Sunadome Hironobu, Matsumoto Hisako, Nagasaki Tadao, Hayashi Yusuke, Terada Satoru, Nishi Kenta, Nomura Natsuko, Kogo Mariko, Morimoto Chie, Oguma Tsuyoshi, Sato Susumu, Hirai Toyohiro
Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University Kyoto, Kyoto, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University Kyoto, Kyoto, Japan.
J Asthma Allergy. 2025 Sep 3;18:1229-1237. doi: 10.2147/JAA.S523832. eCollection 2025.
Biologics are crucial for severe asthma treatment, but their high costs pose challenges. Omalizumab (OML) is dosed on the basis of patient-specific factors. The purpose of this study is to clarify the clinical characteristics of severe asthmatics who maintain long-term control on omalizumab including healthcare cost considerations.
A retrospective, multicenter cohort study was conducted. Patients receiving OML at three institutions were enrolled. Patients continuing OML (C-OML) were compared with those switching to other biologics (S-OML) in terms of clinical background, cost-effectiveness, and type-2 inflammation levels.
Forty-seven patients were enrolled. The C-OML group achieved exacerbation control comparable to that of the S-OML group, with a median OML dose of 300 mg/month, resulting in significantly lower personal payments ( < 0.01). Compared with the S-OML group, the C-OML group had a greater prevalence of overweight ( = 0.04), a lower prevalence of eosinophilic chronic rhinosinusitis ( < 0.01), and a trend toward a higher prevalence of allergic rhinitis ( = 0.06). Effective asthma control with OML was associated with nonsevere type-2 inflammation (eosinophils < 300/μL and FeNO < 50 ppb).
Patients with nonsevere type-2 inflammation and a high BMI can achieve effective asthma control with OML, reducing treatment costs. Identifying this phenotype can improve the cost-effectiveness of biologic therapies for patients with severe asthma.
生物制剂对重度哮喘治疗至关重要，但其高昂成本带来了挑战。奥马珠单抗（OML）根据患者个体因素给药。本研究旨在阐明在奥马珠单抗治疗下维持长期病情控制的重度哮喘患者的临床特征，包括医疗成本考量。
进行了一项回顾性、多中心队列研究。纳入在三家机构接受OML治疗的患者。将继续使用OML的患者（C-OML组）与改用其他生物制剂的患者（S-OML组）在临床背景、成本效益和2型炎症水平方面进行比较。
共纳入47例患者。C-OML组实现了与S-OML组相当的病情加重控制，OML中位剂量为300毫克/月，个人支付费用显著更低（<0.01）。与S-OML组相比，C-OML组超重患病率更高（=0.04），嗜酸性粒细胞性慢性鼻-鼻窦炎患病率更低（<0.01），过敏性鼻炎患病率有更高的趋势（=0.06）。OML有效控制哮喘与非重度2型炎症相关（嗜酸性粒细胞<300/微升且呼出气一氧化氮<50 ppb）。
非重度2型炎症且体重指数较高的患者使用OML可有效控制哮喘，降低治疗成本。识别这种表型可提高重度哮喘患者生物治疗的成本效益。
