Saco Tara Vinyette, Pepper Amber N, Lockey Richard F
a Division of Allergy and Immunology, Department of Internal Medicine , University of South Florida Morsani College of Medicine and James A. Haley Veterans Affairs Medical Center , Tampa , FL , USA.
Expert Rev Clin Immunol. 2017 May;13(5):405-413. doi: 10.1080/1744666X.2017.1316194. Epub 2017 Apr 19.
The classification of asthma into phenotypes and endotoypes allows for the use of targeted therapies, including three biologics which target interleukin 5 (IL-5) signaling in eosinophilic asthma. Areas covered: As of December 2016, two monoclonal antibodies, mepolizumab and reslizumab, are approved by U.S. Food and Drug Administration and one, benralizumab, is in clinical development. Two phase 3 trials for benralizumab, SIROCCO and CALIMA, were published in September 2016. Although there are no direct comparisons among these three anti-IL-5 therapies, the goal of this review is to summarize the current data and discuss their potential similarities and differences, with a focus on benralizumab. Expert commentary: Compared to mepolizumab and reslizumab, the possible advantages of benralizumab are less frequent dosing and a potential to reduce exacerbations irrespective of the blood eosinophil count. Some improvements in asthma symptom scores and quality of life occur with all three biologics, but the clinical meaningfulness of these improvements is less clear. A more defined reference range for eosinophil levels is necessary to determine which subjects will best benefit from these medications. Until quality randomized controlled trials directly compare the three, choosing among them for the treatment of eosinophilic asthma remains difficult.
将哮喘分为不同的表型和内型有助于采用靶向治疗，其中包括三种针对嗜酸性粒细胞性哮喘中白细胞介素5（IL-5）信号通路的生物制剂。涵盖领域：截至2016年12月，两种单克隆抗体，即美泊利珠单抗和瑞利珠单抗，已获美国食品药品监督管理局批准，另一种，即贝那利珠单抗，正处于临床开发阶段。两项关于贝那利珠单抗的3期试验，即SIROCCO和CALIMA试验，于2016年9月发表。尽管这三种抗IL-5疗法之间没有直接比较，但本综述的目的是总结当前数据，并讨论它们可能的异同，重点是贝那利珠单抗。专家评论：与美泊利珠单抗和瑞利珠单抗相比，贝那利珠单抗可能的优势在于给药频率较低，且无论血液嗜酸性粒细胞计数如何，都有可能减少病情加重。使用这三种生物制剂后，哮喘症状评分和生活质量均有一定改善，但这些改善的临床意义尚不清楚。需要一个更明确的嗜酸性粒细胞水平参考范围，以确定哪些受试者将从这些药物中获益最大。在高质量随机对照试验直接比较这三种药物之前，在它们之间选择用于治疗嗜酸性粒细胞性哮喘仍然很困难。
