Choosing the Right Biologic for the Right Patient With Severe Asthma.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2024-09-06 DOI:10.1016/j.chest.2024.08.045
Simon Couillard, David J Jackson, Ian D Pavord, Michael E Wechsler
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引用次数: 0

Abstract

In this instalment of the How I Do It series on severe asthma, we tackle the clinical conundrum of choosing the right biologic for the right patient with severe asthma. With 6 biologics now approved for use in this area comprising 4 different targeting strategies (anti-Ig E: omalizumab; anti-IL-5 and anti-IL-5-receptor: mepolizumab, reslizumab, and benralizumab; anti-IL-4-receptor: dupilumab; anti-thymic stromal lymphopoietin: tezepelumab), this question is increasingly complex. Recognizing that no head-to-head trial has compared biologics, we based our review on the expected effects of inhibiting different aspects of type 2 airway inflammation, supported whenever possible by clinical trial and real-world data. We use 4 variations of a case of severe uncontrolled asthma to develop concepts and considerations introduced in the previous installment ("Workup of Severe Asthma") and discuss pregnancy-related, biomarker-related, comorbidity-related, and corticosteroid dependency-related considerations when choosing a biologic. The related questions of deciding when, why, and how to switch from one biologic to another also are discussed. Overall, we consider that the choice of biologics should be based on the available clinical trial data for the desired efficacy outcomes, the biomarker profile of the patient, safety profiles (eg, when pregnancy is considered), and opportunities to target 2 comorbidities with 1 biologic. Using systemic and airway biomarkers (blood eosinophils and exhaled nitric oxide) and other phenotypic characteristics, we suggest a framework to facilitate therapeutic decision-making. Post hoc studies and new comparative studies are needed urgently to test this framework and to determine whether it allows us to make other clinically useful predictions.

我是怎么做的为重症哮喘患者选择合适的生物制剂。
在 "我是怎么做的:重症哮喘 "系列的新一期文章中,我们将探讨如何为重症哮喘患者选择合适的生物制剂这一临床难题。目前已有 6 种生物制剂获准用于该领域,包括 4 种不同的靶向策略(抗免疫球蛋白 E,奥马珠单抗;抗白细胞介素 (IL)-5/5 受体,mepolizumab、reslizumab 和 benralizumab;抗 IL-4 受体,dupilumab;抗胸腺基质淋巴细胞生成素,tezepelumab),因此这个问题变得越来越复杂。我们认识到目前还没有头对头比较生物制剂的试验,因此我们的综述以抑制 2 型气道炎症不同方面的预期效果为基础,并尽可能以临床试验和实际数据为支持。我们使用四种不同的重症未控制哮喘病例来阐释前一篇《重症哮喘分期治疗》中介绍的概念和注意事项,并讨论在选择生物制剂时与妊娠、生物标志物、合并症和皮质类固醇依赖相关的注意事项。我们还讨论了决定何时、为何以及如何从一种生物制剂转为另一种生物制剂的相关问题。总之,我们认为生物制剂的选择应基于以下因素:所需疗效的现有临床试验数据;患者的生物标志物特征;安全性特征(如考虑妊娠时);以及用一种生物制剂治疗两种合并症的机会。利用全身和气道生物标志物(血液嗜酸性粒细胞和呼出一氧化氮(FeNO))及其他表型特征,我们提出了一个有助于治疗决策的框架。我们亟需进行事后研究和新的比较研究来检验这一框架,并确定它是否能让我们做出其他临床有用的预测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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