IL-5/IL-5R阻断使非甾体抗炎药加重性呼吸疾病患者能够安全重新使用非甾体抗炎药

文献信息

中文摘要

背景： 针对白细胞介素-5（IL-5）通路的生物制剂治疗可改善非甾体抗炎药（NSAID）加重性呼吸疾病（NERD）患者的哮喘控制和伴鼻息肉的慢性鼻窦炎（CRSwNP）。然而，其对NSAID耐受性的影响尚不充分明确。
目的： 本研究旨在探讨抗IL-5/IL-5受体（IL-5R）治疗是否能改善NERD合并混合反应（BRs）患者的NSAID耐受性。
方法： 比较生物制剂治疗前后的临床参数，包括哮喘控制测试（ACT）、22项鼻窦结局测试（SNOT-22）、生活质量视觉模拟量表（VAS）评分、鼻息肉分级以及吸入性糖皮质激素/长效β2受体激动剂（ICS/LABA）剂量。在生物制剂治疗期间重复进行ASA激发试验，并与既往激发试验结果进行比较；同时比较生物制剂治疗组与未使用生物制剂的对照组之间的结局。
结果： 接受生物制剂治疗的患者与基线相比显示出显著改善，嗜酸性粒细胞计数从695（590-892.5）降至50（30-60），ACT评分从12（8.7-18）升至24（20.7-24.2），SNOT-22评分从56（51-73）降至16（5.7-28.7），VAS评分从1（0-2.2）改善至9（7-10），所有p=0.001。ASA激发试验阳性率降至28.5%（p=0.002），所有患者从高剂量ICS/LABA降级至中/低剂量。在仍不耐受的四名患者中，反应发生在更高的累积剂量下，起病延迟且症状较轻。
结论： 我们的研究表明，阻断IL-5通路显著改善了NERD/BRs患者的临床结局并降低了ASA超敏反应，突显了其在哮喘控制之外改变疾病表型的潜在作用。

英文摘要

BACKGROUND: Biologic therapies targeting the interleukin-5 (IL-5) pathway improve asthma control and chronic rhinosinusitis with nasal polyposis (CRSwNP) in patients with non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD). However, their effect on NSAID tolerance remains insufficiently characterized.
OBJECTIVE: This study aimed to investigate whether anti-IL-5/IL-5 receptor (IL-5R) treatments could improve NSAID tolerance in patients with NERD and Blended Reactions (BRs).
METHOD: Clinical parameters, including the Asthma Control Test (ACT), 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS) scores for quality of life, nasal polyp grade, and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) dose, were compared before and after biologic therapy. ASA provocation tests were repeated during biologic treatment and compared with prior challenge results; outcomes were also compared between the biologic-treated group and the biologic-naive comparison group.
RESULTS: Patients who received biological treatments showed significant improvements compared to baseline, with eosinophil counts decreasing from 695 (590-892.5) to 50 (30-60), ACT scores increasing from 12 (8.7-18) to 24 (20.7-24.2), SNOT-22 scores declining from 56 (51-73) to 16 (5.7-28.7), and VAS scores improving from 1 (0-2.2) to 9 (7-10), all with p=0.001. ASA provocation positivity decreased to 28.5% (p=0.002), and all patients stepped down from high-dose to medium/low-dose ICS/LABA. Among the four patients who remained intolerant, reactions occurred at higher cumulative doses, with delayed onset and milder symptoms.
CONCLUSION: Our study indicated that blockade of IL-5 pathway significantly improved clinical outcomes and reduced ASA hypersensitivity in patients with NERD/BRs, highlighting their potential role in modifying disease phenotype beyond asthma control.