Department of Pulmonology and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
Department of Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
Int J Chron Obstruct Pulmon Dis. 2023 May 5;18:755-763. doi: 10.2147/COPD.S370165. eCollection 2023.
Monoclonal antibodies targeting interleukin 5 (IL5) or its receptor (IL5R) are frequently used in severe asthma, in which they reduce exacerbations rate and oral corticosteroids (OCS) exposure. Anti-IL5/IL5Rs have been studied in patients with chronic obstructive pulmonary disease (COPD) without convincing benefits. However, these therapies have been used in clinical practice in COPD with apparently good results.
To describe the clinical characteristics and therapeutic response of COPD patients treated with anti-IL5/IL5R in a real-world setting.
This is a retrospective case series of patients followed at the Quebec Heart and Lung Institute COPD clinic. Men or women, with an established diagnosis of COPD, and treated either with Mepolizumab or Benralizumab were included. Demographics, disease and exacerbation-related data, airway comorbidities, lung function, and inflammatory profile were extracted from patients' hospital files at baseline visit and 12 months post-treatment. Therapeutic response to biologics was assessed by measuring change in annual exacerbation rate and/or OCS daily dose.
Seven COPD patients treated with biologics were identified (5M:2F). All were found to be OCSdependent at baseline. Radiological evidence of emphysema was found in all patients. One case was diagnosed with asthma before age 40. Residual eosinophilic inflammation was found in 5/6 patients (blood eosinophils count 237 ± 225×10 cells/L) despite chronic OCS use. After 12 months of anti-IL5 treatment, mean OCS dose dropped from 12.0 ± 7.6 to 2.6 ± 4.3 mg/day, representing a 78% decrease. Annual exacerbations rate was reduced by 88%, from 8.2 ± 3.3 to 1.0 ± 1.2 per year.
Chronic OCS use is a common characteristic of patients treated with anti-IL5/IL5R biological therapies in this real-world setting. In this population, it may be effective in decreasing OCS exposure and exacerbation.
靶向白细胞介素 5（IL-5）或其受体（IL-5R）的单克隆抗体常用于严重哮喘，可降低哮喘恶化率和口服皮质类固醇（OCS）的暴露。在慢性阻塞性肺疾病（COPD）患者中，抗 IL-5/IL-5R 的研究并未取得令人信服的益处。然而，这些疗法已在 COPD 的临床实践中使用，且效果良好。
描述在真实环境中使用抗 IL-5/IL-5R 治疗 COPD 患者的临床特征和治疗反应。
这是魁北克心肺研究所 COPD 诊所的一项回顾性病例系列研究。纳入的患者为男性或女性，确诊为 COPD，且接受 Mepolizumab 或 Benralizumab 治疗。在基线访视和治疗后 12 个月时，从患者的医院档案中提取人口统计学、疾病和加重相关数据、气道合并症、肺功能和炎症特征。通过测量每年加重率和/或 OCS 日剂量的变化来评估生物制剂的治疗反应。
共确定了 7 例接受生物制剂治疗的 COPD 患者（5 例男性：2 例女性）。所有患者在基线时均依赖 OCS。所有患者均有肺气肿的放射学证据。1 例患者在 40 岁前被诊断为哮喘。尽管长期使用 OCS，但仍有 5/6 例患者存在残留嗜酸性粒细胞炎症（血嗜酸性粒细胞计数 237±225×10 细胞/L）。抗 IL-5 治疗 12 个月后，OCS 剂量从 12.0±7.6mg 降至 2.6±4.3mg/天，降幅为 78%。每年加重率降低了 88%，从 8.2±3.3 次/年降至 1.0±1.2 次/年。
在这个真实环境中，慢性 OCS 使用是接受抗 IL-5/IL-5R 生物治疗的患者的一个共同特征。在该人群中，它可能有效降低 OCS 暴露和加重。
