Lombardi Carlo, Menzella Francesco, Berti Alvise
Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy.
Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy.
Drugs Context. 2024 Jul 22;13. doi: 10.7573/dic.2024-4-2. eCollection 2024.
Patients with severe asthma are often dependent on oral corticosteroids (OCS) and have frequent exacerbations. This article aims to report very long-term data of patients with severe eosinophilic asthma assessing asthma control, lung function, inhaled corticosteroid (ICS) dose reduction, and clinical and biological parameters of patients treated with mepolizumab.
Four cases of adult patients with severe eosinophilic asthma who were treated for 60 months or more with mepolizumab 100 mg/4 weeks, leading to the stable discontinuation of OCS, are presented. ICS dose, OCS dose and withdrawal date, lung function, eosinophil count, fractional exhaled nitric oxide, and asthma control test were recorded as well as exacerbations in the 12 months before commencing mepolizumab and in the 12 months before the last follow-up visit.
Three of the patients were men, median age was 52.5 years (range 79-53), median length of asthma before mepolizumab start was 67.5 months (range 24-240), three had chronic rhinosinusitis without nasal polyposis and two were atopic. All had eosinophil counts >300 cells/μL at baseline. The median follow-up was 73.5 months (range 71-74), and OCS withdrawal from baseline occurred after a median of 13 months of mepolizumab treatment (range 12-39). A substantial reduction of ICS treatment was registered as well as improvement in asthma control test, fractional exhaled nitric oxide and functional parameters, and a significant reduction of exacerbations in the last 12 months before last visit was observed as compared to the 12 months before baseline (from a median of 4 (range 3-6) to 0; =0.0286).
Mepolizumab could be a 'disease-modifying' agent, with high tolerability and a good efficacy profile in the long term.
重度哮喘患者通常依赖口服糖皮质激素（OCS），且病情频繁加重。本文旨在报告重度嗜酸性粒细胞性哮喘患者的长期数据，评估哮喘控制情况、肺功能、吸入性糖皮质激素（ICS）剂量减少情况以及接受美泊利珠单抗治疗患者的临床和生物学参数。
介绍了4例成年重度嗜酸性粒细胞性哮喘患者，他们接受美泊利珠单抗100mg/4周治疗60个月或更长时间，导致OCS稳定停用。记录了ICS剂量、OCS剂量及停用日期、肺功能、嗜酸性粒细胞计数、呼出一氧化氮分数和哮喘控制测试，以及开始使用美泊利珠单抗前12个月和最后一次随访前12个月的病情加重情况。
3例患者为男性，中位年龄为52.5岁（范围79 - 53岁），开始使用美泊利珠单抗前哮喘的中位病程为67.5个月（范围24 - 240个月），3例患有无鼻息肉的慢性鼻窦炎，2例为特应性体质。所有患者基线时嗜酸性粒细胞计数均>300个细胞/μL。中位随访时间为73.5个月（范围71 - 74个月），美泊利珠单抗治疗中位13个月（范围12 - 39个月）后OCS从基线水平停用。ICS治疗显著减少，哮喘控制测试、呼出一氧化氮分数和功能参数有所改善，与基线前12个月相比，末次随访前12个月病情加重显著减少（从中位4次（范围3 - 6次）降至0次；P = 0.0286）。
美泊利珠单抗可能是一种“疾病修饰”药物，长期耐受性高且疗效良好。
