Plank Pia Maria, Hinze Christopher Alexander, Campbell Victoria, Konwert Stefanie, Welte Tobias, Drick Nora, Kayser Moritz Z, Suhling Hendrik, Fuge Jan
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany.
J Asthma Allergy. 2023 Apr 18;16:421-431. doi: 10.2147/JAA.S403296. eCollection 2023.
Asthma is associated with a high prevalence of psychopathological disorders, especially depressive disorders or anxiety. In patients with uncontrolled severe asthma, monoclonal antibody (mAb)-therapy positively influenced control of mental disorders. Therefore, we evaluated the impact of antibody therapy on the burden of these mental diseases depending on responder status.
Data were collected retrospectively in patients with uncontrolled severe asthma (n = 82) prior to mAb-therapy ("baseline") (omalizumab, dupilumab, benralizumab or mepolizumab). Symptoms of Major Depressive Disorder (MDD) or General Anxiety Disorder (GAD) were detected at baseline using the Hospital Anxiety and Depression Scale (HADS), as well as general sociodemographic data and lung function parameters. At 6-month (±3 month) follow-up, the burden of psychopathological symptoms under mAb-therapy was assessed using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder Scale-2 (GAD-2). Response status was classified using the Biologics Asthma Response Score (BARS), assessing exacerbations, oral corticosteroid usage and asthma control test (ACT) score. Predictors for non-response to mAb-therapy were identified using linear regression analysis.
Patients with severe asthma suffered from symptoms of MDD/GAD more often compared to the general population, with a higher prevalence among mAb therapy non-responders. mAb-responders exhibited a declining burden of MDD, better quality of life (QoL), less exacerbations, better lung function and better disease control compared to non-responders. A history of symptoms of depression was identified as a predictor for non-response to mAb-therapy.
Asthma symptoms and psychological problems are linked and more prevalent in our cohort of severe asthma patients than in the general population. Patients with signs of MDD/GAD before mAb-therapy show less mAb therapy response suggesting a negative impact of prior psychological problems on treatment response. In some patients, the score on MDD/GAD was caused by severe asthma - here symptoms decreased after effective treatment.
哮喘与精神心理障碍的高患病率相关，尤其是抑郁症或焦虑症。在未得到控制的重度哮喘患者中，单克隆抗体（mAb）治疗对精神障碍的控制有积极影响。因此，我们根据反应者状态评估了抗体治疗对这些精神疾病负担的影响。
回顾性收集82例未得到控制的重度哮喘患者在接受mAb治疗（奥马珠单抗、度普利尤单抗、贝那利珠单抗或美泊利珠单抗）之前（“基线”）的数据。使用医院焦虑抑郁量表（HADS）在基线时检测重度抑郁症（MDD）或广泛性焦虑症（GAD）的症状，以及一般社会人口学数据和肺功能参数。在6个月（±3个月）随访时，使用患者健康问卷-2（PHQ-2）和广泛性焦虑症量表-2（GAD-2）评估mAb治疗下的精神病理症状负担。使用生物制剂哮喘反应评分（BARS）对反应状态进行分类，评估病情加重情况、口服糖皮质激素使用情况和哮喘控制测试（ACT）评分。使用线性回归分析确定mAb治疗无反应的预测因素。
与普通人群相比，重度哮喘患者更常出现MDD/GAD症状，在mAb治疗无反应者中患病率更高。与无反应者相比，mAb反应者的MDD负担减轻、生活质量（QoL）更好、病情加重更少、肺功能更好且疾病控制更好。抑郁症状史被确定为mAb治疗无反应的预测因素。
哮喘症状与心理问题相关，在我们的重度哮喘患者队列中比普通人群更普遍。在mAb治疗前有MDD/GAD迹象的患者对mAb治疗的反应较差，表明先前的心理问题对治疗反应有负面影响。在一些患者中，MDD/GAD评分是由重度哮喘引起的——在此有效治疗后症状减轻。
