度普利尤单抗治疗呼吸系统疾病患者血液嗜酸性粒细胞增多症的分析：一个真实的快照
2025/03/03
摘要
背景：与度普利尤单抗治疗相关的血嗜酸性粒细胞计数（BEC）短暂且通常无症状的增加已被描述。与BEC增加和症状发生相关的预测因素的研究仍然很少。
目的：研究在接受度普利尤单抗治疗的患有哮喘和/或慢性鼻窦炎伴鼻息肉（CRSwNP）的真实多中心队列患者中，BEC增加的频率、时间、持续时间、临床相关性和潜在预测因素。
方法：评估基线时和普利尤单抗治疗开始后每3个月的BEC和临床状况。还记录了任何药物不良反应。通过随访BEC值<0.5×109细胞/L来定义与普利尤单抗相关的嗜酸性粒细胞增多症的缓解。
结果：总体而言，195名患者中有108名（55%）在开始使用度普利尤单抗后BEC增加，但195名患者中只有29名（14.9%）出现嗜酸性粒细胞增多。BEC峰值出现在治疗开始后6个月，9个月后（中位时间）消退。基线BEC在0.5至1.5个细胞x 109L之间的患者发生嗜酸性粒细胞增多症的概率是3.3倍。在BEC峰值期间，患有并发症的患者和BEC有任何增加的患者出现症状的比例较高。
结论：在现实环境中，度普利尤单抗治疗哮喘和/或CRSwNP患者通常与短暂的BEC增加有关，但很少发生嗜酸性粒细胞增多症。少数受试者观察到与BEC峰值同时出现的症状发作。BEC不应排除度普利尤单抗的启动或继续，但在治疗开始后至少8个月内应进行监测，特别是在基线嗜酸性粒细胞增多/嗜酸性粒细胞增多和/或合并症的情况下。
背景：与度普利尤单抗治疗相关的血嗜酸性粒细胞计数（BEC）短暂且通常无症状的增加已被描述。与BEC增加和症状发生相关的预测因素的研究仍然很少。
目的：研究在接受度普利尤单抗治疗的患有哮喘和/或慢性鼻窦炎伴鼻息肉（CRSwNP）的真实多中心队列患者中，BEC增加的频率、时间、持续时间、临床相关性和潜在预测因素。
方法：评估基线时和普利尤单抗治疗开始后每3个月的BEC和临床状况。还记录了任何药物不良反应。通过随访BEC值<0.5×109细胞/L来定义与普利尤单抗相关的嗜酸性粒细胞增多症的缓解。
结果：总体而言，195名患者中有108名（55%）在开始使用度普利尤单抗后BEC增加，但195名患者中只有29名（14.9%）出现嗜酸性粒细胞增多。BEC峰值出现在治疗开始后6个月，9个月后（中位时间）消退。基线BEC在0.5至1.5个细胞x 109L之间的患者发生嗜酸性粒细胞增多症的概率是3.3倍。在BEC峰值期间，患有并发症的患者和BEC有任何增加的患者出现症状的比例较高。
结论：在现实环境中，度普利尤单抗治疗哮喘和/或CRSwNP患者通常与短暂的BEC增加有关，但很少发生嗜酸性粒细胞增多症。少数受试者观察到与BEC峰值同时出现的症状发作。BEC不应排除度普利尤单抗的启动或继续，但在治疗开始后至少8个月内应进行监测，特别是在基线嗜酸性粒细胞增多/嗜酸性粒细胞增多和/或合并症的情况下。
（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. 2025 Feb 14:S2213-2198(25)00165-5. doi: 10.1016/j.jaip.2025.01.040.）
Profiling blood hypereosinophilia in patients on dupilumab treatment for respiratory conditions: a real-life snapshot
Marco Caminati, Matteo Maule, Diego Bagnasco, Bianca Beghè, Fulvio Braido, Luisa Brussino, Paolo Cameli, Maria Giulia Candeliere, Giovanna Elisiana Carpagnano, Giulia Costanzo, Claudia Crimi, Mariella D'Amato, Stefano Del Giacco, Gabriella Guarnieri, Mona-Rita Yacoub, Claudio Micheletto, Filippo Moletta, Stefania Nicola, Bianca Olivieri, Laura Pini, Michele Schiappoli, Elena Scarpieri, Rachele Vaia, Andrea Vianello, Dina Visca, Antonio Spanevello, Gianenrico Senna, Roberto Benoni
Abstract
Background: Transient and usually asymptomatic increase in blood eosinophil count (BEC) associated with dupilumab treatment has been described. Predicting factors related to BEC increase and symptoms occurrence are still poorly investigated.
Objective: To investigate frequency, timing, duration, clinical relevance and potential predictors of BEC increase in a real-life multicentre cohort of patients affected by asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab.
Methods: BEC and clinical conditions at baseline and every 3 months after dupilumab treatment start were assessed. Any adverse drug reaction was also recorded. Remission of dupilumab-associated eosinophilia was defined by follow-up BEC values < 0.5 x10ˆ9 cells/L.
Results: Overall, 108 out of 195 (55%) patients experienced an increased BEC after dupilumab initiation but only 29 out of 195 (14.9%) showed hypereosinophilia. BEC peak occurred 6 months after the treatment start and resolved after 9 months (median time). Probability of developing hypereosinophilia was 3.3 times higher in patients with baseline BEC between 0.5 and 1.5 cells x 109L. Symptoms occurrence during BEC peak was higher in patients with comorbidities and in patients showing any increase of BEC.
Conclusions: In a real-life setting dupilumab treatment in asthma and/or CRSwNP patients was often associated with transient BEC increase but hypereosinophilia rarely occurred. Onset of symptoms co-occurring with BEC peak was observed in a minority of subjects. BEC should not preclude itself dupilumab initiation or continuation but deserves to be monitored for at least 8 months after the treatment start, particularly in the case of baseline eosinophilia/hypereosinophilia and/or comorbidities.
Marco Caminati, Matteo Maule, Diego Bagnasco, Bianca Beghè, Fulvio Braido, Luisa Brussino, Paolo Cameli, Maria Giulia Candeliere, Giovanna Elisiana Carpagnano, Giulia Costanzo, Claudia Crimi, Mariella D'Amato, Stefano Del Giacco, Gabriella Guarnieri, Mona-Rita Yacoub, Claudio Micheletto, Filippo Moletta, Stefania Nicola, Bianca Olivieri, Laura Pini, Michele Schiappoli, Elena Scarpieri, Rachele Vaia, Andrea Vianello, Dina Visca, Antonio Spanevello, Gianenrico Senna, Roberto Benoni
Abstract
Background: Transient and usually asymptomatic increase in blood eosinophil count (BEC) associated with dupilumab treatment has been described. Predicting factors related to BEC increase and symptoms occurrence are still poorly investigated.
Objective: To investigate frequency, timing, duration, clinical relevance and potential predictors of BEC increase in a real-life multicentre cohort of patients affected by asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab.
Methods: BEC and clinical conditions at baseline and every 3 months after dupilumab treatment start were assessed. Any adverse drug reaction was also recorded. Remission of dupilumab-associated eosinophilia was defined by follow-up BEC values < 0.5 x10ˆ9 cells/L.
Results: Overall, 108 out of 195 (55%) patients experienced an increased BEC after dupilumab initiation but only 29 out of 195 (14.9%) showed hypereosinophilia. BEC peak occurred 6 months after the treatment start and resolved after 9 months (median time). Probability of developing hypereosinophilia was 3.3 times higher in patients with baseline BEC between 0.5 and 1.5 cells x 109L. Symptoms occurrence during BEC peak was higher in patients with comorbidities and in patients showing any increase of BEC.
Conclusions: In a real-life setting dupilumab treatment in asthma and/or CRSwNP patients was often associated with transient BEC increase but hypereosinophilia rarely occurred. Onset of symptoms co-occurring with BEC peak was observed in a minority of subjects. BEC should not preclude itself dupilumab initiation or continuation but deserves to be monitored for at least 8 months after the treatment start, particularly in the case of baseline eosinophilia/hypereosinophilia and/or comorbidities.
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