Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland.
J Allergy Clin Immunol Pract. 2021 Jun;9(6):2315-2320.e1. doi: 10.1016/j.jaip.2021.02.048. Epub 2021 Mar 6.
Severe asthma with fungal sensitization (SAFS) is a complex clinical phenotype associated with poorly controlled type 2 inflammation and significant morbidity from both the disease itself and a high steroid burden.
To assess the effectiveness of biologic therapies targeting eosinophilic inflammation in SAFS.
We assessed the effectiveness of treatment with mepolizumab or benralizumab in patients with SAFS, and compared outcomes with patients with severe atopic asthma without fungal sensitization and patients with severe nonatopic asthma. Baseline clinical characteristics and clinical outcomes at 48 weeks were evaluated. A subgroup analysis was performed of patients who met the criteria for allergic bronchopulmonary aspergillosis (ABPA) rather than SAFS.
A total of 193 patients treated with mepolizumab (n = 63) or benralizumab (n = 130) were included. Patients with SAFS had higher baseline IgE level compared with patients with severe atopic asthma without fungal sensitization and severe nonatopic asthma (733 ± 837 IU/mL vs 338 ± 494 and 142 ± 171, respectively; both P < .001). There were no other significant baseline differences in clinical characteristics between groups. At 48 weeks, there were significant improvements in 6-item asthma control questionnaire score and exacerbation frequency, and reduction in maintenance oral corticosteroid dose across all groups (all P < .05). No significant between-group differences in outcomes were observed at 48 weeks. Patients with ABPA (n = 9) had a significant reduction in exacerbation frequency (P = .013) with treatment.
Treatment with eosinophil-targeting biologics led to improvements in exacerbation frequency, oral corticosteroid requirements, and patient-reported outcomes in patients with SAFS, with a reduction in exacerbations in the subgroup of patients with ABPA. These data highlight the potential clinical utility of targeting eosinophilic inflammation in SAFS and ABPA.
真菌致敏性重度哮喘（SAFS）是一种与 2 型炎症控制不佳和疾病本身以及高皮质类固醇负担导致的高发病率相关的复杂临床表型。
评估针对嗜酸性粒细胞炎症的生物疗法在 SAFS 中的疗效。
我们评估了美泊利单抗或贝那鲁单抗治疗 SAFS 患者的疗效，并将结果与重度特应性哮喘无真菌致敏患者和重度非特应性哮喘患者进行比较。评估了 48 周时的基线临床特征和临床结局。对符合变应性支气管肺曲霉病（ABPA）标准而非 SAFS 的患者进行了亚组分析。
共纳入 193 例接受美泊利单抗（n=63）或贝那鲁单抗（n=130）治疗的患者。与重度特应性哮喘无真菌致敏患者和重度非特应性哮喘患者相比，SAFS 患者的基线 IgE 水平更高（733±837 IU/mL 比 338±494 和 142±171；均 P<0.001）。各组间在临床特征方面无其他显著的基线差异。在 48 周时，所有组的 6 项哮喘控制问卷评分和加重频率均有显著改善，维持口服皮质类固醇剂量降低（均 P<0.05）。在 48 周时，各组间的结局无显著差异。9 例 ABPA 患者（n=9）治疗后加重频率显著降低（P=0.013）。
针对嗜酸性粒细胞的生物制剂治疗可改善 SAFS 患者的加重频率、口服皮质类固醇需求和患者报告的结局，ABPA 亚组患者的加重次数减少。这些数据强调了靶向 SAFS 和 ABPA 中的嗜酸性粒细胞炎症的潜在临床应用。
