Haasler I, Taube C
Pneumologie. 2017 Oct;71(10):684-698. doi: 10.1055/s-0043-102773. Epub 2017 Oct 10.
Biologicals are a therapeutic option for patients with severe asthma. Difficult asthma in patients with untreated comorbidities or persistent trigger factors is much more common than severe refractory asthma. Optimized medical treatment, adherence to medication, elimination of trigger factors and treatment of comorbidities are essential before escalating the therapy with a biological. A careful phenotyping of patient with severe asthma is necessary because all available biological are only effective in certain phenotypes of the disease. For patients with severe allergic asthma an antibody against IgE (Omalizumab) is available. For patients with severe asthma and eosinophilic inflammation the Interleukin (IL)-5 Antibodies Mepolizumab and Reslizumab have recently been approved. The most prominent effect of biological treatment is the reduction of acute exacerbations in these patients. Further antibodies against IL-5 receptor (Benralizumab) or against the IL-4 receptor alpha chain (Dupilumab) are in advanced clinical development.
生物制剂是重度哮喘患者的一种治疗选择。在未治疗合并症或存在持续触发因素的患者中，难治性哮喘比重度难治性哮喘更为常见。在使用生物制剂升级治疗之前，优化药物治疗、坚持用药、消除触发因素以及治疗合并症至关重要。对重度哮喘患者进行仔细的表型分析很有必要，因为所有可用的生物制剂仅对该疾病的某些表型有效。对于重度过敏性哮喘患者，有一种抗IgE抗体（奥马珠单抗）可供使用。对于重度哮喘和嗜酸性粒细胞炎症患者，白细胞介素（IL）-5抗体美泊利单抗和瑞利珠单抗最近已获批。生物治疗最显著的效果是减少这些患者的急性加重发作。针对IL-5受体的进一步抗体（贝那利珠单抗）或针对IL-4受体α链的抗体（度普利尤单抗）正处于临床开发后期。
