Busse William W
Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Curr Opin Allergy Clin Immunol. 2018 Dec;18(6):509-518. doi: 10.1097/ACI.0000000000000487.
For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma.
Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good.
For patients with severe asthma and biomarkers indicating a type 2 inflammatory pathway, the addition of biologics has proven to be an effective approach to achieve disease control and is an appropriate next step treatment.
对于重度哮喘患者，疾病控制未达成，导致持续发病和病情加重风险。生物制剂的出现为许多重度哮喘患者提供了一种新的治疗形式。
四种单克隆抗体生物制剂已获批用于临床：奥马珠单抗（抗IgE）和三种抗嗜酸性粒细胞干预药物（美泊利单抗、瑞利珠单抗和贝那利珠单抗）。这四种生物制剂靶向2型炎症途径的组成部分，生物标志物可反映该途径：外周血嗜酸性粒细胞和呼出一氧化氮。在重度哮喘中，生物制剂减少了哮喘发作。抗嗜酸性粒细胞生物制剂还改善了肺功能。这些生物制剂的安全性良好。
对于重度哮喘且生物标志物表明存在2型炎症途径的患者，添加生物制剂已被证明是实现疾病控制的有效方法，是合适的下一步治疗措施。
