Pianigiani Tommaso, Alderighi Lorenzo, Meocci Martina, Messina Maddalena, Perea Beatrice, Luzzi Simona, Bergantini Laura, D'Alessandro Miriana, Refini Rosa Metella, Bargagli Elena, Cameli Paolo
Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
Antioxidants (Basel). 2023 Feb 7;12(2):400. doi: 10.3390/antiox12020400.
Fractional exhaled nitric oxide (FeNO) is a biomarker of airway inflammation associated with airway hyper-responsiveness and type-2 inflammation. Its role in the management of severe asthmatic patients undergoing biologic treatment, as well as FeNO dynamics during biologic treatment, is largely unexplored.
The aim was to evaluate published data contributing to the following areas: (1) FeNO as a predictive biomarker of response to biologic treatment; (2) the influence of biologic treatment in FeNO values; (3) FeNO as a biomarker for the prediction of exacerbations in patients treated with biologics.
The systematic search was conducted on the Medline database through the Pubmed search engine, including all studies from 2009 to the present.
Higher baseline values of FeNO are associated with better clinical control in patients treated with omalizumab, dupilumab, and tezepelumab. FeNO dynamics during biologic treatment highlights a clear reduction in FeNO values in patients treated with anti-IL4/13 and anti-IL13, as well as in patients treated with tezepelumab. During the treatment, FeNO may help to predict clinical worsening and to differentiate eosinophilic from non-eosinophilic exacerbations.
Higher baseline FeNO levels appear to be associated with a greater benefit in terms of clinical control and reduction of exacerbation rate, while FeNO dynamics during biologic treatment remains a largely unexplored issue since few studies have investigated it as a primary outcome. FeNO remains detectable during biologic treatment, but its potential utility as a biomarker of clinical control is still unclear and represents an interesting research area to be developed.
呼出一氧化氮分数（FeNO）是一种与气道高反应性和2型炎症相关的气道炎症生物标志物。其在接受生物治疗的重度哮喘患者管理中的作用以及生物治疗期间的FeNO动态变化在很大程度上尚未得到探索。
旨在评估以下方面的已发表数据：（1）FeNO作为生物治疗反应的预测生物标志物；（2）生物治疗对FeNO值的影响；（3）FeNO作为预测接受生物制剂治疗患者病情加重的生物标志物。
通过PubMed搜索引擎在Medline数据库上进行系统检索，包括2009年至今的所有研究。
在接受奥马珠单抗、度普利尤单抗和替泽佩单抗治疗的患者中，较高的FeNO基线值与更好的临床控制相关。生物治疗期间的FeNO动态变化显示，接受抗IL4/13和抗IL13治疗的患者以及接受替泽佩单抗治疗的患者的FeNO值明显降低。在治疗期间，FeNO可能有助于预测临床恶化，并区分嗜酸性粒细胞性加重和非嗜酸性粒细胞性加重。
较高的FeNO基线水平似乎在临床控制和降低加重率方面具有更大益处，而生物治疗期间的FeNO动态变化在很大程度上仍是一个未被探索的问题，因为很少有研究将其作为主要结局进行研究。在生物治疗期间FeNO仍可检测到，但其作为临床控制生物标志物的潜在效用仍不清楚，是一个有待开发的有趣研究领域。
