The efficacy and safety of biologics for patients with severe asthma: an umbrella review of systematic reviews and meta-analyses.

IF 3.1 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Frontiers in Medicine Pub Date : 2025-05-30 eCollection Date: 2025-01-01 DOI:10.3389/fmed.2025.1573596

Qionghua Xiao, Yuanming Huang, Bingyu Xue, Minghang Wang

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引用次数: 0

Abstract

Introduction: Many systematic reviews and meta-analyses (SR/MAs) have evaluated the efficacy of biologic therapy for severe asthma. However, the quality of these SR/MAs is unclear, which may influence the selection of biologics and lead to misleading clinical decisions. Therefore, this umbrella review aims to objectively evaluate the quality of these SR/MAs and reassess the efficacy of biologic therapy for severe asthma.

Methods: A systematic search was performed in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE databases. Literature screening and data extraction were conducted according to inclusion and exclusion criteria. Then, we evaluated the methodological quality of these SR/MAs using A MeaSurement Tool to Assess Reviews 2 (AMSTAR 2). In addition, the re-meta-analysis of study outcomes was performed applying R 4.3.3 software.

Results: The umbrella review included 23 SR/MAs. In the evaluation of methodological quality, five SR/MAs were rated as high quality, one was rated as moderate, and 17 were rated as low or critically low. In terms of efficacy evaluation, biologics were associated with a 45% reduction in AER (RR: 0.55; P < 0.0001), a 57% reduction of asthma-related hospitalizations (RR: 0.43; P < 0.0001), an increase in the forced expiratory volume in 1 s (FEV1) of 0.13 L (P < 0.0001), a reduction in asthma control questionnaire (ACQ) scores by 0.33 points (P < 0.0001), an increase in asthma quality of life questionnaire (AQLQ) scores by 0.26 points (P < 0.0001), and a reduction in fractional exhaled nitric oxide (FeNO) levels by 22.52 ppb (P < 0.0001). In terms of safety evaluation, overall, biologics demonstrated favorable safety.

Conclusion: This umbrella review has demonstrated that biologics have good efficacy and acceptable safety in the treatment of severe asthma. However, the methodological quality of included SR/MAs was mostly low or critically low, suggesting that we need to be cautious when interpreting the results of this study. Therefore, more high-quality SR/MAs are needed to provide robust clinical evidence.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024607393.

查看原文本刊更多论文

生物制剂对严重哮喘患者的疗效和安全性：系统评价和荟萃分析的综合综述。

许多系统综述和荟萃分析（SR/MAs）已经评估了生物治疗严重哮喘的疗效。然而，这些SR/ ma的质量尚不清楚，这可能会影响生物制剂的选择并导致误导性的临床决策。因此，本综述旨在客观评价这些SR/MAs的质量，并重新评估生物治疗对严重哮喘的疗效。方法：系统检索PubMed、EMBASE、Cochrane Library、Web of Science和MEDLINE数据库。根据纳入标准和排除标准进行文献筛选和资料提取。然后，我们使用测量工具评估评论2 （AMSTAR 2）评估这些SR/ ma的方法学质量。此外，应用r4.3.3软件对研究结果进行重新meta分析。结果：共纳入23例SR/MAs。在方法学质量评价中，5个SR/MAs为高质量，1个为中等质量，17个为低或极低质量。在疗效评估方面，生物制剂与AER降低45%相关(RR: 0.55；P < 0.0001)，哮喘相关住院率降低57% (RR: 0.43；P < 0.0001)， 1秒内用力呼气量（FEV1）增加0.13 L (P < 0.0001)，哮喘控制问卷（ACQ）评分降低0.33分（P < 0.0001），哮喘生活质量问卷（AQLQ）评分增加0.26分（P < 0.0001），呼气分数一氧化氮（FeNO）水平降低22.52 ppb （P < 0.0001）。在安全性评价方面，总体而言，生物制剂表现出良好的安全性。结论：本综述表明，生物制剂治疗重症哮喘具有良好的疗效和可接受的安全性。然而，纳入的SR/MAs的方法学质量大多较低或极低，这表明我们在解释本研究结果时需要谨慎。因此，需要更多高质量的SR/MAs来提供有力的临床证据。系统综述注册：https://www.crd.york.ac.uk/PROSPERO/，标识符CRD42024607393。

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

Frontiers in Medicine Medicine-General Medicine

CiteScore

5.10

自引率

5.10%

发文量

3710

审稿时长

12 weeks

期刊介绍： Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate - the use of patient-reported outcomes under real world conditions - the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines - the scientific bases for guidelines and decisions from regulatory authorities - access to medicinal products and medical devices worldwide - addressing the grand health challenges around the world