Navarro-Cascales Tatiana, Colque-Bayona Monica, Fernandez-Concha Inés, Laorden Daniel, Quirce Santiago, Domínguez-Ortega Javier
Department of Allergy, La Paz University Hospital, Madrid, Spain.
Institute for Health Research (IdiPAZ), Madrid, Spain.
J Asthma. 2025 Feb;62(2):319-327. doi: 10.1080/02770903.2024.2400607. Epub 2024 Sep 14.
This study aimed to compare the clinical characteristics and treatment outcomes of allergic patients (AP) and non-allergic patients (NAP) with severe eosinophilic asthma (SEA) treated with anti-IL5/IL5R biologic agents (mepolizumab, benralizumab, or reslizumab) over one year. Sub-analyses assessed treatment response variations between AP and NAP based on the biological used and compared outcomes among AP with and without fungal allergy.
Observational retrospective analysis. Clinical characteristics, laboratory findings, pulmonary function tests, Asthma Control Test (ACT) scores, oral corticosteroid (OCS) usage, and exacerbation frequency were assessed at the initiation of biological treatment and after one year.
Sixty-five patients with SEA were included, 41 AP and 24 NAP. 55.4% were treated with mepolizumab, 33.8% with benralizumab, and 10.8% with reslizumab. Before anti-IL5/5R treatment, AP had worse baseline outcomes but there were no differences in pulmonary function. Mean annual exacerbation rate and percentage of patients requiring OCS and dose of prednisone were higher in AP than NAP. AP had significantly higher total IgE values. After one year of treatment, more AP discontinued OCS than NAP ( = 0.025). Both experienced a significant reduction in exacerbation frequency ( = 0.001) and improved respiratory function. 70.7% of AP and 60% of NAP improved ACT ≥3 points. There was no significant difference between AP and NAP using mepolizumab ( = 0.145) or benralizumab ( = 0.174) in reducing OCS.
Anti-IL5/IL5R reduced the need for OCS and improved asthma control, regardless of allergic status. Fungal allergy led to lower ACT scores and higher exacerbations than other allergens; both groups improved with anti-IL5/ILR.
本研究旨在比较接受抗IL5/IL5R生物制剂（美泊利单抗、贝那利珠单抗或瑞利珠单抗）治疗一年的重度嗜酸性粒细胞性哮喘（SEA）过敏患者（AP）和非过敏患者（NAP）的临床特征及治疗效果。亚分析基于所使用的生物制剂评估AP和NAP之间的治疗反应差异，并比较有和没有真菌过敏的AP患者的治疗结果。
观察性回顾分析。在生物治疗开始时和一年后评估临床特征、实验室检查结果、肺功能测试、哮喘控制测试（ACT）评分、口服糖皮质激素（OCS）使用情况和加重频率。
纳入65例SEA患者，41例AP和24例NAP。55.4%接受美泊利单抗治疗，33.8%接受贝那利珠单抗治疗，10.8%接受瑞利珠单抗治疗。在抗IL5/5R治疗前，AP的基线结果较差，但肺功能无差异。AP的年平均加重率、需要OCS的患者百分比和泼尼松剂量均高于NAP。AP的总IgE值显著更高。治疗一年后，停用OCS的AP比NAP更多（P = 0.025）。两者的加重频率均显著降低（P = 0.001），呼吸功能改善。70.7%的AP和60%的NAP的ACT改善≥3分。在减少OCS使用方面，使用美泊利单抗（P = 0.145）或贝那利珠单抗（P = 0.174）的AP和NAP之间无显著差异。
无论过敏状态如何，抗IL5/IL5R均可减少对OCS的需求并改善哮喘控制。与其他过敏原相比，真菌过敏导致ACT评分更低、加重更频繁；两组使用抗IL5/ILR后均有改善。
