Erroz Ferrer María, Paniagua García Miren, Sánchez Natividad Viguria, Moreno-Galarraga Laura
Pediatric Service, University Hospital of Navarra (HUN), 31006 Pamplona, Spain.
IdiSNA, Health Research Institute of Navarra, 31006 Pamplona, Spain.
Children (Basel). 2025 Aug 20;12(8):1092. doi: 10.3390/children12081092.
BACKGROUND/OBJECTIVES: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment.
We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab.
Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy.
This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential.
背景/目的：生物疗法的出现改变了重度哮喘的治疗方式，提供了针对性的治疗方法，可改善症状控制并减少病情加重。然而，仅根据初始反应就选择使用生物制剂可能并非最佳选择。临床医生必须定期重新评估所选生物制剂的适用性，同时考虑患者特征的变化以及治疗选择的不断增加。本文旨在强调在接受生物疗法的儿科患者长期管理中进行个体化决策的重要性，探讨可能支持更换生物制剂治疗的各种原因。
我们通过一个案例来说明这种方法：一名14岁的重度过敏性哮喘青春期女孩，最初接受奥马珠单抗治疗，临床、实验室和功能方面均有改善。尽管有这种积极反应，但患者因注射频率和就诊次数而报告满意度较低，导致依从性差。经过全面重新评估后，治疗改为使用tezepelumab。
更换治疗后，患者病情保持稳定控制，肺功能略有改善，同时依从性、满意度和生活质量显著提高。每年的就诊次数从24次减少到12次，注射次数从每年104次减少到12次。患者对新治疗方案表示高度满意，治疗的经济负担也大幅减轻。我们列出了一个表格，总结了开始或更换生物疗法时需要考虑的主要和次要因素。
该案例强调，在评估儿科哮喘生物疗法的更换时，需要超越传统标准，如疗效不佳和不良反应。还应考虑合并症、注射频率和次数、给药途径和成本等因素，因为它们会直接影响儿童和青少年的依从性和临床结果。随着治疗选择的增加，定期重新评估和个性化调整仍然至关重要。
