Manchester University NHS Foundation Hospital Trust, the University of Manchester, Manchester, UK.
Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Int J Chron Obstruct Pulmon Dis. 2023 Jul 27;18:1595-1599. doi: 10.2147/COPD.S418944. eCollection 2023.
Exacerbations in chronic obstructive pulmonary disease (COPD), which tend to occur in clusters and increase with disease severity, come with high societal and economic burdens. Prevention and delay of recurrent exacerbations is an unmet and significant therapeutic need for patients with COPD. GALATHEA (NCT02138916) and TERRANOVA (NCT02155660) were trials assessing efficacy of benralizumab in patients with frequent COPD exacerbations despite treatment. Although these studies found that benralizumab given as an add-on treatment did not significantly reduce annual rates of COPD exacerbations after 56 weeks of treatment, in the following exploratory post hoc analysis of the GALATHEA and TERRANOVA trials we identified a potential responder population in which treatment with benralizumab prevents recurrent COPD exacerbations during 30- and 90-day periods following an initial exacerbation, a vulnerable period for an exacerbation to occur. This responder population was characterized by high blood eosinophil counts and frequent previous exacerbations despite optimized triple therapy. These results highlight the importance of targeted therapies for high-risk populations and merit further research into the benefits of biologic therapies for COPD exacerbations.
慢性阻塞性肺疾病(COPD)的恶化通常呈簇状发生,并随疾病严重程度的增加而加重,给社会和经济带来了沉重负担。预防和延缓 COPD 患者的复发性恶化是一项尚未满足的重大治疗需求。GALATHEA(NCT02138916)和 TERRANOVA(NCT02155660)是两项评估贝那鲁肽治疗频繁 COPD 恶化患者疗效的试验。尽管这些研究发现,贝那鲁肽作为附加治疗,在 56 周的治疗后,并未显著降低 COPD 恶化的年发生率,但在对 GALATHEA 和 TERRANOVA 试验的后续探索性事后分析中,我们确定了一个潜在的应答人群,即在初始恶化后 30 天和 90 天的时间内,贝那鲁肽治疗可预防复发性 COPD 恶化,这是恶化发生的脆弱时期。该应答人群的特征是血液嗜酸性粒细胞计数高,尽管接受了优化的三联疗法,但仍频繁发生恶化。这些结果强调了针对高危人群的靶向治疗的重要性,并值得进一步研究生物疗法对 COPD 恶化的益处。