JAIP:美泊利单抗治疗重度嗜酸性粒细胞性哮喘后的糖皮质激素反应性

2022-07-27 小文子 MedSci原创

研究探索了在接受美泊利单抗治疗的重度嗜酸性粒细胞性哮喘患者中口服糖皮质激素的临床和抗炎作用。

美泊利单抗是治疗重度嗜酸性粒细胞性哮喘的人源性抗 IL-5单克隆抗体。美泊利单抗抑制IL-5的活性,减少重度嗜酸性粒细胞性哮喘(SEA)患者的急性加重频率并维持口服糖皮质激素(OCS)剂量。尽管抗 IL-5 治疗提示残留糖皮质激素反应机制,但一些患者仍依赖 OCS。The Journal of Allergy and Clinical Immunology: In Practice杂志发表了一项研究,确定在接受美泊利单抗治疗的 SEA 患者中 OCS 的临床和抗炎作用。

研究人员在接受美泊利单抗治疗≥12周的 SEA 成人患者中进行了泼尼松龙(0.5 mg/kg/d,最大 40 mg/d,持续14±2 d)的随机、安慰剂对照交叉试验。比较泼尼松龙和安慰剂治疗后哮喘症状、生活质量、肺功能、FeNO、血液和痰嗜酸性粒细胞计数的变化。进行事后探索性分析,根据基线FeNO、血嗜酸性粒细胞计数、和 ACQ-5 评分确定泼尼松龙反应的差异。

27例患者完成了研究。与安慰剂相比,泼尼松龙未改善ACQ-5(泼尼松龙vs安慰剂变化的平均差异为-0.23,95%CI,-0.58~0.11)、mini-AQLQ得分(0.03,95%CI,-0.26~0.42)、SGRQ得分(0.24,95%CI,-3.20~3.69)、总体哮喘症状的VAS评分(0.11,95%CI,-0.58~0.80)。

FEV1有改善趋势(变化的平均差异为105mL,95%CI,-4~213 mL);FEF25-75改善了484 mL/s(95%CI,151~816 mL/s)。与安慰剂相比,泼尼松龙使FeNO降低了41%(95%CI,25%~54%)。泼尼松龙治疗后,血嗜酸性粒细胞计数降低49%(95%CI,31%~62%),痰液嗜酸性粒细胞降低71%(95%CI,26%~89%)。

OCS 可改善小气道阻塞并减少2型炎症生物标志物,但对接受美泊利单抗治疗的重度嗜酸性粒细胞性哮喘患者的症状或生活质量无显著影响。

原文出处:

Yang F, Busby J, Heaney LG, Pavord ID, Brightling CE, Borg K, McDowell JP, Diver SE, Shrimanker R, Bradding P, Shepherd M, Chaudhuri R, on behalf of the Medical Research Council: Refractory Asthma Stratification Programme (RASP-UK Consortium), Corticosteroid responsiveness following mepolizumab in severe eosinophilic asthma - a randomised, placebocontrolled crossover trial [MAPLE], The Journal of Allergy and Clinical Immunology: In Practice (2022), doi: https://doi.org/10.1016/j.jaip.2022.06.050.

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新研究:儿童时期患支气管炎增加中年后患肺病风险!

研究结果有助于医生确定哪些儿童能从更仔细的健康监测和早期干预中受益。

J Allergy Clin Immunol Pract :Dupilumab治疗特应性皮炎时嗜酸性粒细胞计数变化是否影响疗效?

有研究在Dupilumab临床试验中观察到血液中嗜酸性粒细胞计数会有短暂增加,本文就相关临床试验进行了汇总分析。

Allergy:妊娠期使用抗生素增加儿童喘息、哮喘以及特应性进程的风险

母亲在妊娠期间使用抗生素与儿童喘息或哮喘的发生风险增加相关。

Clin Nutr:产前摄入维生素D在儿童哮喘和喘息发生中的作用

产前维生素摄入维生素D可降低后代喘息的风险。但是,该结论是对极低质量的系统综述,因此结果存在疑问。