生物制剂在哮喘中的作用
2020/01/02
摘要
与控制良好的哮喘患者相比，重度未控制哮喘患者的发病率以及卫生保健使用率高得不成比例。这些患者的治疗方案以前是有限的，且其副作用是不可接受的，但生物制剂疗法的出现为这些患者提供了希望。生物疗法是针对哮喘发病机制中所涉及的特定炎症通路，特别是Th2相关性支气管哮喘表型患者。在过去的十多年里，抗IgE疗法已经改善了过敏性哮喘的治疗效果，三种抗IL-5生物制剂和一种抗IL-4R生物制剂最近被认为是治疗T2哮喘的有效药物。在恰当的患者中应用靶向治疗可以减少哮喘发作，改善肺功能，减少口服糖皮质激素的应用，并改善患者的生活质量。除了目前已批准的生物制剂，一些针对上游炎症介质的生物制剂正在进行临床试验，可能即将获得批准。本文将回顾目前已获批准的治疗重度未控制哮喘的每种生物制剂的作用机制、适应症、预期疗效和副作用，并探讨未来潜在的治疗靶点。
Role of Biologics in Asthma.
McGregor MC, et al. Am J Respir Crit Care Med. 2018 Dec 10.
Abstract
Patients with severe uncontrolled asthma have disproportionally high morbidity and health care utilization as compared to their peers with well-controlled disease. While treatment options for these patients were previously limited with unacceptable side effects, the emergence of biologic therapies for the treatment of asthma has provided promising targeted therapy for these patients. Biologic therapies target specific inflammatory pathways involved in the pathogenesis of asthma, particularly in patients with an endotype driven by type 2 (T2) inflammation. In addition to anti-IgE therapy that has improved outcomes in allergic asthma for over a decade, three anti-IL-5 biologics and one anti-IL-4R biologic have recently emerged as promising treatments for T2 asthma. These targeted therapies have been shown to reduce asthma exacerbations, improve lung function, reduce oral corticosteroid use, and improve quality of life in appropriately selected patients. In addition to the currently approved biologic agents, several biologics targeting upstream inflammatory mediators are in clinical trials with possible approval on the horizon. This article will review the mechanism of action, indications, expected benefits, and side effects of each of the currently approved biologics for severe uncontrolled asthma, as well as discuss promising therapeutic targets for the future.
与控制良好的哮喘患者相比，重度未控制哮喘患者的发病率以及卫生保健使用率高得不成比例。这些患者的治疗方案以前是有限的，且其副作用是不可接受的，但生物制剂疗法的出现为这些患者提供了希望。生物疗法是针对哮喘发病机制中所涉及的特定炎症通路，特别是Th2相关性支气管哮喘表型患者。在过去的十多年里，抗IgE疗法已经改善了过敏性哮喘的治疗效果，三种抗IL-5生物制剂和一种抗IL-4R生物制剂最近被认为是治疗T2哮喘的有效药物。在恰当的患者中应用靶向治疗可以减少哮喘发作，改善肺功能，减少口服糖皮质激素的应用，并改善患者的生活质量。除了目前已批准的生物制剂，一些针对上游炎症介质的生物制剂正在进行临床试验，可能即将获得批准。本文将回顾目前已获批准的治疗重度未控制哮喘的每种生物制剂的作用机制、适应症、预期疗效和副作用，并探讨未来潜在的治疗靶点。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(McGregor MC, et al. Am J Respir Crit Care Med. 2018 Dec 10.)
(McGregor MC, et al. Am J Respir Crit Care Med. 2018 Dec 10.)
Role of Biologics in Asthma.
McGregor MC, et al. Am J Respir Crit Care Med. 2018 Dec 10.
Abstract
Patients with severe uncontrolled asthma have disproportionally high morbidity and health care utilization as compared to their peers with well-controlled disease. While treatment options for these patients were previously limited with unacceptable side effects, the emergence of biologic therapies for the treatment of asthma has provided promising targeted therapy for these patients. Biologic therapies target specific inflammatory pathways involved in the pathogenesis of asthma, particularly in patients with an endotype driven by type 2 (T2) inflammation. In addition to anti-IgE therapy that has improved outcomes in allergic asthma for over a decade, three anti-IL-5 biologics and one anti-IL-4R biologic have recently emerged as promising treatments for T2 asthma. These targeted therapies have been shown to reduce asthma exacerbations, improve lung function, reduce oral corticosteroid use, and improve quality of life in appropriately selected patients. In addition to the currently approved biologic agents, several biologics targeting upstream inflammatory mediators are in clinical trials with possible approval on the horizon. This article will review the mechanism of action, indications, expected benefits, and side effects of each of the currently approved biologics for severe uncontrolled asthma, as well as discuss promising therapeutic targets for the future.
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糠酸莫米松联合福莫特罗与糠酸莫米松治疗的严重哮喘事件比较
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抗IgE单克隆抗体奥马珠单抗通过与Fcγ受体结合引起不良反应
