Bonato Matteo, Savoia Francesca, Orzes Enrico, Favero Elisabetta, Senna Gianenrico, Romagnoli Micaela
Pulmonology Unit, Ca' Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 3100 Treviso, Italy.
Allergological and Rare Disease Centre, Internal Medicine Department, Ca' Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy.
Antibodies (Basel). 2025 Jul 22;14(3):61. doi: 10.3390/antib14030061.
: Mepolizumab is an effective treatment for severe eosinophilic asthma, leading to a depletion of blood eosinophil levels, the clinical relevance of which remains unclear. : The aim of this study was to assess the relationship between mepolizumab-induced blood eosinophil reduction and clinical outcome in patients with severe eosinophilic asthma, in particular, whether the magnitude of blood eosinophil reduction was associated with clinical remission. : We conducted a real-world retrospective analysis of 58 adult patients with severe eosinophilic asthma treated with mepolizumab. Clinical and respiratory functional parameters were evaluated at the start of mepolizumab treatment (T0) and after two years of treatment (T2; mean follow-up: 22.8 ± 7.5 months). Blood eosinophil counts were recorded at T0 and during the first year of treatment (T1; mean follow-up: 7.7 ± 4.1 months). : After two years of mepolizumab treatment, 58 severe asthmatic patients showed significant improvements in ACT score, FVC, and FEV and a reduction in acute exacerbations and the use of maintenance therapies. Clinical remission was achieved in 55.1% of patients. Lower blood eosinophil counts during the first year (T1) were associated with greater improvements in lung function and fewer exacerbations. A greater relative decrease in eosinophils from baseline to T1 (ΔEOS%) was significantly associated with remission, reductions in exacerbations, and no maintenance OCS use. ΔEOS% was the only independent predictor of remission in the multivariate analysis. A ≥90% reduction predicted remission with 80% specificity (AUC = 0.726). : Monitoring blood eosinophils after mepolizumab initiation could be a useful tool for predicting long-term response to treatment. In particular, a reduction by over 90% of peripheral blood eosinophils during the first year of mepolizumab treatment predicts clinical remission with a specificity of 80%. Considering the accessibility and the low cost of this biomarker, it may help to optimize long-term asthma management.
美泊利珠单抗是重度嗜酸性粒细胞性哮喘的有效治疗药物，可使血液嗜酸性粒细胞水平降低，但其临床相关性仍不明确。本研究旨在评估美泊利珠单抗诱导的血液嗜酸性粒细胞减少与重度嗜酸性粒细胞性哮喘患者临床结局之间的关系，特别是血液嗜酸性粒细胞减少的程度是否与临床缓解相关。我们对58例接受美泊利珠单抗治疗的重度嗜酸性粒细胞性哮喘成年患者进行了一项真实世界回顾性分析。在美泊利珠单抗治疗开始时（T0）和治疗两年后（T2；平均随访时间：22.8±7.5个月）评估临床和呼吸功能参数。在T0以及治疗的第一年（T1；平均随访时间：7.7±4.1个月）记录血液嗜酸性粒细胞计数。美泊利珠单抗治疗两年后，58例重度哮喘患者的ACT评分、FVC和FEV均有显著改善，急性加重次数和维持治疗的使用减少。55.1%的患者实现了临床缓解。第一年（T1）血液嗜酸性粒细胞计数较低与肺功能改善更大和加重次数减少相关。从基线到T1嗜酸性粒细胞的相对下降幅度更大（ΔEOS%）与缓解、加重次数减少以及未使用维持性口服糖皮质激素显著相关。在多变量分析中，ΔEOS%是缓解的唯一独立预测因素。降低≥90%预测缓解的特异性为80%（AUC=0.726）。在开始使用美泊利珠单抗后监测血液嗜酸性粒细胞可能是预测治疗长期反应的有用工具。特别是，在美泊利珠单抗治疗的第一年外周血嗜酸性粒细胞减少超过90%预测临床缓解的特异性为80%。考虑到这种生物标志物的可及性和低成本，它可能有助于优化哮喘的长期管理。
