抗白细胞介素-5生物制剂治疗严重哮喘的长期疗效评价
2020/11/17
摘要
背景：严重嗜酸细胞性哮喘患者对各种抗白细胞介素5（IL-5）生物制剂有不同的反应，从超级应答到无应答。在部分应答者的残余疾病表现可能会促使医生在生物制剂之间进行转换。需要更多关于反应、转换和残留疾病表现的数据来改进个性化治疗。
目的：评估：（1）长期抗IL-5治疗超、部分和无应答者的发生率和预测因素；（2）抗IL-5生物制剂之间转换的频率和原因；（3）残余疾病表现的性质。
方法：在这项为期2年的随访研究中，包括了使用抗IL-5生物制剂（美泊利单抗、瑞替珠单抗、贝那利珠单抗）的重度哮喘患者（n=114）。在基线检查和2年随访时收集患者特征（临床、功能、炎症）和合并症。
定义：“超级应答者”在2年随访中无残留疾病表现；“部分应答者”出现残留疾病表现，“无应答者”因临床恶化停止抗IL-5治疗<2年。
结果：经2年抗IL-5治疗后，14%的患者为超级应答者，69%为部分应答者，11%为无应答者。哮喘持续时间短、FEV1增高可预测超级反应，且与成人哮喘、无鼻息肉和BMI较低有关。抗IL-5生物制剂之间的转换频繁发生（41%）。经过2年的治疗，最常见的残余疾病表现为肺功能受损（59%）、鼻部疾病（58%）和哮喘症状（48%）。
结论：经2年抗IL-5治疗后，83%的重症哮喘患者有良好的疗效，其中14%为超级应答者。大多数部分应答者存在肺功能受损或鼻部疾病，导致医生在生物制剂之间切换。
Long-term therapy response to anti-interleukin-5 biologics in severe asthma - a real-life evaluation
Katrien Eger, Johannes A Kroes, Anneke Ten Brinke, Elisabeth H Bel.
Abstract
Background: Patients with severe eosinophilic asthma show different responses to various anti-interleukin (IL)-5 biologics, ranging from super- to non-response. Residual disease manifestations observed in partial responders may prompt physicians to switch between biologics. More data on response, switches, and residual disease manifestations are needed to improve personalized treatment.
Objective: To assess; (1) prevalences and predictors of super-, partial- and non-responders to long-term anti-IL-5 treatment, (2) frequency and reasons for switches between anti-IL-5 biologics, (3) nature of residual disease manifestations.
Methods: In this 2-years follow-up study, severe asthma patients were included who initiated an anti-IL-5 biologic (mepolizumab, reslizumab, benralizumab) (n=114). Patient characteristics (clinical, functional, inflammatory) and co-morbidities were collected at baseline and 2-years follow-up.
Definitions: "super-responders" showed no residual disease manifestations at 2-years follow-up; "partial responders" experienced residual disease manifestations, and "non-responders" discontinued anti-IL-5 treatment <2yr because of clinical worsening.
Results: After 2-years anti-IL-5 treatment 14% of patients were super responders, 69% partial responders, and 11% non-responders. Super-response was predicted by shorter asthma duration and higher FEV1, and tended to be associated with adult-onset asthma, absence of nasal polyps and lower BMI. Switches between anti-IL-5 biologics occurred frequently (41%). After 2-years treatment most common residual disease manifestations included impaired lung function (59%), uncontrolled sino-nasal disease (58%) and uncontrolled asthma symptoms (48%).
Conclusion: After 2 years of anti-IL-5 treatment, a favorable response was found in 83% of severe asthma patients, including a super-response in 14%. Most partial responders show impaired lung function or uncontrolled sino-nasal disease, causing physicians to switch between biologics.
背景：严重嗜酸细胞性哮喘患者对各种抗白细胞介素5（IL-5）生物制剂有不同的反应，从超级应答到无应答。在部分应答者的残余疾病表现可能会促使医生在生物制剂之间进行转换。需要更多关于反应、转换和残留疾病表现的数据来改进个性化治疗。
目的：评估：（1）长期抗IL-5治疗超、部分和无应答者的发生率和预测因素；（2）抗IL-5生物制剂之间转换的频率和原因；（3）残余疾病表现的性质。
方法：在这项为期2年的随访研究中，包括了使用抗IL-5生物制剂（美泊利单抗、瑞替珠单抗、贝那利珠单抗）的重度哮喘患者（n=114）。在基线检查和2年随访时收集患者特征（临床、功能、炎症）和合并症。
定义：“超级应答者”在2年随访中无残留疾病表现；“部分应答者”出现残留疾病表现，“无应答者”因临床恶化停止抗IL-5治疗<2年。
结果：经2年抗IL-5治疗后，14%的患者为超级应答者，69%为部分应答者，11%为无应答者。哮喘持续时间短、FEV1增高可预测超级反应，且与成人哮喘、无鼻息肉和BMI较低有关。抗IL-5生物制剂之间的转换频繁发生（41%）。经过2年的治疗，最常见的残余疾病表现为肺功能受损（59%）、鼻部疾病（58%）和哮喘症状（48%）。
结论：经2年抗IL-5治疗后，83%的重症哮喘患者有良好的疗效，其中14%为超级应答者。大多数部分应答者存在肺功能受损或鼻部疾病，导致医生在生物制剂之间切换。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2020 Oct 15; S2213-2198(20)31121-1. doi: 10.1016/j.jaip.2020.10.010.)
(J Allergy Clin Immunol Pract. 2020 Oct 15; S2213-2198(20)31121-1. doi: 10.1016/j.jaip.2020.10.010.)
Long-term therapy response to anti-interleukin-5 biologics in severe asthma - a real-life evaluation
Katrien Eger, Johannes A Kroes, Anneke Ten Brinke, Elisabeth H Bel.
Abstract
Background: Patients with severe eosinophilic asthma show different responses to various anti-interleukin (IL)-5 biologics, ranging from super- to non-response. Residual disease manifestations observed in partial responders may prompt physicians to switch between biologics. More data on response, switches, and residual disease manifestations are needed to improve personalized treatment.
Objective: To assess; (1) prevalences and predictors of super-, partial- and non-responders to long-term anti-IL-5 treatment, (2) frequency and reasons for switches between anti-IL-5 biologics, (3) nature of residual disease manifestations.
Methods: In this 2-years follow-up study, severe asthma patients were included who initiated an anti-IL-5 biologic (mepolizumab, reslizumab, benralizumab) (n=114). Patient characteristics (clinical, functional, inflammatory) and co-morbidities were collected at baseline and 2-years follow-up.
Definitions: "super-responders" showed no residual disease manifestations at 2-years follow-up; "partial responders" experienced residual disease manifestations, and "non-responders" discontinued anti-IL-5 treatment <2yr because of clinical worsening.
Results: After 2-years anti-IL-5 treatment 14% of patients were super responders, 69% partial responders, and 11% non-responders. Super-response was predicted by shorter asthma duration and higher FEV1, and tended to be associated with adult-onset asthma, absence of nasal polyps and lower BMI. Switches between anti-IL-5 biologics occurred frequently (41%). After 2-years treatment most common residual disease manifestations included impaired lung function (59%), uncontrolled sino-nasal disease (58%) and uncontrolled asthma symptoms (48%).
Conclusion: After 2 years of anti-IL-5 treatment, a favorable response was found in 83% of severe asthma patients, including a super-response in 14%. Most partial responders show impaired lung function or uncontrolled sino-nasal disease, causing physicians to switch between biologics.
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