SUNY Upstate Medical University College of Medicine, Syracuse, NY, USA.
Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1001 Main Street, Buffalo, NY, 14203, USA.
Clin Rev Allergy Immunol. 2020 Oct;59(2):160-174. doi: 10.1007/s12016-019-08760-x.
Asthma has been increasingly recognized as being a heterogeneous disease with multiple distinct mechanisms and pathophysiologies. Evidence continues to build regarding the existence of different cell types, environmental exposures, pathogens, and other factors that produce a similar set of symptoms known collectively as asthma. This has led to a movement from a "one size fits all" symptom-based methodology to a more patient-centered, individualized approach to asthma treatment targeting the underlying disease process. A significant contributor to this shift to more personalized asthma therapy has been the increasing availability of numerous biologic therapies in recent years, providing the opportunity for more targeted treatments. When targeted biologics began to be developed for treatment of asthma, the hope was that distinct biomarkers would become available, allowing the clinician to determine which biologic therapy was best suited for which patients. Presence of certain biomarkers, like eosinophilia or antigen-specific IgE, is important features of specific asthma phenotypes. Currently available biomarkers can help with decision making about biologics, but are generally too broad and non-specific to clearly identify an asthma phenotype or the single biologic best suited to an asthmatic. Identification of further biomarkers is the subject of intense research. Yet, identifying a patient's asthma phenotype can help in predicting disease course, response to treatment, and biologic therapies to consider. In this review, major asthma phenotypes are reviewed, and the evidence for the utility of various biologics, both those currently on the market and those in the development process, in each of these phenotypes is explored.
哮喘已被越来越多地认为是一种具有多种不同机制和病理生理学的异质性疾病。越来越多的证据表明，存在不同的细胞类型、环境暴露、病原体和其他因素，它们产生一组相似的统称为哮喘的症状。这导致了从基于症状的“一刀切”方法向更以患者为中心、针对哮喘潜在疾病过程的个体化治疗方法的转变。近年来，许多生物疗法的日益普及是这种向更个体化哮喘治疗转变的重要因素，为更有针对性的治疗提供了机会。当针对哮喘的靶向生物疗法开始开发时，人们希望能够获得独特的生物标志物，使临床医生能够确定哪种生物疗法最适合哪种患者。某些生物标志物的存在，如嗜酸性粒细胞增多或抗原特异性 IgE，是特定哮喘表型的重要特征。目前可用的生物标志物有助于做出关于生物疗法的决策，但通常过于广泛和非特异性，无法明确识别哮喘表型或最适合哮喘患者的单一生物疗法。进一步的生物标志物的鉴定是激烈研究的主题。然而，确定患者的哮喘表型有助于预测疾病进程、治疗反应和可考虑的生物疗法。在这篇综述中，回顾了主要的哮喘表型，并探讨了各种生物疗法在每种表型中的效用证据，包括目前市场上的和正在开发过程中的生物疗法。
