Papaioannou Andriana I, Fouka Evangelia, Papakosta Despina, Papiris Spyridon, Loukides Stelios
National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece.
Respiratory Medicine Department, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clin Exp Allergy. 2021 Feb;51(2):221-227. doi: 10.1111/cea.13809. Epub 2020 Dec 16.
During the last decades, new treatments targeting disease mechanisms referred as biologics have been introduced in the therapy of asthma and currently, five monoclonal antibodies have been approved. Although these therapeutic agents have been formulated to target specific asthma endotypes, it is often difficult for the treating physician to identify which patient is the best candidate for each one of these specific treatments especially in the clinical scenario of a patient in whom clinical characteristics overlap between different endotypes, allowing the selection of more than one biologic agent. As no head-to-head comparisons between these biologics have been attempted, there is no evidence on the superiority of one biologic agent over the other. Furthermore, a physician's first therapeutic decision, no matter how carefully has been made, may often result in suboptimal clinical response and drug discontinuation, indicating the need for switching to a different biologic. In this short review, we discuss the available evidence regarding the switching between biologics in patients with severe asthma and we propose a simple algorithm on switching possibilities in case that the physicians' initial choice is proven not to be the best.
在过去几十年中，哮喘治疗领域引入了针对疾病机制的新型治疗方法，即生物制剂，目前已有五种单克隆抗体获批。尽管这些治疗药物是针对特定哮喘内型设计的，但治疗医生往往很难确定哪位患者最适合每种特定治疗方法，尤其是在不同内型临床特征重叠、可选择多种生物制剂的临床情况下。由于尚未对这些生物制剂进行直接比较，因此没有证据表明一种生物制剂优于另一种。此外，医生的首个治疗决策，无论制定得多么谨慎，往往可能导致临床反应欠佳和药物停用，这表明需要改用另一种生物制剂。在这篇简短的综述中，我们讨论了重度哮喘患者生物制剂转换的现有证据，并针对医生的初始选择被证明并非最佳的情况，提出了一个关于转换可能性的简单算法。
