Wark Peter, Hussaini Sikandar, Holder Carl, Powell Heather, Gibson Peter, Oldmeadow Christopher
Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales, Australia.
School of Medicine and Public Health, University of Newcastle, New Lambton, New South Wales, Australia.
J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3428-3433.e1. doi: 10.1016/j.jaip.2020.05.055. Epub 2020 Jun 16.
Severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) are important complications of severe asthma. The evidence for treating them with omalizumab is limited.
To determine the effectiveness of treatment with omalizumab in patients with severe allergic asthma comparing those with and without evidence of fungal sensitization using data recorded in the Australian Xolair Registry.
Data from 205 patients who received omalizumab and recorded in the Australian Xolair Registry were analyzed to determine change in the Juniper 5-item Asthma Control Questionnaire (ACQ-5) score, exacerbation frequency, and oral corticosteroid dose over a 24-month period of omalizumab treatment. Patients were grouped into cohorts on the basis of fungal sensitization, and an analysis of improvement in outcomes between baseline and 24 months was conducted within each group. A further subgroup analysis of patients with ABPA was also conducted.
Patients with SAFS (n = 62), including those with ABPA (ASAFS), were as likely to demonstrate significant improvements in ACQ-5 score and exacerbations and reduced regular oral corticosteroid dose over 24 months as those with severe asthma without sensitization to fungi (n = 156). After adjusting for age, sex, body mass index, smoking history, and baseline FEV%, the effects still remained. A subgroup analysis of 11 patients with ABPA similarly demonstrated a significant improvement on omalizumab.
Omalizumab is an effective therapy in ASAFS, leading to sustained improvements in symptoms and exacerbations for 24 months. The benefit for ABPA is less clear because of the small sample size.
重度哮喘合并真菌致敏（SAFS）和变应性支气管肺曲霉病（ABPA）是重度哮喘的重要并发症。使用奥马珠单抗治疗这些疾病的证据有限。
利用澳大利亚Xolair注册中心记录的数据，比较有和没有真菌致敏证据的重度过敏性哮喘患者使用奥马珠单抗治疗的有效性。
分析澳大利亚Xolair注册中心记录的205例接受奥马珠单抗治疗患者的数据，以确定在奥马珠单抗治疗的24个月期间，朱尼珀5项哮喘控制问卷（ACQ-5）评分、急性加重频率和口服糖皮质激素剂量的变化。根据真菌致敏情况将患者分组，并在每组内进行基线和24个月之间结局改善情况的分析。还对ABPA患者进行了进一步的亚组分析。
SAFS患者（n = 62），包括ABPA患者（ASAFS），与无真菌致敏的重度哮喘患者（n = 156）一样，在24个月内ACQ-5评分、急性加重情况可能有显著改善，且常规口服糖皮质激素剂量减少。在调整年龄、性别、体重指数、吸烟史和基线FEV%后，效果仍然存在。对11例ABPA患者的亚组分析同样显示奥马珠单抗治疗有显著改善。
奥马珠单抗是治疗ASAFS的有效疗法，可使症状和急性加重持续改善24个月。由于样本量小，对ABPA的益处尚不清楚。
