Baena-Cagnani Carlos E, Teijeiro Alvaro, Canonica G Walter
aResearch Centre for Respiratory Medicine, Faculty of Medicine, Catholic University of Córdoba, Córdoba bLIBRA Foundation, Buenos Aires cRespiratory Centre, Pediatric Hospital, Córdoba, Argentina dAllergy & Respiratory Disease Clinic, University of Genoa, IRCCS AOU S. Martino, Genova, Italy *Deceased.
Curr Opin Allergy Clin Immunol. 2015 Jun;15(3):267-71. doi: 10.1097/ACI.0000000000000161.
Allergic asthma, which is the most frequent asthma phenotype, is mainly a chronic inflammatory disease characterized by elevated serum IgE levels and specific-IgE against common allergens. A significant group of asthmatic children have uncontrolled moderate/severe symptoms despite the use of medium/high doses of inhaled corticosteroids (ICS) in combination with another controller. Asthma guidelines suggest omalizumab as an add-on therapy in these children and recent evidence has shown the efficacy and safety of this mAb against IgE.
Asthma cannot be cured and current available treatments are unable to modify the natural course of the disease. Recent studies have shown positive effects of omalizumab in reducing airway inflammation and remodelling. Herein, a 4-year follow-up of a group of children with moderate/severe uncontrolled asthma taking part in a randomized double blind placebo control with omalizumab is shown. After discontinuation of anti-IgE, children were followed up for 4 years. During the first 3 years of follow-up, they were completely free of asthma symptoms without any need of ICS or rescue medication.
The new evidence published and the clinical observation described herein generate the hypothesis that treatment with omalizumab could potentially modify the natural course of asthma. However, further studies are needed.
过敏性哮喘是最常见的哮喘表型，主要是一种慢性炎症性疾病，其特征为血清IgE水平升高以及针对常见变应原的特异性IgE。尽管使用中/高剂量吸入性糖皮质激素（ICS）联合另一种控制药物，但仍有相当一部分哮喘儿童的中度/重度症状无法得到控制。哮喘指南建议奥马珠单抗作为这些儿童的附加治疗药物，最近的证据表明这种抗IgE单克隆抗体具有疗效和安全性。
哮喘无法治愈，目前可用的治疗方法无法改变疾病的自然进程。最近的研究表明奥马珠单抗在减轻气道炎症和重塑方面具有积极作用。在此展示了一组中度/重度未控制哮喘儿童参与奥马珠单抗随机双盲安慰剂对照试验的4年随访结果。停用抗IgE后，对儿童进行了4年的随访。在随访的前3年中，他们完全没有哮喘症状，无需使用ICS或急救药物。
本文发表的新证据和临床观察结果提出了一个假设，即奥马珠单抗治疗可能会改变哮喘的自然进程。然而，还需要进一步的研究。
