Peta-Lee Sacks, Christian M Meerwein, Peter Earls, Cedric Hiel, Christine Choy, Raewyn G Campbell, Raymond Sacks, Larry Kalish, Richard J Harvey
{"title":"持续嗜酸性粒细胞炎症不是2型CRS患者抗il - 5r治疗失败并需要切换到抗il -4/13治疗的特征","authors":"Peta-Lee Sacks, Christian M Meerwein, Peter Earls, Cedric Hiel, Christine Choy, Raewyn G Campbell, Raymond Sacks, Larry Kalish, Richard J Harvey","doi":"10.1002/alr.23534","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Type 2 inflammation dominates eosinophilic chronic rhinosinusitis (eCRS) and adult onset asthma. IL-4, -5, and -13 are prominent disease mediators. Disease control can be achieved with biologic therapies. However, despite some patients entering remission, others experience poor control.</p><p><strong>Aim: </strong>We aimed to describe eCRS patients treated with anti-IL-5R antibody (benralizumab) and assess characteristics between responders and those requiring class switching to anti-IL-4/13R (dupilumab).</p><p><strong>Method: </strong>A retrospective cohort study was performed on consecutive adult patients with eCRS and asthma who had commenced benralizumab. Disease control was defined as controlled or poorly controlled (EPOS2020 partly control/uncontrolled). Poorly controlled patients were switched to dupilumab. Baseline and post-IL-5R characteristics including age, sex, 22-item Sinonasal Outcome Test (SNOT-22), Asthma Control Questionnaire (ACQ) score, and serum/tissue eosinophilia were assessed. Disease control post-class switching was reassessed. Factors predicting poorly controlled disease on anti-IL-5R therapy were sought.</p><p><strong>Results: </strong>Fifty patients were assessed (51.44 ± 12.73 years, 56% female). Poorly controlled disease on anti-IL-5R requiring class switch to dupilumab was seen in 42%. Poorly controlled patients were younger (46.14 ± 10.76 vs. 55.28 ± 12.83 years, p = 0.01) with higher baseline SNOT-22 (61.42 ± 19.19 vs. 42.32 ± 21.55, p < 0.01). Baseline ACQ scores and eosinophil count (0.78 ± 0.49 vs. 0.62 ± 0.34 × 10<sup>9</sup>cells/L, p = 0.23) and were similar between groups. In the poorly controlled patients on anti-IL-5R therapy, eosinophilia had reduced in both serum (0.78 ± 0.5 vs. 0.02 ± 0.1 × 10<sup>9</sup>cells/L, p < 0.01) and tissue (>100 cells/HPF: 100% vs. 29%, p = 0.01). Class switching resulted in disease control for 65%.</p><p><strong>Conclusion: </strong>Neither eosinophilia nor its reduction predicted a non-responder group to anti-IL-5R therapy. While the eosinophil population may be a good marker for the CRS phenotype seen in nasal polyps, it is unlikely to be the cell population driving the disease process.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2000,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Persistent Eosinophilic Inflammation Is Not a Feature of Type 2 CRS Patients Failing Anti-IL-5R Therapy and Requiring Class Switching to Anti-IL-4/13.\",\"authors\":\"Peta-Lee Sacks, Christian M Meerwein, Peter Earls, Cedric Hiel, Christine Choy, Raewyn G Campbell, Raymond Sacks, Larry Kalish, Richard J Harvey\",\"doi\":\"10.1002/alr.23534\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Type 2 inflammation dominates eosinophilic chronic rhinosinusitis (eCRS) and adult onset asthma. IL-4, -5, and -13 are prominent disease mediators. Disease control can be achieved with biologic therapies. However, despite some patients entering remission, others experience poor control.</p><p><strong>Aim: </strong>We aimed to describe eCRS patients treated with anti-IL-5R antibody (benralizumab) and assess characteristics between responders and those requiring class switching to anti-IL-4/13R (dupilumab).</p><p><strong>Method: </strong>A retrospective cohort study was performed on consecutive adult patients with eCRS and asthma who had commenced benralizumab. Disease control was defined as controlled or poorly controlled (EPOS2020 partly control/uncontrolled). Poorly controlled patients were switched to dupilumab. Baseline and post-IL-5R characteristics including age, sex, 22-item Sinonasal Outcome Test (SNOT-22), Asthma Control Questionnaire (ACQ) score, and serum/tissue eosinophilia were assessed. Disease control post-class switching was reassessed. Factors predicting poorly controlled disease on anti-IL-5R therapy were sought.</p><p><strong>Results: </strong>Fifty patients were assessed (51.44 ± 12.73 years, 56% female). Poorly controlled disease on anti-IL-5R requiring class switch to dupilumab was seen in 42%. Poorly controlled patients were younger (46.14 ± 10.76 vs. 55.28 ± 12.83 years, p = 0.01) with higher baseline SNOT-22 (61.42 ± 19.19 vs. 42.32 ± 21.55, p < 0.01). Baseline ACQ scores and eosinophil count (0.78 ± 0.49 vs. 0.62 ± 0.34 × 10<sup>9</sup>cells/L, p = 0.23) and were similar between groups. In the poorly controlled patients on anti-IL-5R therapy, eosinophilia had reduced in both serum (0.78 ± 0.5 vs. 0.02 ± 0.1 × 10<sup>9</sup>cells/L, p < 0.01) and tissue (>100 cells/HPF: 100% vs. 29%, p = 0.01). Class switching resulted in disease control for 65%.</p><p><strong>Conclusion: </strong>Neither eosinophilia nor its reduction predicted a non-responder group to anti-IL-5R therapy. While the eosinophil population may be a good marker for the CRS phenotype seen in nasal polyps, it is unlikely to be the cell population driving the disease process.</p>\",\"PeriodicalId\":13716,\"journal\":{\"name\":\"International Forum of Allergy & Rhinology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.2000,\"publicationDate\":\"2025-01-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Forum of Allergy & Rhinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/alr.23534\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Forum of Allergy & Rhinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/alr.23534","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
Persistent Eosinophilic Inflammation Is Not a Feature of Type 2 CRS Patients Failing Anti-IL-5R Therapy and Requiring Class Switching to Anti-IL-4/13.
Background: Type 2 inflammation dominates eosinophilic chronic rhinosinusitis (eCRS) and adult onset asthma. IL-4, -5, and -13 are prominent disease mediators. Disease control can be achieved with biologic therapies. However, despite some patients entering remission, others experience poor control.
Aim: We aimed to describe eCRS patients treated with anti-IL-5R antibody (benralizumab) and assess characteristics between responders and those requiring class switching to anti-IL-4/13R (dupilumab).
Method: A retrospective cohort study was performed on consecutive adult patients with eCRS and asthma who had commenced benralizumab. Disease control was defined as controlled or poorly controlled (EPOS2020 partly control/uncontrolled). Poorly controlled patients were switched to dupilumab. Baseline and post-IL-5R characteristics including age, sex, 22-item Sinonasal Outcome Test (SNOT-22), Asthma Control Questionnaire (ACQ) score, and serum/tissue eosinophilia were assessed. Disease control post-class switching was reassessed. Factors predicting poorly controlled disease on anti-IL-5R therapy were sought.
Results: Fifty patients were assessed (51.44 ± 12.73 years, 56% female). Poorly controlled disease on anti-IL-5R requiring class switch to dupilumab was seen in 42%. Poorly controlled patients were younger (46.14 ± 10.76 vs. 55.28 ± 12.83 years, p = 0.01) with higher baseline SNOT-22 (61.42 ± 19.19 vs. 42.32 ± 21.55, p < 0.01). Baseline ACQ scores and eosinophil count (0.78 ± 0.49 vs. 0.62 ± 0.34 × 109cells/L, p = 0.23) and were similar between groups. In the poorly controlled patients on anti-IL-5R therapy, eosinophilia had reduced in both serum (0.78 ± 0.5 vs. 0.02 ± 0.1 × 109cells/L, p < 0.01) and tissue (>100 cells/HPF: 100% vs. 29%, p = 0.01). Class switching resulted in disease control for 65%.
Conclusion: Neither eosinophilia nor its reduction predicted a non-responder group to anti-IL-5R therapy. While the eosinophil population may be a good marker for the CRS phenotype seen in nasal polyps, it is unlikely to be the cell population driving the disease process.
期刊介绍：
International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy.
International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
