Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Allergy. 2023 Jul;78(7):1934-1948. doi: 10.1111/all.15711. Epub 2023 Mar 27.
Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.
This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance, and hospital admissions.
In the matched analysis (n = 350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p < 0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs. 20.55% reduction; p = 0.023). There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).
In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes; however, anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.
患有严重哮喘的患者可能表现出代表重叠表型的特征，使他们有资格接受一种以上的生物制剂。我们的目的是描述既适合抗 IgE 又适合抗 IL-5/5R 的成年严重哮喘患者的特征，并比较这两种生物制剂在现实生活中的疗效。
这是一项前瞻性队列研究，纳入了来自 22 个国家的、符合抗 IgE 和抗 IL-5/5R 治疗标准的国际严重哮喘登记（ISAR）的成年严重哮喘患者。在 1:1 匹配队列中比较了抗 IgE 和抗 IL-5/5R 的疗效。哮喘加重率是主要的有效性终点。次要终点包括长期口服皮质类固醇（LTOCS）的使用、哮喘相关急诊室（ER）就诊和住院治疗。
在匹配分析（n=350/组）中，抗 IL-5/5R 组的年平均哮喘加重率下降了 47.1%，抗 IgE 组下降了 38.7%。与接受抗 IgE 治疗的患者相比，接受抗 IL-5/5R 治疗的患者未来发生哮喘加重的可能性较低（校正 IRR 0.76；95%CI 0.64，0.89；p<0.001），且 LTOCS 剂量的平均减少量更大（减少 37.44% vs. 20.55%；p=0.023）。有一些证据表明，接受抗 IL-5/5R 治疗的患者哮喘相关住院治疗（IRR 0.64；95%CI 0.38，1.08）的次数更少，但 ER 就诊（IRR 0.94；95%CI 0.61，1.43）的次数并无差异。
在现实生活中，抗 IgE 和抗 IL-5/5R 均可改善同时适合这两种生物制剂类别的患者的哮喘结局；然而，抗 IL-5/5R 在减少哮喘加重和 LTOCS 使用方面更具优势。
