Otten Josje, van der Lans Rik, de Corso Eugenio, Dziadziulia Kanstantsin, Hilvering Bart, Weersink Els, Bonini Matteo, Hagemann Jan, Thaitrakool Wanrawee, Montuori Claudio, Klimek Ludger, Reitsma Sietze, Fokkens Wytske
Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
Expert Rev Clin Immunol. 2023 Jul-Dec;19(8):1041-1049. doi: 10.1080/1744666X.2023.2218617. Epub 2023 May 29.
Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch.
Ninety-four patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated.
Twenty patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. Fifty-one patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. Twenty-eight patients experienced insufficient control of both upper and lower airways. Thirteen patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision-making.
For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore, we suggest to use dupilumab as first choice when switching biologic agents.
2型靶向生物制剂已率先在哮喘治疗中上市，自2019年起也用于慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的治疗。由于缺乏关于最佳生物制剂选择的明确指南和预测指标，患者有时需要更换生物制剂治疗，以获得最佳治疗效果。在本文中，我们评估了更换生物制剂的原因以及每次序贯更换后的治疗效果。
对94例因治疗CRSwNP和哮喘而从一种生物制剂换用另一种生物制剂的患者进行了评估。
20例患者的CRSwNP得到了满意控制，但重度哮喘控制不佳。51例患者的重度哮喘得到了满意控制，但CRSwNP/鼻息肉样变（EOM）控制不佳。28例患者的上、下气道控制均不佳。13例患者因副作用而不得不更换生物制剂。此外，还描述了2例病例以阐明临床决策。
对于上述患者，必须采用多学科方法来找到最合适的生物制剂。如果第一种抗IL-5治疗不成功，换用第二种抗IL-5治疗似乎无效。大多数对奥马珠单抗和/或抗IL-5治疗无效的患者在使用度普利尤单抗时病情得到了良好控制。因此，我们建议在更换生物制剂时将度普利尤单抗作为首选。
