哮喘联盟

   摘要
   几年前，奥玛珠单抗就已是治疗重症哮喘的市售药物，至今仍是市场上唯一用于治疗该病的单克隆抗体药物。随后发表的多篇文献证实了奥玛珠单抗的有效性和疗效。同时，有证据显示特应性和非特应性重症哮喘的发病机制存在重叠。然而，对于奥玛珠单抗在非特应性疾病中的治疗价值似乎也存在某些分歧，因为一些研究未显示奥玛珠单抗在这些患者中有任何获益。近期的研究也一直在试图寻找除lgE水平之外的、合适的预测标志物来评价奥玛珠单抗的作用。
   本文简要总结了哮喘的治疗进展、疾病的病理生理学及奥玛珠单抗的作用机制。笔者还对已发表的在不同国家成人和儿童中进行的对照和非对照研究（又称“真实世界的研究”）做了描述，并对目前该药在重症过敏性哮喘管理中的地位提出了个人观点。笔者对奥马珠单抗治疗非特应性患者的最新证据提出了个人观点，并强调了其对当前临床实践的影响和我们的认知差距。笔者认为，奥玛珠单抗不仅仅是一种IgE阻断药，由于其对不同生物通路的多重作用应被视为一种能改善疾病的治疗方法。最后，提出了未来研究的方向。
 

（苏楠 审校）
Drugs. 2014 Apr 2. [Epub ahead of print]

 

Omalizumab for Severe Asthma: Efficacy Beyond the Atopic Patient?
 

Domingo C.
 

ABSTRACT
Several years ago, omalizumab became commercially available for the treatment of severe asthma. It remains the only monoclonal antibody to be marketed for this purpose. Since then, many studies have been published endorsing its efficacy and effectiveness. Concomitantly, evidence of an overlap between atopic and non-atopic severe asthma has emerged. However, there also appears to be some disagreement regarding the value of omalizumab in the management of non-atopic disease, as some studies have failed to show any benefit in these patients. The recent literature has also sought to identify appropriate prognostic biomarkers for the use of omalizumab, other than immunoglobulin (IgE) levels. This article briefly summarizes the evolution of asthma treatment, the pathophysiology of the condition, and the method of action of omalizumab. The author describes the controlled and uncontrolled studies (also named "real-life studies") published in adult and pediatric populations in different countries and expresses his view on the current place of the drug in the management of severe allergic asthma. He offers a personal perspective on the recent evidence for the use of omalizumab in non-atopic patients, highlighting the implications for current clinical practice and the gaps in our knowledge. The author justifies his belief that omalizumab is not only an IgE-blocking drug and should be considered as a disease-modifying therapy because of its multiple effects on different biologic pathways. Finally, some areas for future research are indicated.
 

Drugs. 2014 Apr 2. [Epub ahead of print]