特应性皮炎患者对杜匹单抗反应的相关因素：系统回顾与元分析》。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-11-01 DOI:10.1016/j.jaip.2024.08.054

Piyaporn Chokevittaya MD , Noraworn Jirattikanwong MD , Torpong Thongngarm MD , Phichayut Phinyo MD. PhD , Chamard Wongsa MD

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引用次数: 0

摘要

背景杜匹单抗被批准用于治疗中重度特应性皮炎（AD）。然而，仍有相当一部分患者没有反应，而与杜匹单抗反应相关的因素仍然有限：系统回顾并确定与杜匹单抗治疗特应性皮炎相关的因素：我们检索了从开始到2023年3月的电子数据库，包括PubMed/MEDLINE、Embase、Ovid和Cochrane对照试验中心。主要结果是与杜匹单抗在AD中的反应相关的因素。采用随机效应荟萃分析法对湿疹面积和严重程度指数（EASI）评分在12-16周时降低75%的相关几率（OR）和95%置信区间（CI）进行了综合分析：在涉及5575名AD患者的21项研究中，有3项是对3期dupilumab研究的事后分析，12项是回顾性研究，6项是前瞻性研究。以12-16周时达到EASI75的患者百分比定义的与杜匹单抗良好反应相关的因素包括：女性，OR值（95% CI）为2.16（1.38，3.38）；年龄较小，2.81（1.64，4.81），无过敏性鼻炎 2.64（1.07，6.50），体重指数较低 1.97（1.18，3.30），血液嗜酸性粒细胞计数较低 6.47（3.36，12.48），证据确定性极低。发病年龄、基线EASI评分、总IgE水平和血清乳酸脱氢酶水平与杜匹单抗反应无关：结论：女性、年轻、无过敏性鼻炎、较低的体重指数和较低的血液嗜酸性粒细胞计数与AD患者对杜匹单抗的良好反应有关。在临床实践中考虑使用杜比单抗治疗时，应将这些因素考虑在内。

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Factors Associated With Dupilumab Response in Atopic Dermatitis: A Systematic Review and Meta-Analysis

Background

Dupilumab was approved for treating moderate to severe atopic dermatitis (AD). However, a notable subset of patients remains unresponsive and factors associated with dupilumab response remain limited.

Objective

To review and establish factors related to dupilumab response systematically in AD.

Methods

We searched electronic databases, including PubMed and MEDLINE, Embase, Ovid, and the Cochrane Center of Controlled Trials from inception to March 2023. The primary outcome was factors linked to dupilumab response in AD. The odds ratios and 95% CIs related to a 75% reduction at 12 to 16 weeks in the Eczema Area and Severity Index (EASI) score were synthesized using a random-effects meta-analysis.

Results

Of 21 studies involving 5,575 patients with AD, three were post hoc analyses of phase 3 dupilumab studies, 12 were retrospective, and six were prospective studies. Factors associated with favorable responses to dupilumab, defined by the percentage of patients achieving EASI75 at 12 to 16 weeks, included female sex (OR [95% CI] = 2.16 [1.38-3.38]), young age (2.81 [1.64-4.81]), absence of allergic rhinitis (2.64 [1.07-6.50]), low body mass index (1.97 [1.18-3.30]), and low blood eosinophil count (6.47 [3.36-12.48]), with very low certainty of evidence. Age at onset, baseline EASI score, total IgE level, and serum lactate dehydrogenase level were unrelated to dupilumab response.

Conclusions

Female sex, young age, absence of allergic rhinitis, low body mass index, and low blood eosinophil count were associated with a favorable response to dupilumab in patients with AD. These factors should be taken into account when considering dupilumab therapy in clinical practice.

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.