McCracken Jennifer L, Tripple Julia W, Calhoun William J
Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston, Texas, USA.
Curr Opin Allergy Clin Immunol. 2016 Aug;16(4):375-82. doi: 10.1097/ACI.0000000000000284.
Current asthma management relies on inhaled corticosteroids, but some asthma is not well controlled with inhaled steroids alone or in combination with long-acting bronchodilators or leukotriene pathway inhibitors. The field of biologic therapy has grown dramatically in the past two decades, with current availability of three molecules, with two distinct and highly selective approaches to interfering with the allergic and eosinophilic airway inflammation common to most asthma. This review summarizes current and future options for incorporating biologic therapy into the overall management of asthma.
Two new biologic agents have been recently introduced in the United States market, supported by well controlled, randomized clinical trials. These trials have provided insight into the types of patients who are most likely to benefit from these novel agents.
In asthma patients with frequent exacerbations, the addition of a biologic agent targeting the interleukin-5 pathway, or immunoglobulin E, can significantly reduce exacerbations and improve asthma control. The clinical predictors of utility of specific agents overlap with one another, highlighting the importance of clinical judgment in the overall management of this complex disorder.
目前哮喘管理依赖吸入性糖皮质激素，但部分哮喘单用吸入性糖皮质激素或与长效支气管扩张剂或白三烯途径抑制剂联合使用时控制不佳。在过去二十年中，生物治疗领域发展迅速，目前有三种分子可供使用，通过两种不同且高度选择性的方法来干扰大多数哮喘常见的过敏性和嗜酸性气道炎症。本综述总结了将生物治疗纳入哮喘整体管理的当前及未来选择。
在美国市场，两项新的生物制剂已在严格控制的随机临床试验支持下推出。这些试验为最可能从这些新型药物中获益的患者类型提供了见解。
在频繁发作的哮喘患者中，添加针对白细胞介素-5途径或免疫球蛋白E的生物制剂可显著减少发作并改善哮喘控制。特定药物效用的临床预测指标相互重叠，突出了临床判断在这种复杂疾病整体管理中的重要性。
