Quarato Carla Maria Irene, Tondo Pasquale, Lacedonia Donato, Soccio Piera, Fuso Paolo, Sabato Eugenio, Hoxhallari Anela, Foschino Barbaro Maria Pia, Scioscia Giulia
Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, 71122 Foggia, Italy.
Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy.
J Clin Med. 2024 Jan 4;13(1):291. doi: 10.3390/jcm13010291.
Nowadays, highly selective biological drugs offer the possibility of treating severe type 2 asthma. However, in the real-life setting, it is crucial to confirm the validity of the chosen biological treatment by evaluating the achievement of clinical remission. The main aims of this real-life study were to evaluate the efficacy of dupilumab in terms of clinical, functional, and inflammatory outcomes at 6, 12, 18, and 24 months of treatment and to estimate the percentage of patients achieving partial or complete clinical remission at 12 and 24 months of treatment. In addition, we attempted to identify whether baseline clinical characteristics of patients could be associated with clinical remission at 24 months of treatment. In this observational prospective study, 20 outpatients with severe uncontrolled eosinophilic asthma were prescribed dupilumab and followed-up after 6, 12, 18, and 24 months of treatment. At each patient visit, need for oral corticosteroids (OCS) and corticosteroid required dose, number of exacerbations during the previous year or from the previous visit, asthma control test (ACT) score, pre-bronchodilator forced expiratory volume in the 1st second (FEV), fractional exhaled nitric oxide at a flow rate of 50 mL/s (FeNO), and blood eosinophil count were assessed. The number of OCS-dependent patients was reduced from 10 (50%) at baseline to 5 (25%) at one year (T12) and 2 years (T24). The average dose of OCS required by patients demonstrated a significant reduction at T12 (12.5 ± 13.75 mg vs. 2.63 ± 3.94 mg, = 0.015), remaining significant even at T24 (12.5 ± 13.75 mg vs. 2.63 ± 3.94 mg, = 0.016). The number of exacerbators showed a statistically significant decrease at T24 (10 patients, 50% vs. 3 patients, 15%, = 0.03). The mean number of exacerbations demonstrated a statistically significant reduction at T24 (1.45 ± 1.58 vs. 0.25 ± 0.43, = 0.02). The ACT score improved in a statistically significant manner at T12 (15.30 ± 4.16 vs. 21.40 ± 2.35, < 0.0001), improving further at T24 (15.30 ± 4.16 vs. 22.10 ± 2.59, < 0.0001). The improvement in pre-bronchodilator FEV values reached statistical significance at T24 (79.5 ± 14.4 vs. 87.7 ± 13.8, = 0.03). The reduction in flow at the level of the small airways (FEF) also demonstrated an improvement, although it did not reach statistical significance either at T12 or T24. A total of 11 patients (55%) showed clinical remission at T12 (6 complete + 5 partial) and 12 patients (60%) reached clinical remission at T24 (9 complete + 3 partial). Only obesity was associated with a negative odds ratio (OR) for achieving clinical remission at T24 (OR: 0.03, 95% CI: 0.002-0.41, = 0.004). No other statistically significant differences in baseline characteristics emerged between patients who reached clinical remission at T24 and the group of patients who did not achieve this outcome. Dupilumab appears to be an effective drug in promoting achievement of clinical remission in patients with severe uncontrolled eosinophilic asthma. The achievement of clinical remission should be continuously evaluated during treatment. Further studies are needed to clarify whether certain baseline clinical characteristics can help predict dupilumab favorable outcomes.
如今,高选择性生物药物为治疗重度2型哮喘提供了可能。然而,在现实生活中,通过评估临床缓解的达成情况来确认所选生物治疗的有效性至关重要。这项现实生活研究的主要目的是评估度普利尤单抗在治疗6、12、18和24个月时在临床、功能和炎症结局方面的疗效,并估计在治疗12和24个月时实现部分或完全临床缓解的患者百分比。此外,我们试图确定患者的基线临床特征是否与治疗24个月时的临床缓解相关。在这项观察性前瞻性研究中,20例重度未控制嗜酸性粒细胞性哮喘门诊患者被处方度普利尤单抗,并在治疗6、12、18和24个月后进行随访。每次患者就诊时,评估口服糖皮质激素(OCS)的需求和所需糖皮质激素剂量、前一年或上次就诊以来的加重次数、哮喘控制测试(ACT)评分、支气管扩张剂前第1秒用力呼气量(FEV)、流速为50 mL/s时的呼出一氧化氮分数(FeNO)以及血液嗜酸性粒细胞计数。OCS依赖患者的数量从基线时的10例(50%)降至1年(T12)时的5例(25%)和2年(T24)时的5例(25%)。患者所需OCS的平均剂量在T12时显著降低(12.5±13.75 mg对2.63±3.94 mg,P = 0.015),甚至在T24时仍具有显著性(12.5±13.75 mg对2.63±3.94 mg,P = 0.016)。加重患者的数量在T24时显示出统计学上的显著减少(10例患者,50%对3例患者,15%,P = 0.03)。加重次数的平均值在T24时显示出统计学上的显著减少(1.45±1.58对0.25±0.43,P = 0.02)。ACT评分在T12时以统计学上显著的方式改善(15.30±4.16对21.40±2.35,P < 0.0001),在T24时进一步改善(15.30±4.16对22.10±2.59,P < 0.0001)。支气管扩张剂前FEV值的改善在T24时达到统计学显著性(79.5±14.4对87.7±13.8,P = 0.03)。小气道水平气流(FEF)的降低也显示出改善,尽管在T12或T24时均未达到统计学显著性。共有11例患者(55%)在T12时显示临床缓解(6例完全缓解 + 5例部分缓解),12例患者(60%)在T24时达到临床缓解(9例完全缓解 + 3例部分缓解)。只有肥胖与T24时实现临床缓解的负比值比(OR)相关(OR:0.03,95%置信区间:0.002 - 0.41,P = 0.004)。在T24时达到临床缓解的患者与未达到此结果的患者组之间,基线特征没有其他统计学上的显著差异。度普利尤单抗似乎是一种有效的药物,可促进重度未控制嗜酸性粒细胞性哮喘患者实现临床缓解。在治疗期间应持续评估临床缓解的达成情况。需要进一步研究以阐明某些基线临床特征是否有助于预测度普利尤单抗的良好结局。
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