Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, School of Medicine, Ankara, Turkey.
Int Arch Allergy Immunol. 2024;185(10):947-952. doi: 10.1159/000539310. Epub 2024 Jun 12.
Non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is heterogeneous in both phenotypes and endotypes. Due to insufficient head-to-head comparison studies, it is hard to decide which biological to initiate. This study aimed to compare the efficacy of omalizumab and mepolizumab which can be used in the treatment of patients with severe eosinophilic asthma diagnosed with N-ERD.
The population of this observational, cross-sectional study comprised of N-ERD patients who received omalizumab or mepolizumab for at least 6 months for severe asthma. Outcomes included the asthma control test (ACT), and sino-nasal outcome test scores (SNOT-22), blood eosinophil counts at initiation of biological treatment (T0, baseline) and at the end of 6th months (T6). Adverse effects related to biological treatment and changes of oral corticosteroids dose was recorded.
The study included a total of 22 patients, of whom 11 received mepolizumab and 11 received omalizumab. The change in ACT, SNOT-22, eosinophil counts, and adverse effects related to biologicals were similar at T6 (p = 0.606, p = 0.168, p = 0.05, p = 0.053, respectively). However, when examining the SNOT-22 and ACT based on the cumulative distribution curve (SUCRA), mepolizumab (SUCRA value: 0.61, 0.72, respectively) demonstrated greater efficacy compared to omalizumab (SUCRA value: 0.19, 0.35, respectively). The oral corticosteroids discontinuation rate was similar between the two groups (p = 0.05).
We found both omalizumab and mepolizumab to be effective in treatment; however, we determined that mepolizumab may have a potential superiority in efficacy.
非甾体抗炎药加重的呼吸道疾病（N-ERD）在表型和内型上均具有异质性。由于缺乏头对头比较研究，因此很难决定启动哪种生物制剂。本研究旨在比较奥马珠单抗和美泊利珠单抗在治疗诊断为 N-ERD 的重度嗜酸性粒细胞性哮喘患者中的疗效。
本观察性、横断面研究的人群包括接受奥马珠单抗或美泊利珠单抗治疗至少 6 个月的重度哮喘 N-ERD 患者。结局包括哮喘控制测试（ACT）和鼻-鼻窦结局测试评分（SNOT-22）、生物治疗起始时（T0，基线）和第 6 个月末（T6）的血嗜酸性粒细胞计数。记录与生物治疗相关的不良反应和口服皮质类固醇剂量的变化。
本研究共纳入 22 例患者，其中 11 例接受美泊利珠单抗治疗，11 例接受奥马珠单抗治疗。在 T6 时，ACT、SNOT-22、嗜酸性粒细胞计数和与生物制剂相关的不良反应的变化无统计学差异（p = 0.606、p = 0.168、p = 0.05、p = 0.053）。然而，根据累积分布曲线（SUCRA）检查 SNOT-22 和 ACT，美泊利珠单抗（SUCRA 值：0.61、0.72）的疗效优于奥马珠单抗（SUCRA 值：0.19、0.35）。两组的口服皮质类固醇停药率相似（p = 0.05）。
我们发现奥马珠单抗和美泊利珠单抗在治疗中均有效，但我们确定美泊利珠单抗在疗效上可能具有潜在优势。
