Atayık Emel, Aytekin Gökhan
Department of Immunology and Allergy, Konya City Hospital, Konya, Turkey.
Turk Thorac J. 2022 Sep;23(5):348-354. doi: 10.5152/TurkThoracJ.2022.22023.
Anecdotal reports among clinicians treating severe asthma patients with novel add-on treatments such as mepolizumab suggest that a fraction of these patients may experience a much more dramatic benefit from these agents than reported in large, randomized controlled studies. Although these patients have been referred to as super-responders in some studies, currently, there is no consensus regarding the nomenclature. Therefore, our aim was to assess the real-life data among patients receiving mepolizumab treatment due to severe eosinophilic asthma, in an effort to determine potential clinical and laboratory differences between super-responders and other group of patients.
Data from adult patients who received at least four doses of mepolizumab due to persistent severe asthma between Janury 1, 2020, and December 31, 2021, in a Tertiary Allergy Clinic were evaluated in a retrospective manner.
A total of 57 patients with severe asthma receiving mepolizumab treatment were included [female: 38, male: 19]. At 4th- and 12th-month after initiation of mepolizumab treatment, significant differences in forced expiratory volume in 1 second, forced vital capacity, forced expiratory volume in 1 second/forced vital capacity, blood eosinophil count, and serum immunoglobulin E level were detected as compared to baseline (P < .001, P < 0.001, P =.027, P < .001, and P =.035). Also, at the 12th-month of treatment with mepolizumab, there were significant differences compared to baseline in asthma control test scores, number of asthma exacerbations, non-planned emergency room visits, hospitalizations, and daily need for oral corticosteroids (P <.001, for all parameters). Also, there was not a statistically significant difference between super-responders and responders groups in regard to age, gender, duration of disease, duration of mepolizumab treatment, allergen sensitivities, and comorbid conditions (chronic rhinosinusitis, nasal polyps, and aspirin sensitivity).
Our results suggest that mepolizumab may be an effective therapeutic option in patients with severe asthma. On the other hand, patients who were considered to be super-responders to mepolizumab treatment were not significantly different from the remaining group of patients (responders). Obviously, further studies are warranted to better define the super-responders among patients with severe asthma who receive mepolizumab treatment.
临床医生在使用诸如美泊利珠单抗等新型附加疗法治疗重度哮喘患者时的轶事报告表明，这些患者中有一部分可能从这些药物中获得比大型随机对照研究报告中更显著的益处。尽管在一些研究中这些患者被称为超级反应者，但目前对于该术语尚无共识。因此，我们的目的是评估因重度嗜酸性粒细胞性哮喘接受美泊利珠单抗治疗的患者的实际数据，以确定超级反应者与其他患者组之间潜在的临床和实验室差异。
对2020年1月1日至2021年12月31日期间在一家三级过敏诊所因持续性重度哮喘接受至少四剂美泊利珠单抗治疗的成年患者的数据进行回顾性评估。
共有57例接受美泊利珠单抗治疗的重度哮喘患者纳入研究[女性：38例，男性：19例]。在开始美泊利珠单抗治疗后的第4个月和第12个月，与基线相比，1秒用力呼气容积、用力肺活量、1秒用力呼气容积/用力肺活量、血嗜酸性粒细胞计数和血清免疫球蛋白E水平均有显著差异（P <.001、P < 0.001、P =.027、P <.001和P =.035）。此外，在美泊利珠单抗治疗的第12个月，哮喘控制测试评分、哮喘发作次数、非计划急诊就诊次数、住院次数以及口服糖皮质激素的每日需求量与基线相比均有显著差异（所有参数P <.001）。而且，超级反应者组与反应者组在年龄、性别、病程、美泊利珠单抗治疗时长、过敏原敏感性和合并症（慢性鼻 - 鼻窦炎、鼻息肉和阿司匹林敏感性）方面无统计学显著差异。
我们的结果表明美泊利珠单抗可能是重度哮喘患者的一种有效治疗选择。另一方面，被认为是美泊利珠单抗治疗超级反应者的患者与其余患者组（反应者）并无显著差异。显然，有必要进行进一步研究以更好地界定接受美泊利珠单抗治疗的重度哮喘患者中的超级反应者。
