Menzella Francesco, Biava Mirella, Bagnasco Diego, Galeone Carla, Simonazzi Anna, Ruggiero Patrizia, Facciolongo Nicola
Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, Italy.
University of Rome "La Sapienza", Rome, Italy.
Drugs Context. 2019 Apr 15;8:212580. doi: 10.7573/dic.212580. eCollection 2019.
Severe refractory asthma is characterized by a higher risk of asthma-related symptoms, morbidities, and exacerbations. This disease also determines much greater healthcare costs and deterioration in health-related quality of life (HR-QoL). Another concern, which is currently much discussed, is the high percentage of patients needing regular use of oral corticosteroids (OCS), which can lead to several systemic side effects. Airway eosinophilia is present in the majority of asthmatic patients, and elevated levels of blood and sputum eosinophils are associated with worse control of asthma. Regarding severe refractory eosinophilic asthma, interleukin-5 (IL-5) plays a fundamental role in the inflammatory response, due to the profound effect on eosinophils biology. The advent of the biological therapies provided an effective strategy, even if the increased number of molecules with different targets raised the challenge of choosing the right therapy and avoid overlapping. When considering severe refractory eosinophilic asthma and anti-IL-5 treatments, it is not easy to define which drug to choose between mepolizumab, reslizumab, and benralizumab. In this article, we carried out an indirect comparison among literature data, especially between OCS reduction studies (ZONDA-SIRIUS) and pivotal studies (SIROCCO-MENSA), evaluating whether the clinical efficacy and the steroid-sparing effect of benralizumab may represent an advantage over other compounds. This data could help the clinician in the decision process of treatment choice, within the different available therapeutic options for eosinophilic refractory severe asthma.
重度难治性哮喘的特点是哮喘相关症状、发病率和急性加重的风险更高。这种疾病还导致更高的医疗成本以及健康相关生活质量（HR-QoL）的下降。另一个目前备受讨论的问题是，有很大比例的患者需要定期使用口服糖皮质激素（OCS），这可能会导致多种全身副作用。大多数哮喘患者存在气道嗜酸性粒细胞增多，血液和痰液中嗜酸性粒细胞水平升高与哮喘控制不佳有关。对于重度难治性嗜酸性粒细胞性哮喘，白细胞介素-5（IL-5）在炎症反应中起关键作用，因为它对嗜酸性粒细胞生物学有深远影响。生物疗法的出现提供了一种有效的策略，尽管具有不同靶点的分子数量增加带来了选择正确疗法并避免重叠的挑战。在考虑重度难治性嗜酸性粒细胞性哮喘和抗IL-5治疗时，很难确定在美泊利单抗、瑞利珠单抗和贝那利珠单抗之间选择哪种药物。在本文中，我们对文献数据进行了间接比较，特别是在OCS减量研究（ZONDA-SIRIUS）和关键研究（SIROCCO-MENSA）之间，评估贝那利珠单抗的临床疗效和激素节省效应是否可能比其他化合物更具优势。这些数据可以帮助临床医生在嗜酸性粒细胞性难治性重度哮喘的不同可用治疗选择中进行治疗选择的决策过程。
