{"title":"基于血液嗜酸性粒细胞计数的抗IL-5生物制剂、奥马珠单抗和杜比鲁单抗对哮喘相关结果的影响差异。","authors":"Yuya Kimura, Maho Suzukawa, Norihiko Inoue, Shinobu Imai, Hiromasa Horiguchi, Manabu Akazawa, Hirotoshi Matsui","doi":"10.12932/AP-290623-1645","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Selecting optimal biologics based on type 2 biomarkers has been of interest in severe asthma treatment. However, few direct biomarker stratification-based comparisons have been made.</p><p><strong>Objective: </strong>To compare the effectiveness of anti-IL-5 (mepolizumab, benralizumab), omalizumab, and dupilumab in reducing the number of hospitalizations from asthma and exacerbations across all and eosinophil-stratified subgroups.</p><p><strong>Methods: </strong>A retrospective cohort study using the National Hospital Organization database (2016-2020) was performed. Asthmatic patients using biologics were selected, and the baseline backgrounds of the groups were balanced using inverse probability treatment weighting for propensity scores. Weighted rate ratios (RRs) were obtained using a Poisson regression model.</p><p><strong>Results: </strong>Among the 320 patients with asthma using biologics, 205 (64.1%), 75 (23.4%), and 40 (12.5%) were categorized into the anti-IL-5, omalizumab, and dupilumab groups, respectively. After weighting, there were 47.1, 30.0, and 62.6 hospitalizations per 100 person-years [omalizumab vs. anti-IL-5: weighted RR, 0.61 (0.34-1.08); dupilumab vs. anti-IL-5: 1.48 (0.81-2.72)], and 117.0, 134.6, and 287.3 exacerbations per 100 person-years [omalizumab vs. anti-IL-5: 1.13 (0.83-1.54); dupilumab vs. anti-IL-5: 2.69 (1.91-3.78)] in these respective groups. In patients with eosinophil of ≥ 300/μL, the dupilumab group had more exacerbations compared with the anti-IL-5 group [weighted RR, 2.85 (1.82-4.46)]. In patients with eosinophil of < 300/μL, the omalizumab group had fewer hospitalizations compared with the anti-IL-5 group [weighted RR, 0.32 (0.13-0.51)].</p><p><strong>Conclusion: </strong>Anti-IL-5 biologics may be more effective than dupilumab in patients with high blood eosinophil counts, while less effective than omalizumab in patients with low eosinophil counts.</p>","PeriodicalId":8552,"journal":{"name":"Asian Pacific journal of allergy and immunology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differences in asthma-related outcomes by anti-IL-5 biologics, omalizumab, and dupilumab based on blood eosinophil counts.\",\"authors\":\"Yuya Kimura, Maho Suzukawa, Norihiko Inoue, Shinobu Imai, Hiromasa Horiguchi, Manabu Akazawa, Hirotoshi Matsui\",\"doi\":\"10.12932/AP-290623-1645\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Selecting optimal biologics based on type 2 biomarkers has been of interest in severe asthma treatment. However, few direct biomarker stratification-based comparisons have been made.</p><p><strong>Objective: </strong>To compare the effectiveness of anti-IL-5 (mepolizumab, benralizumab), omalizumab, and dupilumab in reducing the number of hospitalizations from asthma and exacerbations across all and eosinophil-stratified subgroups.</p><p><strong>Methods: </strong>A retrospective cohort study using the National Hospital Organization database (2016-2020) was performed. Asthmatic patients using biologics were selected, and the baseline backgrounds of the groups were balanced using inverse probability treatment weighting for propensity scores. Weighted rate ratios (RRs) were obtained using a Poisson regression model.</p><p><strong>Results: </strong>Among the 320 patients with asthma using biologics, 205 (64.1%), 75 (23.4%), and 40 (12.5%) were categorized into the anti-IL-5, omalizumab, and dupilumab groups, respectively. After weighting, there were 47.1, 30.0, and 62.6 hospitalizations per 100 person-years [omalizumab vs. anti-IL-5: weighted RR, 0.61 (0.34-1.08); dupilumab vs. anti-IL-5: 1.48 (0.81-2.72)], and 117.0, 134.6, and 287.3 exacerbations per 100 person-years [omalizumab vs. anti-IL-5: 1.13 (0.83-1.54); dupilumab vs. anti-IL-5: 2.69 (1.91-3.78)] in these respective groups. In patients with eosinophil of ≥ 300/μL, the dupilumab group had more exacerbations compared with the anti-IL-5 group [weighted RR, 2.85 (1.82-4.46)]. In patients with eosinophil of < 300/μL, the omalizumab group had fewer hospitalizations compared with the anti-IL-5 group [weighted RR, 0.32 (0.13-0.51)].</p><p><strong>Conclusion: </strong>Anti-IL-5 biologics may be more effective than dupilumab in patients with high blood eosinophil counts, while less effective than omalizumab in patients with low eosinophil counts.</p>\",\"PeriodicalId\":8552,\"journal\":{\"name\":\"Asian Pacific journal of allergy and immunology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-01-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Pacific journal of allergy and immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.12932/AP-290623-1645\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Pacific journal of allergy and immunology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12932/AP-290623-1645","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ALLERGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:根据 2 型生物标志物选择最佳生物制剂一直是重症哮喘治疗领域的关注点。然而,基于生物标志物分层的直接比较还很少:比较抗IL-5(mepolizumab、benralizumab)、奥马珠单抗和杜匹单抗在减少所有亚组和嗜酸性粒细胞分层亚组的哮喘住院次数和病情加重次数方面的有效性:利用国家医院组织数据库(2016-2020年)进行了一项回顾性队列研究。研究选择了使用生物制剂的哮喘患者,并使用反概率治疗加权倾向评分平衡了各组的基线背景。采用泊松回归模型得出加权比率(RR):在使用生物制剂的 320 名哮喘患者中,205 人(64.1%)、75 人(23.4%)和 40 人(12.5%)分别被归入抗 IL-5、奥马珠单抗和杜匹单抗组。加权后,每 100 人年分别有 47.1 人、30.0 人和 62.6 人住院[奥马珠单抗 vs. 抗 IL-5:加权 RR,0.61(0.34-1.08);杜匹单抗 vs. 抗 IL-5:1.48(0.81-2.72)],以及每百人年分别出现 117.0、134.6 和 287.3 次病情加重[奥马珠单抗 vs. 抗-IL-5:1.13(0.83-1.54);杜匹单抗 vs. 抗-IL-5:2.69(1.91-3.78)]。在嗜酸性粒细胞≥300/μL的患者中,与抗IL-5组相比,dupilumab组的病情加重率更高[加权RR,2.85(1.82-4.46)]。在嗜酸性粒细胞小于300/μL的患者中,奥马珠单抗组的住院率低于抗IL-5组[加权RR,0.32(0.13-0.51)]:抗IL-5生物制剂对嗜酸性粒细胞计数高的患者可能比杜匹单抗更有效,而对嗜酸性粒细胞计数低的患者则不如奥马珠单抗有效。
Differences in asthma-related outcomes by anti-IL-5 biologics, omalizumab, and dupilumab based on blood eosinophil counts.
Background: Selecting optimal biologics based on type 2 biomarkers has been of interest in severe asthma treatment. However, few direct biomarker stratification-based comparisons have been made.
Objective: To compare the effectiveness of anti-IL-5 (mepolizumab, benralizumab), omalizumab, and dupilumab in reducing the number of hospitalizations from asthma and exacerbations across all and eosinophil-stratified subgroups.
Methods: A retrospective cohort study using the National Hospital Organization database (2016-2020) was performed. Asthmatic patients using biologics were selected, and the baseline backgrounds of the groups were balanced using inverse probability treatment weighting for propensity scores. Weighted rate ratios (RRs) were obtained using a Poisson regression model.
Results: Among the 320 patients with asthma using biologics, 205 (64.1%), 75 (23.4%), and 40 (12.5%) were categorized into the anti-IL-5, omalizumab, and dupilumab groups, respectively. After weighting, there were 47.1, 30.0, and 62.6 hospitalizations per 100 person-years [omalizumab vs. anti-IL-5: weighted RR, 0.61 (0.34-1.08); dupilumab vs. anti-IL-5: 1.48 (0.81-2.72)], and 117.0, 134.6, and 287.3 exacerbations per 100 person-years [omalizumab vs. anti-IL-5: 1.13 (0.83-1.54); dupilumab vs. anti-IL-5: 2.69 (1.91-3.78)] in these respective groups. In patients with eosinophil of ≥ 300/μL, the dupilumab group had more exacerbations compared with the anti-IL-5 group [weighted RR, 2.85 (1.82-4.46)]. In patients with eosinophil of < 300/μL, the omalizumab group had fewer hospitalizations compared with the anti-IL-5 group [weighted RR, 0.32 (0.13-0.51)].
Conclusion: Anti-IL-5 biologics may be more effective than dupilumab in patients with high blood eosinophil counts, while less effective than omalizumab in patients with low eosinophil counts.
期刊介绍:
The Asian Pacific Journal of Allergy and Immunology (APJAI) is an online open access journal with the recent impact factor (2018) 1.747
APJAI published 4 times per annum (March, June, September, December). Four issues constitute one volume.
APJAI publishes original research articles of basic science, clinical science and reviews on various aspects of allergy and immunology. This journal is an official journal of and published by the Allergy, Asthma and Immunology Association, Thailand.
The scopes include mechanism, pathogenesis, host-pathogen interaction, host-environment interaction, allergic diseases, immune-mediated diseases, epidemiology, diagnosis, treatment and prevention, immunotherapy, and vaccine. All papers are published in English and are refereed to international standards.