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重度哮喘生物治疗的联合应用:我们目前的进展如何?

Combination of Biological Therapy in Severe Asthma: Where We Are?

作者信息

Carriera Lorenzo, Fantò Marta, Martini Alessia, D'Abramo Alice, Puzio Genesio, Scaramozzino Marco Umberto, Coppola Angelo

机构信息

Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.

UOSD Allergologia e Immunologia Clinica, A.O. San Donato, USL Toscana Sud Est, 52100 Arezzo, Italy.

出版信息

J Pers Med. 2023 Nov 10;13(11):1594. doi: 10.3390/jpm13111594.

Abstract

Biological drugs have revolutionized the management of severe asthma. However, a variable number of patients remain uncontrolled or only partially controlled even after the appropriate administration of a biologic agent. The combination of two biologics may target different inflammatory pathways, and it has been used in patients suffering from uncontrolled severe asthma with evidence of both allergic and eosinophilic phenotypes or severe asthma and type2 comorbidities. Combination therapy has also been used to handle anti-IL4/13R induced hypereosinophilia. There is insufficient data on combining biologics for the treatment of severe uncontrolled asthma and type 2 comorbidities, also because of the high cost, and currently no guideline recommends dual biologic therapy. A systematic search was performed using the Medline and Scopus databases. Published data on concurrent administration of two biological drugs in severe, uncontrolled asthma patients has been reported in 28 real-world studies and 1 clinical trial. Data extraction was followed by a descriptive and narrative synthesis of the findings. Future studies should be conducted to further assess the safety, efficacy, and cost-effectiveness of this therapeutic strategy.

摘要

生物药物彻底改变了重度哮喘的治疗方式。然而,即使在适当使用生物制剂后,仍有数量不等的患者病情未得到控制或仅部分得到控制。两种生物制剂联合使用可能针对不同的炎症途径,已被用于治疗重度哮喘控制不佳且具有过敏和嗜酸性粒细胞表型证据或重度哮喘合并2型共病的患者。联合疗法也被用于处理抗IL4/13R诱导的嗜酸性粒细胞增多症。关于联合使用生物制剂治疗重度未控制哮喘和2型共病的数据不足,这也是由于成本高昂,目前尚无指南推荐双重生物制剂疗法。我们使用Medline和Scopus数据库进行了系统检索。在28项真实世界研究和1项临床试验中报告了关于在重度未控制哮喘患者中同时使用两种生物药物的已发表数据。数据提取后,对研究结果进行了描述性和叙述性综合分析。未来应开展研究以进一步评估这种治疗策略的安全性、有效性和成本效益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63aa/10672189/ac45c4296951/jpm-13-01594-g001.jpg

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