重度嗜酸性哮喘患者对美泊利珠单抗治疗反应向缓解的不同轨迹
2024/10/29
摘要
以高疾病负担为特征的重度嗜酸性哮喘患者受益于美泊利珠单抗，它可以改善症状并减少恶化，可能导致亚组的临床缓解。本研究旨在确定美泊利珠单抗对重度嗜酸性哮喘的治疗反应轨迹，并评估临床缓解的现实情况。来自澳大利亚Mepolizumab登记处的数据用于评估3、6和12个月时的治疗反应。使用基于组的轨迹模型确定治疗反应轨迹。在轨迹之间比较了12个月时达到临床缓解的比例，即症状得到良好控制、没有恶化、没有口服皮质类固醇（OCS）用于哮喘管理，并使用逻辑回归分析确定了轨迹的基线预测因素。我们确定了三个轨迹组：第1组，反应性哮喘，OCS使用较少（n=170）；第2组，反应性迟发性哮喘（n=58）；第3组为阻塞性和反应性较差的哮喘（n=70）。第1组和第2组的临床缓解率分别为36.5%和25.9%，高于第3组的5.7%（p<0.001）。以第3组为参照，指定组的基线预测因素包括第1组较低的OCS剂量；第2组预测的FEV1%越大，哮喘生活质量问卷得分越高，OCS剂量越高，鼻息肉越严重。重度嗜酸性哮喘患者对美泊利珠单抗的治疗反应遵循3条轨迹，实现临床缓解的比例不同，基线特征也不同。治疗反应的变异性可能会影响美泊利珠单抗治疗的临床缓解。
Distinct trajectories of treatment response to mepolizumab toward remission in patients with severe eosinophilic asthma
Yuto Hamada, Dennis Thomas, Erin S Harvey, Sean Stevens, Michael Fricker, Hayley Lewthwaite, Vanessa M McDonald, Andrew Gillman, Mark Hew, Vicky Kritikos, John W Upham, Peter G Gibson
Abstract
Patients with severe eosinophilic asthma, characterised by a high disease burden, benefit from mepolizumab, which improves symptoms and reduces exacerbations, potentially leading to clinical remission in a subgroup. This study aimed to identify treatment response trajectories to mepolizumab for severe eosinophilic asthma and to assess the achievement of clinical remission.Data from the Australian Mepolizumab Registry were used to assess treatment responses at 3, 6, and 12 months. The treatment response trajectories were identified using a group-based trajectory model. The proportions achieving clinical remission at 12 months, which was defined as well-controlled symptoms, no exacerbations, and no oral corticosteroid (OCS) use for asthma management, were compared between trajectories, and baseline predictors of the trajectories were identified using logistic regression analysis.We identified three trajectory groups: group 1, responsive asthma with less OCS use (n=170); group 2, responsive late-onset asthma (n=58); and group 3, obstructed and less responsive asthma (n=70). Groups 1 and 2 demonstrated higher proportions achieving clinical remission at 36.5% and 25.9%, respectively, compared to group 3 with 5.7% (p <0.001). Baseline predictors for assigned groups included lower OCS dose in group 1; greater FEV1% predicted, higher Asthma Quality of Life Questionnaire score, higher OCS dose, and nasal polyps in group 2; with group 3 as the reference.Treatment response to mepolizumab in severe eosinophilic asthma follows 3 trajectories with varying proportions achieving clinical remission and differing baseline characteristics. Treatment response variability may influence the achievement of clinical remission with mepolizumab therapy.
以高疾病负担为特征的重度嗜酸性哮喘患者受益于美泊利珠单抗，它可以改善症状并减少恶化，可能导致亚组的临床缓解。本研究旨在确定美泊利珠单抗对重度嗜酸性哮喘的治疗反应轨迹，并评估临床缓解的现实情况。来自澳大利亚Mepolizumab登记处的数据用于评估3、6和12个月时的治疗反应。使用基于组的轨迹模型确定治疗反应轨迹。在轨迹之间比较了12个月时达到临床缓解的比例，即症状得到良好控制、没有恶化、没有口服皮质类固醇（OCS）用于哮喘管理，并使用逻辑回归分析确定了轨迹的基线预测因素。我们确定了三个轨迹组：第1组，反应性哮喘，OCS使用较少（n=170）；第2组，反应性迟发性哮喘（n=58）；第3组为阻塞性和反应性较差的哮喘（n=70）。第1组和第2组的临床缓解率分别为36.5%和25.9%，高于第3组的5.7%（p<0.001）。以第3组为参照，指定组的基线预测因素包括第1组较低的OCS剂量；第2组预测的FEV1%越大，哮喘生活质量问卷得分越高，OCS剂量越高，鼻息肉越严重。重度嗜酸性哮喘患者对美泊利珠单抗的治疗反应遵循3条轨迹，实现临床缓解的比例不同，基线特征也不同。治疗反应的变异性可能会影响美泊利珠单抗治疗的临床缓解。
(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)
(Eur Respir J. 2024 Oct 10:2400782. doi: 10.1183/13993003.00782-2024.)
(Eur Respir J. 2024 Oct 10:2400782. doi: 10.1183/13993003.00782-2024.)
Distinct trajectories of treatment response to mepolizumab toward remission in patients with severe eosinophilic asthma
Yuto Hamada, Dennis Thomas, Erin S Harvey, Sean Stevens, Michael Fricker, Hayley Lewthwaite, Vanessa M McDonald, Andrew Gillman, Mark Hew, Vicky Kritikos, John W Upham, Peter G Gibson
Abstract
Patients with severe eosinophilic asthma, characterised by a high disease burden, benefit from mepolizumab, which improves symptoms and reduces exacerbations, potentially leading to clinical remission in a subgroup. This study aimed to identify treatment response trajectories to mepolizumab for severe eosinophilic asthma and to assess the achievement of clinical remission.Data from the Australian Mepolizumab Registry were used to assess treatment responses at 3, 6, and 12 months. The treatment response trajectories were identified using a group-based trajectory model. The proportions achieving clinical remission at 12 months, which was defined as well-controlled symptoms, no exacerbations, and no oral corticosteroid (OCS) use for asthma management, were compared between trajectories, and baseline predictors of the trajectories were identified using logistic regression analysis.We identified three trajectory groups: group 1, responsive asthma with less OCS use (n=170); group 2, responsive late-onset asthma (n=58); and group 3, obstructed and less responsive asthma (n=70). Groups 1 and 2 demonstrated higher proportions achieving clinical remission at 36.5% and 25.9%, respectively, compared to group 3 with 5.7% (p <0.001). Baseline predictors for assigned groups included lower OCS dose in group 1; greater FEV1% predicted, higher Asthma Quality of Life Questionnaire score, higher OCS dose, and nasal polyps in group 2; with group 3 as the reference.Treatment response to mepolizumab in severe eosinophilic asthma follows 3 trajectories with varying proportions achieving clinical remission and differing baseline characteristics. Treatment response variability may influence the achievement of clinical remission with mepolizumab therapy.
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