Papadopoulos Nikolaos G, Barnes Peter, Canonica Giorgio Walter, Gaga Mina, Heaney Liam, Menzies-Gow Andrew, Kritikos Vicky, Fitzgerald Mark
Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.
Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece.
Allergy. 2020 Jul;75(7):1555-1563. doi: 10.1111/all.14256. Epub 2020 Mar 17.
New therapeutic options for severe asthma have recently emerged, mostly in the form of monoclonal antibodies ("biologicals") targeting relevant inflammatory pathways. Currently available agents target different aspects of "Type 2" immunity, and their indications often include overlapping patient groups. We present a round-table discussion that took place during the Annual Meeting of the Respiratory Effectiveness Group (REG), on the reasoning behind the use of different add-on medications for severe asthma, and crucially, on selection strategies. The proposed rational is based on current evidence, including real-life studies, as well as on the appreciation of the relevant complexities. Direct head-to-head comparisons of biologicals are lacking; therefore, algorithms for initial choice and potential switch between agents should be based on understanding the key characteristics of different options and the development of a clear plan with predefined targets and shared decision-making, in a structured way.
重度哮喘的新治疗选择最近已出现，大多是以针对相关炎症途径的单克隆抗体（“生物制剂”）形式出现。目前可用的药物针对“2型”免疫的不同方面，其适应症通常包括重叠的患者群体。我们介绍了在呼吸有效性小组（REG）年会上进行的一次圆桌讨论，内容涉及对重度哮喘使用不同附加药物背后的推理，以及至关重要的选择策略。所提出的原理基于当前证据，包括真实世界研究，以及对相关复杂性的认识。生物制剂缺乏直接的头对头比较；因此，药物初始选择和潜在转换的算法应基于对不同选择的关键特征的理解，并以结构化方式制定一个具有预定义目标和共同决策的明确计划。
