Robarts Research Institute; Department of Medical Biophysics, Western University, London, ON, Canada.
University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital Vancouver, Vancouver, BC, Canada.
Chest. 2023 Jul;164(1):27-38. doi: 10.1016/j.chest.2023.02.009. Epub 2023 Feb 11.
We previously showed in patients with poorly controlled eosinophilic asthma that a single dose of benralizumab resulted in significantly improved Asthma Control Questionnaire (ACQ-6) score and Xe MRI ventilation defect percent (VDP) 28 days postinjection, and Xe MRI VDP and CT airway mucus occlusions were shown to independently predict this early ACQ-6 response to benralizumab.
Do early VDP responses at 28 days persist, and do FEV, fractional exhaled nitric oxide, and mucus plug score improve during a 2.5 year treatment period?
Participants with poorly controlled eosinophilic asthma completed spirometry, ACQ-6, and MRI, 28 days, 1 year, and 2.5 years after initiation of treatment with benralizumab; chest CT was acquired at enrollment and 2.5 years later.
Of 29 participants evaluated at 28 days post-benralizumab, 16 participants returned for follow-up while on therapy at 1 year, and 13 participants were evaluable while on therapy at 2.5 years post-benralizumab initiation. As compared with 28 days post-benralizumab, ACQ-6 score (2.0 ± 1.4) significantly improved after 1 year (0.5 ± 0.6, P = .02; 95% CI, 0.1-1.1) and 2.5 years (0.5 ± 0.5, P = .03; 95% CI, 0.1-1.1). The mean VDP change at 2.5 years (-4% ± 3%) was greater than the minimal clinically important difference, but not significantly different from VDP measured 28 days post-benralizumab. Mucus score (3 ± 4) was significantly improved at 2.5 years (1 ± 1, P = .03; 95% CI, 0.3-5.5). In six of eight participants with previous occlusions, mucus plugs vanished or substantially diminished 2.5 years later. VDP (P < .001) and mucus score (P < .001) measured at baseline, but not fractional exhaled nitric oxide or FEV, independently predicted ACQ-6 score after 2.5 years.
In poorly controlled eosinophilic asthma, early MRI VDP responses at 28 days post-benralizumab persisted 2.5 years later, alongside significantly improved mucus scores and asthma control.
我们之前在控制不佳的嗜酸性粒细胞性哮喘患者中发现，单次贝那鲁肽治疗可显著改善哮喘控制问卷（ACQ-6）评分，且在注射后 28 天内 Xe 磁共振通气缺陷百分比（VDP）得到改善，并且 Xe MRI VDP 和 CT 气道粘液阻塞被证明可独立预测贝那鲁肽治疗早期的 ACQ-6 反应。
在 2.5 年的治疗期间，28 天时的早期 VDP 反应是否持续存在，以及 FEV、呼气一氧化氮分数和粘液堵塞评分是否改善？
患有控制不佳的嗜酸性粒细胞性哮喘的参与者在开始贝那鲁肽治疗后 28 天、1 年和 2.5 年完成了肺活量测定、ACQ-6 和 MRI；在入组时和 2.5 年后采集了胸部 CT。
在 28 天接受贝那鲁肽治疗后接受评估的 29 名参与者中，有 16 名在治疗 1 年后进行了随访，有 13 名在治疗 2.5 年后进行了评估。与贝那鲁肽治疗后 28 天相比，ACQ-6 评分（2.0±1.4）在 1 年（0.5±0.6，P=0.02；95%CI，0.1-1.1）和 2.5 年（0.5±0.5，P=0.03；95%CI，0.1-1.1）时显著改善。2.5 年时的平均 VDP 变化（-4%±3%）大于最小临床重要差异，但与贝那鲁肽治疗后 28 天的 VDP 测量值无显著差异。粘液评分（3±4）在 2.5 年时显著改善（1±1，P=0.03；95%CI，0.3-5.5）。在 8 名先前有阻塞的参与者中，有 6 名在 2.5 年后粘液栓消失或明显减少。基线时的 VDP（P<0.001）和粘液评分（P<0.001），但不是呼气一氧化氮分数或 FEV，可独立预测 2.5 年后的 ACQ-6 评分。
在控制不佳的嗜酸性粒细胞性哮喘中，贝那鲁肽治疗后 28 天的早期 MRI VDP 反应在 2.5 年后持续存在，同时粘液评分和哮喘控制显著改善。
