早期失败,晚期失败和对严重喘中的生物药物的持续反应:长期,现实世界的多中心研究
D Dacal Rivas1, E Martinez-Moragón2, V Plaza3
1Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain; University of Santiago de Compostela, Spain.
大多数严重喘患者达到生物反应,但近30%的患者经历了晚期失败. 优化吸入治疗和最大限度地提高肺功能可以帮助维持严重喘的治疗反应.
科学领域:
- 肺部病理学 肺部病理学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 用生物药物治疗严重喘 (SA) 显示出有限的反应率,只有三分之一的人达到完全反应.
- 了解治疗失败模式对于优化SA管理至关重要.
- 早期失效 (EF) 和晚期失效 (LF) 代表了SA的生物治疗中的独特挑战.
研究的目的:
- 在用生物药物治疗的严重喘患者中,以表征早期失败 (EF; ≤12个月) 和晚期失败 (LF; 12个月后).
- 确定与对生物疗法的反应和不反应相关的因素.
- 探索治疗失败后恢复的策略.
主要方法:
- 对272名SA成年患者进行了多中心回顾性研究,这些患者接受了长达24个月以上的生物治疗.
- 响应定义为没有严重恶化,喘控制测试得分≥20,并且在12个月后不需要口服皮质类固醇.
- 失败被定义为在12个月 (EF) 或在实现响应 (LF) 后不满足响应标准.
主要成果:
- 在12个月内,97/272名患者 (35.7%) 没有达到反应 (PF);其中40%的患者在吸入治疗优化后恢复了反应.
- 在175名12个月的受访者中,51人 (29.1%) 经历了晚期失败 (SF).
- 经历SF的患者治疗后FEV1较低;36%的患者通过吸入疗法的改变恢复了反应,而未恢复的病例显示出FEV1显著下降.
结论:
- 大多数严重喘患者在12个月后保持生物反应,但很大一部分患者经历了晚期失败.
- 优化吸入疗法是有效的帮助反应恢复的早期和晚期治疗失败.
- 维持或改善肺功能 (FEV1) 对于预防严重喘中对生物药物的反应丧失至关重要.
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