Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Division of Allergy, Immunology and Pulmonology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California.
Ann Allergy Asthma Immunol. 2020 Oct;125(4):433-439. doi: 10.1016/j.anai.2020.06.041. Epub 2020 Jul 3.
Asthma is a heterogeneous disease with emerging phenotypes and endotypes. At present, 5 distinct biologics are Food and Drug Administration-approved as an add-on therapy for difficult-to-control type 2-high asthma. Because allergy specialists manage a spectrum of diseases for which biologics may be appropriate, it is important to understand their prescribing patterns.
To elucidate the allergist's use of biologics in the treatment of asthma, including barriers, preferences, indications for prescribing, measures to determine effectiveness, and cost-effectiveness.
A survey was performed among allergists using a semistructured 10-item self-administered web-based questionnaire and the responses were analyzed using one-way frequencies and multiple logistic regression.
The response rate was approximately 9%. Omalizumab was the most prescribed biologic for asthma (98%), and "uncontrolled asthma despite adherence to controller medication" was the most common reason. The common selection criteria among the biologics included elevated peripheral eosinophil count, asthma with nasal polyps, and asthma type (type 1; type 2; nonallergic). A decreased exacerbation frequency was the best standard to determine the efficacy among biologics. Benralizumab was considered the most cost-effective.
This study represents one of the largest surveys among allergy specialists regarding the real-world use of asthma biologics. It seems that there has been reasonably good dissemination and application of current guidelines among allergists based on prescribing patterns. However, their responses reflect the need for the continued modification of asthma guidelines that incorporate novel biologics and other pathway-specific agents into step therapy. As clinical phenotypes and predictive biomarkers develop, allergy specialists will be better prepared to practice precision medicine that optimizes the use of asthma biologics.
哮喘是一种具有多种表型和内型的异质性疾病。目前，有 5 种不同的生物制剂被美国食品和药物管理局批准为 2 型高反应性难以控制型哮喘的附加治疗药物。由于过敏专家可以管理一系列可能需要使用生物制剂的疾病，因此了解他们的处方模式非常重要。
阐明过敏专家在哮喘治疗中使用生物制剂的情况，包括使用障碍、偏好、处方适应证、确定有效性的措施以及成本效益。
采用半结构式的 10 项自我管理的网络问卷调查了过敏专家，使用单因素频率分析和多因素逻辑回归分析了应答。
应答率约为 9%。奥马珠单抗是治疗哮喘最常被开的生物制剂（98%），最常见的处方适应证是“尽管遵医嘱使用控制药物，但哮喘仍控制不佳”。在生物制剂中，常见的选择标准包括外周血嗜酸性粒细胞计数升高、伴有鼻息肉的哮喘和哮喘类型（1 型；2 型；非过敏性）。生物制剂疗效的最佳标准是减少哮喘发作频率。贝那鲁单抗被认为是最具成本效益的药物。
本研究是过敏专家中针对哮喘生物制剂实际应用情况的最大规模调查之一。根据处方模式，似乎过敏专家对当前指南的传播和应用情况良好。然而，他们的回答反映了需要不断修改哮喘指南，将新型生物制剂和其他特定途径的药物纳入阶梯治疗中。随着临床表型和预测性生物标志物的发展，过敏专家将更好地准备实施优化哮喘生物制剂使用的精准医学。
