重新考虑血液中乙氨基酸细胞,以评估COPD的吸入性皮质类固醇反应:来自FLAME试验的后期分析
Alexander G Mathioudakis1, Sebastian Bate2, Pradeesh Sivapalan3
1Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, England; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, England.
在吸入性皮质类固醇 (ICS) 中测量血液中乙酸细胞计数 (BEC) 或在ICS治疗期间BEC的变化更好地预测COPD患者的治疗反应. 在ICS上测量的BEC对于指导治疗不那么可靠.
科学领域:
- 肺部医学 肺部医学
- 药物基因组学 药物基因组学
背景情况:
- 对于COPD的吸入性皮质类固醇 (ICS) 的多种反应需要个性化治疗.
- 血红蛋白细胞计数 (BEC) 预测了ICS反应,但可以随着治疗而改变.
研究的目的:
- 确定ICS上BEC,ICS外BEC,或ICS治疗期间BEC变化是否最好预测COPD中的ICS反应.
- 为了优化个性化的ICS治疗策略.
主要方法:
- 对FLAME随机对照试验 (RCT) 的后期分析.
- 在52周的时间里,LABA/LAMA与LABA/ICS治疗进行了比较.
- 评估BEC在ICS,离ICS,和BEC变化作为治疗反应的预测指标.
主要成果:
- 对于大多数恶化结果,LABA/LAMA比LABA/ICS优越或不劣.
- 较高的BEC离ICS,较高的BEC在ICS上,以及显著的BEC抑制预测了对LABA/ICS的更好的反应.
- 在具有显著BEC变化的子组中,BEC离ICS和BEC变化比BEC在ICS上更具预测性.
结论:
- 最好使用BEC脱离ICS或BEC变化来指导COPD的ICS治疗决策.
- 在ICS上测量的BEC对治疗反应和潜在的不良事件 (如肺炎) 的预测能力较低.
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