Use of Biologic Drugs for Treatment of Allergic Bronchopulmonary Aspergillosis

S. Albogami
{"title":"Use of Biologic Drugs for Treatment of Allergic Bronchopulmonary Aspergillosis","authors":"S. Albogami","doi":"10.19080/ijoprs.2021.05.555663","DOIUrl":null,"url":null,"abstract":"Allergic bronchopulmonary aspergillosis (ABPA) is an allergic fungal infection that induces immunoglobulin E (IgE) production and eosinophils proliferation and affect mostly asthmatic and cystic fibrosis patients. The mainstay treatment for ABPA is systemic steroid and antifungal treatment which have increasing rates of treatment failure and side effects. Because of their mechanism of action in suppressing IgE or eosinophils, biologic drugs were expected to play an important role in the treatment of ABPA, however, their use in this issue was off label and lack the evidence. In this comprehensive and comparative review, 59 full text articles (228 patients) were selected. The outcomes were analyzed and the percentages of posttreatment change for each variable in each study were collected then the overall median percentages were calculated for each variable for each biologic drug. Comparative discussion of these outcomes was done in terms of clinical and functional response, reduction of exacerbation events, reduction of IgE level and eosinophils count, prevention of complications and patient’s ability to reduce steroid dose or discontinue it. The review shows that the use of biologic drugs for treatment of ABPA is associated with a significant clinical and functional improvement and reduction of exacerbation rates up to 90%. There is more reduction in post-treatment IgE level with mepolizumab and marked reduction in posttreatment eosinophils count with benralizumab. Mepolizumab has the better steroid-sparing effect. Changing from one biologic drug to another with different target in case of treatment failure is advisable. More stronger studies and randomized control trials are needed to figure out the use of biologic drugs for ABPA treatment.","PeriodicalId":257243,"journal":{"name":"International Journal of Pulmonary & Respiratory Sciences","volume":"2 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Pulmonary & Respiratory Sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.19080/ijoprs.2021.05.555663","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 4

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic fungal infection that induces immunoglobulin E (IgE) production and eosinophils proliferation and affect mostly asthmatic and cystic fibrosis patients. The mainstay treatment for ABPA is systemic steroid and antifungal treatment which have increasing rates of treatment failure and side effects. Because of their mechanism of action in suppressing IgE or eosinophils, biologic drugs were expected to play an important role in the treatment of ABPA, however, their use in this issue was off label and lack the evidence. In this comprehensive and comparative review, 59 full text articles (228 patients) were selected. The outcomes were analyzed and the percentages of posttreatment change for each variable in each study were collected then the overall median percentages were calculated for each variable for each biologic drug. Comparative discussion of these outcomes was done in terms of clinical and functional response, reduction of exacerbation events, reduction of IgE level and eosinophils count, prevention of complications and patient’s ability to reduce steroid dose or discontinue it. The review shows that the use of biologic drugs for treatment of ABPA is associated with a significant clinical and functional improvement and reduction of exacerbation rates up to 90%. There is more reduction in post-treatment IgE level with mepolizumab and marked reduction in posttreatment eosinophils count with benralizumab. Mepolizumab has the better steroid-sparing effect. Changing from one biologic drug to another with different target in case of treatment failure is advisable. More stronger studies and randomized control trials are needed to figure out the use of biologic drugs for ABPA treatment.
生物药物治疗过敏性支气管肺曲菌病的应用
过敏性支气管肺曲霉病(ABPA)是一种过敏性真菌感染,可诱导免疫球蛋白E (IgE)的产生和嗜酸性粒细胞的增殖,主要影响哮喘和囊性纤维化患者。ABPA的主要治疗是全身类固醇和抗真菌治疗,但治疗失败率和副作用增加。由于其抑制IgE或嗜酸性粒细胞的作用机制,生物药物有望在ABPA的治疗中发挥重要作用,然而,它们在这一问题上的使用是标签外的,缺乏证据。在这项综合比较综述中,选择了59篇全文文章(228例患者)。对结果进行分析,收集每项研究中每个变量的治疗后变化百分比,然后计算每种生物药物中每个变量的总体中位数百分比。从临床和功能反应、减少加重事件、降低IgE水平和嗜酸性粒细胞计数、预防并发症和患者减少类固醇剂量或停药的能力等方面对这些结果进行了比较讨论。该综述显示,使用生物药物治疗ABPA与显著的临床和功能改善以及恶化率降低高达90%相关。mepolizumab治疗后IgE水平降低更多,benralizumab治疗后嗜酸性粒细胞计数显著降低。Mepolizumab具有更好的类固醇节约效果。如果治疗失败,建议从一种生物药物改为另一种具有不同靶点的生物药物。需要更多更有力的研究和随机对照试验来确定使用生物药物治疗ABPA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信