Schumann Christian, Kropf Cornelia, Wibmer Thomas, Rüdiger Stefan, Stoiber Kathrin Magdalena, Thielen Antje, Rottbauer Wolfgang, Kroegel Claus
Department of Internal Medicine II, University of Ulm Medical Center, Ulm, Germany.
Clin Respir J. 2012 Oct;6(4):215-27. doi: 10.1111/j.1752-699X.2011.00263.x. Epub 2011 Aug 9.
Although the efficacy and safety of omalizumab (OMA) in uncontrolled severe allergic asthma has been demonstrated in several randomised controlled trials (RCTs), information on the treatment in a practice-related setting is limited. Thus, the purpose of this prospective multi-centre study (XCLUSIVE) was to investigate the efficacy, compliance and utilisation of OMA therapy in real-life clinical practice in Germany.
One hundred ninety-five asthmatic patients initiated on anti-Immunoglobulin E (IgE) IgE treatment were followed-up for 6 months. Forced expiratory volume in 1 s (FEV(1) ), exacerbation rate, days of absence, asthma symptoms [Asthma Control Questionnaire (ACQ)], a Global Evaluation of Treatment Effectiveness (GETE) and medication use were assessed.
Measured outcome variables improved after a 16-week treatment period with OMA (FEV(1) +13.7% predicted P < 0.05, exacerbation rate -74.9% P < 0.0001, days of absence -92.1% P < 0.001, ACQ -43.7% P < 0.0001). Investigators evaluated the effectiveness of OMA by GETE in 78.8% as excellent or good (responder), and in 12.6%/8.6% as moderate/poor or worse (non-responder). Responders demonstrated better improvement of FEV(1), exacerbation rate, days of absence, ACQ and reduction of oral corticosteroids compared with non-responders.
Results of effectiveness strongly suggest that the efficacy demonstrated in RCTs can be transposed to a clinical practice-related setting.
尽管在多项随机对照试验(RCT)中已证实奥马珠单抗(OMA)治疗未控制的重度过敏性哮喘的疗效和安全性,但在实际临床环境中的治疗信息有限。因此,这项前瞻性多中心研究(XCLUSIVE)的目的是调查OMA治疗在德国实际临床实践中的疗效、依从性和使用情况。
195例开始接受抗免疫球蛋白E(IgE)治疗的哮喘患者接受了6个月的随访。评估了第1秒用力呼气容积(FEV₁)、加重率、缺勤天数、哮喘症状[哮喘控制问卷(ACQ)]、治疗效果总体评估(GETE)和药物使用情况。
在接受OMA治疗16周后,测量的结果变量有所改善(FEV₁较预计值增加13.7%,P<0.05;加重率降低74.9%,P<0.0001;缺勤天数减少92.1%,P<0.001;ACQ降低43.7%,P<0.0001)。研究者通过GETE评估OMA的有效性,78.8%为优或良(有反应者),12.6%/8.6%为中/差或更差(无反应者)。与无反应者相比,有反应者在FEV₁、加重率、缺勤天数、ACQ方面改善更好,口服糖皮质激素减少。
有效性结果强烈表明,RCT中显示的疗效可转化到与临床实践相关的环境中。