG1抗体，用于治疗有严重哮喘症状的哮喘患者。根据全球哮喘组织制定的指南，奥马珠单抗是治疗步骤5中的一种附加药物，用于治疗对过敏原常年过敏的严重哮喘患者。奥马珠单抗对重症哮喘的治疗效果在多项临床研究中均已得到验证。然而，奥马珠单抗对IgE产生的长期影响和奥马珠单抗的重置用药剂量的可能性尚不清楚。
病例介绍：测量一位63岁的在36个月内每双周服用375mg奥马珠单抗的女性过敏性哮喘患者的血清总IgE和血清游离IgE水平。将奥马珠单抗的剂量减少至每月375mg后该患者的症状没有恶化，并且临床进程仍然良好。在奥马珠单抗的剂量减少后血清游离IgE水平有短暂升高。血清游离IgE水平在降低剂量后的4周内暂时升高，然而，在此之后，血清游离IgE水平就降低至预期水平（低于30 ng/mL）。
结论：本病例显示在长期使用奥马珠单抗后减少剂量是可能的。考虑到奥马珠单抗的高医疗成本，减少其剂量是一个可行的选择。监测其血清游离IgE水平以恰当地确定可以减少剂量的患者，并仔细监测其临床进程可能是有用的。
Serum free IgE guided dose reduction of omalizumab: a case report.
Gon Y1, Ito R1, Maruoka S1, Mizumura K1, Kozu Y1, Hiranuma H1, Iida Y1, Shikano S1, Hashimoto S1.
Abstract
BACKGROUND: Omalizumab is a human IgG1 antibody against IgE used as a therapy for sever asthmatic patients with asthma. According to the guidelines of the Global Initiative for Asthma, omalizumab is an add-on drug at treatment step 5 that is used for severe asthma patients who are allergic to perennial allergens. The effects of omalizumab for severe asthma therapy have been validated in multiple clinical studies. However, the long-term effects of omalizumab on IgE production and possibility of resetting of administration dose of omalizumab remain unknown.
CASE PRESENTATION: The serum total and free IgE levels were measured over time in a 63-year-old female patient with allergic asthma who was administered 375 mg omalizumab biweekly for 36 months. Her symptoms did not worsen and clinical course remained favorable after reducing the dose to 375 mg per month. The serum free IgE levels temporarily increased following a dose reduction of omalizumab. The serum free IgE trough level temporarily increased at 4 weeks after capable to reduce the dosage; however, thereafter, the serum free IgE level decreased to desired levels (below 30 ng/mL).
CONCLUSIONS: The present case shows the possibility of reducing the dose following the long-term use of omalizumab. Considering the high medical cost of omalizumab, the dose reduction may be a viable option. It may be useful to measure the serum free IgE level to appropriately identify patients in whom the dose can be reduced, and to carefully monitor the clinical course.
背景：奥马珠单抗是一种人产生的对抗IgE的IgG1抗体，用于治疗有严重哮喘症状的哮喘患者。根据全球哮喘组织制定的指南，奥马珠单抗是治疗步骤5中的一种附加药物，用于治疗对过敏原常年过敏的严重哮喘患者。奥马珠单抗对重症哮喘的治疗效果在多项临床研究中均已得到验证。然而，奥马珠单抗对IgE产生的长期影响和奥马珠单抗的重置用药剂量的可能性尚不清楚。
病例介绍：测量一位63岁的在36个月内每双周服用375mg奥马珠单抗的女性过敏性哮喘患者的血清总IgE和血清游离IgE水平。将奥马珠单抗的剂量减少至每月375mg后该患者的症状没有恶化，并且临床进程仍然良好。在奥马珠单抗的剂量减少后血清游离IgE水平有短暂升高。血清游离IgE水平在降低剂量后的4周内暂时升高，然而，在此之后，血清游离IgE水平就降低至预期水平（低于30 ng/mL）。
结论：本病例显示在长期使用奥马珠单抗后减少剂量是可能的。考虑到奥马珠单抗的高医疗成本，减少其剂量是一个可行的选择。监测其血清游离IgE水平以恰当地确定可以减少剂量的患者，并仔细监测其临床进程可能是有用的。
（中日友好医院呼吸与危重症医学科 禹汶伯 摘译 林江涛 审校）
（Allergy Asthma Clin Immunol. 2017 Aug 31;13:39. doi: 10.1186/s13223-017-0211-z. eCollection 2017.）
（Allergy Asthma Clin Immunol. 2017 Aug 31;13:39. doi: 10.1186/s13223-017-0211-z. eCollection 2017.）
Serum free IgE guided dose reduction of omalizumab: a case report.
Gon Y1, Ito R1, Maruoka S1, Mizumura K1, Kozu Y1, Hiranuma H1, Iida Y1, Shikano S1, Hashimoto S1.
Abstract
BACKGROUND: Omalizumab is a human IgG1 antibody against IgE used as a therapy for sever asthmatic patients with asthma. According to the guidelines of the Global Initiative for Asthma, omalizumab is an add-on drug at treatment step 5 that is used for severe asthma patients who are allergic to perennial allergens. The effects of omalizumab for severe asthma therapy have been validated in multiple clinical studies. However, the long-term effects of omalizumab on IgE production and possibility of resetting of administration dose of omalizumab remain unknown.
CASE PRESENTATION: The serum total and free IgE levels were measured over time in a 63-year-old female patient with allergic asthma who was administered 375 mg omalizumab biweekly for 36 months. Her symptoms did not worsen and clinical course remained favorable after reducing the dose to 375 mg per month. The serum free IgE levels temporarily increased following a dose reduction of omalizumab. The serum free IgE trough level temporarily increased at 4 weeks after capable to reduce the dosage; however, thereafter, the serum free IgE level decreased to desired levels (below 30 ng/mL).
CONCLUSIONS: The present case shows the possibility of reducing the dose following the long-term use of omalizumab. Considering the high medical cost of omalizumab, the dose reduction may be a viable option. It may be useful to measure the serum free IgE level to appropriately identify patients in whom the dose can be reduced, and to carefully monitor the clinical course.
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