生物制剂对过敏性支气管肺曲霉菌病患者的疗效:系统回顾与元分析》。

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM
Lung Pub Date : 2024-08-01 Epub Date: 2024-06-19 DOI:10.1007/s00408-024-00717-y
Xiaoying Chen, Haopeng Zhi, Xiaohu Wang, Zicong Zhou, Huiting Luo, Jing Li, Roma Sehmi, Paul M O'Byrne, Ruchong Chen
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引用次数: 0

摘要

背景:过敏性支气管肺曲霉菌病(ABPA)的治疗具有挑战性。生物疗法作为 ABPA 的辅助治疗方法已有报道,主要是在病例系列或病例报告中。本研究旨在定性和定量分析生物制剂治疗ABPA的疗效:方法:在PubMed、Web of Science、ClinicalTrials.gov和Embase数据库中检索2023年10月发表的所有关于APBA的文章。所关注的效果是与基线相比的平均变化,包括恶化率、口服皮质类固醇(OCS)用量和总免疫球蛋白E(IgE)水平。报告的结果通过常规或单个患者数据(IPD)荟萃分析进行定量综合。PROSPERO 注册号:CRD42022373396.Results:系统综述共纳入 86 项研究,包括 346 名患者。16项关于奥马珠单抗的研究被纳入常规荟萃分析。奥马珠单抗治疗可明显降低病情恶化率(- 2.29 [95%CI - 3.32, - 1.26])、OCS用量(- 10.91 mg [95%CI - 18.98, - 2.85])和总IgE水平(- 273.07 IU/mL [95%CI - 379.30, - 166.84]),同时提高FEV1预测值(10.09% [95%CI 6.62, 13.55])。通过回顾性分析,我们汇总了31项关于杜必鲁单抗、mepolizumab或benralizumab的研究,并进行了IPD荟萃分析。杜匹鲁单抗和麦泊利单抗都能显著降低病情恶化率、OCS 和总 IgE 水平。本拉珠单抗也有类似的趋势,但没有统计学意义。特珠单抗对 ABPA 的影响证据不足。所有五种生物制剂都会导致较轻的临床症状(如咳嗽、喘息),严重的不良反应在奥马珠单抗治疗中出现过一次:这些结果表明,奥马珠单抗、杜匹单抗和美泊珠单抗对ABPA患者有临床疗效。要证实这些结果,还需要进一步开展样本量更大、随访时间更长的随机对照研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Efficacy of Biologics in Patients with Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis.

Efficacy of Biologics in Patients with Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis.

Background: Treatment of allergic bronchopulmonary aspergillosis (ABPA) is challenging. Biological therapies have been reported as adjunctive treatments for ABPA, primarily in case series or case reports. This study aimed to analyze the efficacy of biologics for managing ABPA both qualitatively and quantitatively.

Methods: All articles on APBA published in October 2023 were searched in PubMed, Web of Science, ClinicalTrials.gov, and Embase databases. The effects of interest were the mean changes from baseline for outcomes, including exacerbation rates, oral corticosteroids usage (OCS), and total immunoglobulin E (IgE) levels. Reported outcomes were quantitatively synthesized by usual or individual patient data (IPD) meta-analyses. PROSPERO registration number: CRD42022373396.

Results: A total of 86 studies were included in the systematic review including 346 patients. Sixteen studies on omalizumab were pooled for the usual meta-analysis. Omalizumab therapy significantly reduced exacerbation rates (- 2.29 [95%CI - 3.32, - 1.26]), OCS dosage (- 10.91 mg [95%CI - 18.98, - 2.85]), and total IgE levels (- 273.07 IU/mL [95%CI - 379.30, - 166.84]), meanwhile improving FEV1% predicted (10.09% [95%CI 6.62, 13.55]). Thirty-one studies on dupilumab, mepolizumab, or benralizumab were pooled to perform an IPD meta-analysis, retrospectively. Both dupilumab and mepolizumab significantly reduced exacerbation rates, OCS, and total IgE levels. Benralizumab showed a similar trend, but it was not statistically significant. Tezepelumab showed weak evidence of its effects on ABPA. All five biologics led to milder clinical symptoms (e.g., cough, wheezing) with serious adverse effects that happened once in omalizumab treatment.

Conclusion: These results indicate the clinical benefit of omalizumab, dupilumab, and mepolizumab in patients with ABPA. Further randomized, controlled studies with a larger sample size and longer follow-up are needed to confirm these findings.

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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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