Visca Dina, Ardesi Francesco, Zappa Martina, Grossi Sarah, Pignatti Patrizia, Vanetti Marco, Pini Laura, Sotgiu Giovanni, Centis Rosella, Migliori Giovanni Battista, Spanevello Antonio
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, via Roncaccio 16, Tradate 21049, Italy.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241304685. doi: 10.1177/17534666241304685.
Benralizumab is a monoclonal antibody treatment for severe eosinophilic asthma (SEA). Few studies investigated its role in airway inflammation and its correlation with lung function.
The aim of the present study is to assess its effect after 1 year of treatment, focusing on airway inflammation.
This is a retrospective observational study, in an Italian tertiary reference centre specialised in diagnosis and management of severe asthma patients.
We conducted a monocentric retrospective study including SEA patients treated with benralizumab for 1 year. Clinical, functional and inflammatory data were collected at baseline, 6 (T6) and 12 (T12) months.
Twenty-two SEA patients on benralizumab were included. We observed a reduction in exacerbations rate and systemic steroid treatment ( < 0.0001) as well as an improvement in asthma control ( < 0.0001), health-related quality of life ( = 0.017) and lung function pre-BD FEV1 (L) ( = 0.02) and percentage ( = 0.004) and post-BD FEV1 (L) ( = 0.01) and percentage ( = 0.003) from baseline to T6 and T12. A reduction in sputum eosinophil percentage was observed at T6 and T12 ( < 0.005). We found a positive correlation between the variation of sputum eosinophils percentage and FEV1 (L) at T12 (rho = -0.79, = 0.04). Moreover, the improvement of FEF from baseline to 6 (rho = -0.53, = 0.03) and 12 (rho = -0.62, = 0.01) months negatively correlated with the duration of asthma disease.In our cohort 12/22 patients were super-responders at T6 and 15/22 at T12. Furthermore, clinical remission was reached by 12/22, and all of them obtained blood and sputum eosinophils counts normalisation.
Our data confirm that it is a rapid and effective treatment for SEA acting on clinical, functional, systemic and airway inflammatory outcomes. Our results highlight the role of induced sputum as a promising non-invasive technique to investigate pathophysiologic mechanisms in severe asthma treated with biologics. Finally, a negative correlation between small airway improvement and the duration of asthma may suggest that a prompt referral to asthma centres may delay lung function worsening. Additional studies are needed to investigate more in-depth the role of induced sputum in the management of asthma, response to treatment and remission.
贝那利珠单抗是一种用于治疗重度嗜酸性粒细胞性哮喘（SEA）的单克隆抗体。很少有研究调查其在气道炎症中的作用及其与肺功能的相关性。
本研究的目的是评估其治疗1年后的效果，重点关注气道炎症。
这是一项在意大利一家专门从事重度哮喘患者诊断和管理的三级参考中心进行的回顾性观察研究。
我们进行了一项单中心回顾性研究，纳入接受贝那利珠单抗治疗1年的SEA患者。在基线、6个月（T6）和12个月（T12）时收集临床、功能和炎症数据。
纳入了22例接受贝那利珠单抗治疗的SEA患者。我们观察到发作率和全身类固醇治疗减少（<0.0001），以及哮喘控制改善（<0.0001）、健康相关生活质量改善（=0.017）、肺功能（支气管舒张前FEV1（L）（=0.02）和百分比（=0.004）以及支气管舒张后FEV1（L）（=0.01）和百分比（=0.003）从基线到T6和T12均有改善。在T6和T12时观察到痰液嗜酸性粒细胞百分比降低（<0.005）。我们发现T12时痰液嗜酸性粒细胞百分比变化与FEV1（L）之间呈正相关（rho=-0.79，=0.04）。此外，从基线到6个月（rho=-0.53，=0.03）和12个月（rho=-0.62，=0.01）FEF的改善与哮喘病程呈负相关。在我们的队列中，12/22例患者在T6时为超级反应者，15/22例在T12时为超级反应者。此外，12/22例患者达到临床缓解，且所有患者的血液和痰液嗜酸性粒细胞计数均恢复正常。
我们的数据证实，它是一种对SEA快速有效的治疗方法，对临床、功能、全身和气道炎症结局均有作用。我们的结果强调了诱导痰液作为一种有前景的非侵入性技术在研究接受生物制剂治疗的重度哮喘病理生理机制中的作用。最后，小气道改善与哮喘病程之间的负相关可能表明，及时转诊至哮喘中心可能会延缓肺功能恶化。需要更多研究来更深入地研究诱导痰液在哮喘管理、治疗反应和缓解中的作用。
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