Canonica Giorgio Walter, Varricchi Gilda, Paoletti Giovanni, Heffler Enrico, Virchow Johann Christian
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy.
Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy; World Allergy Organization (WAO) Center of Excellence, Naples, Italy; Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy.
J Allergy Clin Immunol. 2023 Oct;152(4):835-840. doi: 10.1016/j.jaci.2023.07.009. Epub 2023 Jul 31.
The article discusses the historical evolution of asthma treatment and highlights recent advancements in personalized medicine, specifically the use of biologics in severe asthma therapy and its potential combination with allergen immunotherapy (AIT). One of the major breakthroughs of biologics is their potential effect on airway remodeling, a crucial aspect of asthma chronicity. The article introduces the concept of disease-modifying antiasthmatic drugs, which aim to modify the course of asthma and possibly modulate or prevent airway remodeling. Furthermore, the critical importance of patient-centered outcome measures to evaluate the efficacy and effectiveness of asthma treatments is emphasized, with the innovative concept of asthma remission introduced as a potential outcome. Recent studies suggest that AIT can be used as an additional therapy to biologic agents for the treatment of allergic asthma. The combination of these treatments has been shown to induce improved clinical outcomes. However, AIT is actually not recommended for use in patients with severe asthma, but encouraging results from studies investigating the combined use of AIT and biologics indicate a novel approach to exploring these treatment modalities. In conclusion, the introduction of biologics and AIT has changed the scenario of respiratory allergy treatment, from a "one size fits all" approach to embracing "individual treatments."
本文讨论了哮喘治疗的历史演变,并重点介绍了个性化医疗的最新进展,特别是生物制剂在重度哮喘治疗中的应用及其与变应原免疫疗法(AIT)联合使用的潜力。生物制剂的主要突破之一是它们对气道重塑的潜在作用,而气道重塑是哮喘慢性化的一个关键方面。本文介绍了疾病修饰抗哮喘药物的概念,其旨在改变哮喘病程并可能调节或预防气道重塑。此外,强调了以患者为中心的结局指标对评估哮喘治疗疗效和有效性的至关重要性,并引入了哮喘缓解这一创新概念作为一种潜在结局。最近的研究表明,AIT可作为生物制剂的辅助疗法用于治疗过敏性哮喘。这些治疗方法的联合使用已显示出能改善临床结局。然而,实际上不建议在重度哮喘患者中使用AIT,但对AIT与生物制剂联合使用的研究取得的令人鼓舞的结果表明了探索这些治疗方式的一种新方法。总之,生物制剂和AIT的引入改变了呼吸道过敏治疗的局面,从“一刀切”的方法转变为采用“个体化治疗”。