Department of Allergy and Immunology, Balıkesir University, Balikesir, Turkey.
Department of Pulmonology, Balıkesir University, Balikesir, Turkey.
J Asthma. 2024 Feb;61(2):173-175. doi: 10.1080/02770903.2023.2244590. Epub 2023 Aug 26.
Results of biological therapies are often encouraging for severe asthma who are phenotyped as Type 2 inflammation. Unfortunately, some patients do not achieve the desired responses. In this group of patients, there are often switches between anti Ig E and anti-IL-5s and partial improvements are often is deemed sufficient.
We planned to start combination therapy with mepolizumab and omalizumab in a 52-year-old patient with uncontrolled allergic asthma whose asthma could not be controlled with omalizumab and mepolizumab treatment, respectively. After complete asthma control was achieved, we aimed to discontinue mepolizumab and continue with omalizumab because it was allergic asthma.
The combination of omalizumab 300 mg/month and mepolizumab 100 mg/month was tried and emergency admissions and oral corticosteroids were stopped. At the same time, significant improvement was observed in asthma control test, pulmonary function test and comfort of life.
Combined use of Anti-Ig E (omalizumab) and Anti IL 5 (mepolizumab) with a synergistic effect by acting through both pathways, especially in patients with allergic asthma and high levels of both total Ig E and eosinophilia, was found to be effective and no side effects were observed in long-term follow-up. Combination therapy with omalizumab and mepolizumab may become a safe option in patients with severe allergic asthma with a Type 2 inflammatory phenotype who cannot be controlled with each biologic agent.
生物疗法的结果对于表型为 2 型炎症的严重哮喘患者通常是令人鼓舞的。不幸的是，有些患者无法获得预期的反应。在这群患者中，anti-IgE 和 anti-IL-5 之间经常会发生转换，而部分改善通常被认为是足够的。
我们计划在一位 52 岁的、患有未控制的过敏性哮喘的患者中开始 mepolizumab 和 omalizumab 的联合治疗，该患者的哮喘分别对 omalizumab 和 mepolizumab 治疗无法控制。在完全控制哮喘后，我们旨在停用 mepolizumab 并继续使用 omalizumab，因为这是过敏性哮喘。
尝试了每月使用 300mg 奥马珠单抗和 100mg 美泊利珠单抗的联合治疗，并停止了紧急入院和口服皮质类固醇治疗。同时，在哮喘控制测试、肺功能测试和生活舒适度方面观察到显著改善。
通过两种途径协同作用，联合使用 Anti-IgE（奥马珠单抗）和 Anti IL 5（美泊利珠单抗），特别是在过敏性哮喘和总 IgE 和嗜酸性粒细胞均高的患者中，发现是有效的，并且在长期随访中没有观察到副作用。对于每个生物制剂都无法控制的 2 型炎症表型的严重过敏性哮喘患者，omalizumab 和 mepolizumab 的联合治疗可能成为一种安全的选择。
