Bonini Matteo, Boccabella Cristina, Cefaloni Francesca, De Corso Eugenio, Donfrancesco Federico, Schiavi Enrico, Richeldi Luca
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
National Heart and Lung Institute (NHLI), Imperial College London, London SW7 2AZ, UK.
J Clin Med. 2025 Apr 24;14(9):2928. doi: 10.3390/jcm14092928.
Mepolizumab represents an effective strategy for severe eosinophilic asthma. Small airways disease (SAD) defines a peculiar asthma phenotype related to worse disease control. Limited and indirect findings are currently available on the effect of mepolizumab on SAD. We investigated the impact of mepolizumab on SAD assessed through impulse oscillometry (IOS) and spirometry. As secondary outcomes, we tested the correlation between SAD and clinical, functional and inflammatory parameters. This is a prospective cohort study including severe eosinophilic asthmatics eligible for mepolizumab performed between 2021 and 2023. IOS (R5-R20) and spirometry (FEF25-75%, TLC%, RV/TLC%) parameters were assessed at baseline and over 1 year of mepolizumab. Other functional (FEV1%), clinical (ACT, number of asthma exacerbations/previous year, use of OCS) and inflammatory data (BEC and FeNO) were concomitantly collected for correlations. : A total of 18 patients (mean age 61.1 ± 12.0 y; 10 (55.5%) female) were included. Longitudinal data from 16 patients showed that R5-R20 significantly improved after 12-months treatment (: 0.03), as well as FEF25-75% (: 0.04) and TLC% (0.04). FEV1% and ACT showed a concomitant improvement (: 0.03 and <0.01, respectively). All the steroid-dependent subjects discontinued OCS after 3 months and the percentage of subjects experiencing exacerbations significantly decreased (: <0.01). As per drug effect, BEC consistently decreased (: <0.01). The decrease in R5-R20 correlated with an improvement in FEF25-75% (r: -0.40 : 0.048) and ACT at T12 (r: -0.59 : 0.02). : Twelve months treatment with mepolizumab improved R5-R20, suggesting its additional role as a targeted treatment for distal lung regions. This improvement also correlated with a clinically relevant amelioration of asthma symptoms.
美泊利珠单抗是治疗重度嗜酸性粒细胞性哮喘的一种有效策略。小气道疾病（SAD）是一种特殊的哮喘表型，与疾病控制不佳有关。目前关于美泊利珠单抗对SAD影响的研究结果有限且不直接。我们通过脉冲振荡法（IOS）和肺量计研究了美泊利珠单抗对SAD的影响。作为次要结果，我们测试了SAD与临床、功能和炎症参数之间的相关性。这是一项前瞻性队列研究，纳入了2021年至2023年期间符合使用美泊利珠单抗条件的重度嗜酸性粒细胞性哮喘患者。在基线和使用美泊利珠单抗1年期间评估IOS（R5-R20）和肺量计（FEF25-75%、TLC%、RV/TLC%）参数。同时收集其他功能（FEV1%）、临床（ACT、哮喘发作次数/前一年、口服糖皮质激素（OCS）的使用情况）和炎症数据（嗜酸性粒细胞计数（BEC）和呼出一氧化氮（FeNO））以进行相关性分析。共纳入18例患者（平均年龄61.1±12.0岁；10例（55.5%）为女性）。16例患者的纵向数据显示，治疗12个月后R5-R20显著改善（P：0.03），FEF25-75%（P：0.04）和TLC%（P：0.04）也显著改善。FEV1%和ACT同时改善（P分别为0.03和<0.01）。所有依赖类固醇的受试者在3个月后停用OCS，哮喘发作的受试者百分比显著降低（P：<0.01）。就药物效果而言，BEC持续下降（P：<0.01）。R5-R20的下降与FEF25-75%的改善（r：-0.40，P：0.048）和T12时ACT的改善（r：-0.59，P：0.02）相关。使用美泊利珠单抗治疗12个月可改善R5-R20，表明其对肺远端区域具有靶向治疗的额外作用。这种改善还与哮喘症状的临床相关改善相关。
