Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
Department of Immuno-Rheumatology, Campus Bio-Medico, University of Rome, Italy.
Clin Exp Rheumatol. 2020 Mar-Apr;38 Suppl 124(2):214-220. Epub 2020 Feb 18.
To systematically evaluate, through a Medline search, the role of omalizumab in eosinophilic granulomatosis with polyangiitis (EGPA).
A systematic review was performed with the following inclusion criteria: original articles and case reports written in English and reporting an association between omalizumab and EGPA.
We found 18 papers on EGPA (14 case reports, 3 retrospective cohort studies, 1 prospective cohort study). Omalizumab showed to be effective as corticosteroid-sparing agent in EGPA patients with severe asthmatic manifestations. On the contrary, conflicting results concerned its use in refractory forms of EGPA. Plausible is the increased risk of EGPA onset among asthmatic patients treated with omalizumab, probably related to steroid reduction, even if it cannot be excluded that omalizumab might be occasionally directly involved in the pathogenesis.
Our findings support the use of omalizumab in selected forms of EGPA, but caution in the tapering of corticosteroids is also recommended. Quality of evidence is limited, as the source of information was mainly case reports. Clinical trials are required in order to evaluate the role of omalizumab in EGPA and to ascertain the risk of asthmatic patients given omalizumab to develop EGPA.
通过 Medline 检索，系统评估奥马珠单抗在嗜酸性肉芽肿性多血管炎（EGPA）中的作用。
纳入标准为：英文原创文章和病例报告，且报告奥马珠单抗与 EGPA 之间存在关联。采用系统评价方法进行研究。
共发现 18 篇关于 EGPA 的论文（14 篇病例报告、3 项回顾性队列研究、1 项前瞻性队列研究）。奥马珠单抗作为 EGPA 患者严重哮喘症状的皮质类固醇节约剂有效。然而，其在难治性 EGPA 中的应用结果却相互矛盾。在接受奥马珠单抗治疗的哮喘患者中，EGPA 发病风险增加的可能性较大，这可能与类固醇的减少有关，尽管不能排除奥马珠单抗可能偶尔直接参与发病机制。
我们的研究结果支持在特定形式的 EGPA 中使用奥马珠单抗，但也建议在逐渐减少皮质类固醇用量时要谨慎。由于信息来源主要是病例报告，因此证据质量有限。需要开展临床试验以评估奥马珠单抗在 EGPA 中的作用，并确定接受奥马珠单抗治疗的哮喘患者发生 EGPA 的风险。
