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美泊珠单抗治疗重症哮喘时激素的依从性及临床结局

2020/05/14

   摘要
   介绍:尽管哮喘患者ICS的依从性较差,但吸入性糖皮质激素(ICS)在大部分哮喘患者中能够起到控制疾病的作用。重症嗜酸性粒细胞性哮喘患者可能需要口服糖皮质激素(OCS)和/或生物制剂如美泊利单抗治疗。尚不清楚使用生物制剂时ICS的依从性及临床反应是否会发生改变。
   方法:监测完成美泊珠单抗1年治疗周期的OCS依赖性重症嗜酸性粒细胞哮喘患者的ICS依从性及临床结局。计算生物制剂治疗1年前和1年后的ICS药品占用比例(MPR)(依据处方的使用剂量/预期ICS使用剂量)。分别以MPR> 0.75,0.74-0.51及 <0.5定义为良好、一般及较差。依据美伯利单抗治疗过程中ICS的依从性进行分组,记录生物制剂治疗12个月后的临床结局,包括OCS减量程度、年急性加重比例(AER)。
   结果:在109名使用美泊利单抗的患者中,有91名完成了达12个月的治疗周期并被纳入最终分析。接受美泊利单抗过程中,68%的患者ICS依从性良好,而16名(18%)的ICS依从性差。该研究队列中ICS的使用在美泊珠单抗治疗之前(MPR 0.81±0.32)及过程中(MPR 0.82±0.32;p = 0.78)保持相似。与依从性较差患者相比,具有良好依从性患者的OCS减量程度更大(中位数(四分位间距)OCS减少100(74-100)% vs 60(27-100)%; p = 0.031)并且急性加重比例明显减少(AER变化-2.1±3.1 vs 0.3±2.5 ;p = 0.011)。良好的ICS依从性能够预测停用OCS的可能性(调整后OR值 3.19,95%CI 1.02-9.94;p = 0.045)。
   结论:未规律使用ICS在接受美泊利单抗治疗的重症嗜酸性哮喘患者中很常见,并且与OCS减量及AER具有相关性。

 
(中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校)
(Eur Respir J. 2020 May 7;55(5). pii: 1902259. doi: 10.1183/13993003.02259-2019. Print 2020 May.)


 
 
 
Adherence to corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma.
 
d'Ancona G, Kavanagh J, Roxas C, Green L, Fernandes M, Thomson L, Dhariwal J, Nanzer AM, Jackson DJ, Kent BD.
 
Abstract
INTRODUCTION:Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatic patients, although adherence to prescribed ICS is often poor. Patients with severe 
eosinophilic asthma may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.
METHODS:We examined ICS adherence and clinical outcomes in OCS-dependent severe 
eosinophilic asthma patients who completed 1 year of mepolizumab therapy. The ICS medicines possession ratio (MPR) was calculated (the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR >0.75, intermediate 0.74-0.51 and poor <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.
RESULTS:Out of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. While receiving mepolizumab, 68% had good ICS adherence, with 16 (18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and during mepolizumab treatment (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median (interquartile range) OCS reduction 100 (74-100)% versus 60 (27-100)%; p=0.031) and exacerbations (AER change -2.1±3.1 versus 0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19, 95% CI 1.02-9.94; p=0.045).
CONCLUSION:ICS nonadherence is common in severe eosinophilic asthma patients receiving 
mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.




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