生物制剂在阿司匹林加重性呼吸系统疾病中的疗效
Efficacy of Biologics in Aspirin Exacerbated Respiratory Disease.
文献信息
| PMID | 42828727 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jennifer K Priessnitz |
| 作者单位 | Division of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, USA. |
| 期刊 | Clinical and translational allergy |
| SCI 分区 | Q2 |
| IF | 4.6 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 阿司匹林加重性呼吸系统疾病（AERD），也称为非甾体抗炎药加重性呼吸系统疾病（NERD），其特征为哮喘、伴鼻息肉的慢性鼻窦炎以及对环氧合酶-1抑制剂的超敏反应，常导致严重、难治性气道疾病。靶向2型炎症的生物制剂在AERD中的应用日益增多；但其相对疗效仍未完全明确。
方法： 我们按照既定的叙述性综述框架，对AERD中的生物制剂治疗进行了半系统性叙述性综述。检索了PubMed/Medline、ScienceDirect和ClinicalTrials.gov，以查找报告AERD/NERD或明确定义的AERD/NERD亚组临床结局的研究。本综述综合了当前证据，并提出了一个基于证据的临床框架，以支持AERD患者的生物制剂选择。
结果： 共识别出18项研究，包括随机对照试验、观察性研究和真实世界研究。在这些研究中，度普利尤单抗与上气道和下气道结局的改善最为一致地相关。抗IL-5和抗IL-5Rα治疗减少了嗜酸性粒细胞增多和哮喘急性发作，但对鼻窦的益处不一。奥马珠单抗在选定的特应性表型中以及与脱敏后阿司匹林治疗联合使用时显示出疗效。新兴的亚组数据表明，Tezepelumab可能减少AERD中的哮喘急性发作。
结论： 当前证据表明，生物制剂在AERD中提供了有意义的获益，尽管现有证据受限于样本量小和研究设计异质性。需要前瞻性比较研究来指导最佳生物制剂选择和排序。
英文摘要
BACKGROUND: Aspirin-exacerbated respiratory disease (AERD), also termed nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD), is characterized by asthma, chronic rhinosinusitis with nasal polyposis, and hypersensitivity to cyclooxygenase-1 inhibitors, frequently resulting in severe, treatment-refractory airway disease. Biologic therapies targeting type 2 inflammation are increasingly used in AERD; though their relative efficacy remains incompletely defined.
METHODS: We conducted a semi-systematic narrative review of biologic therapies in AERD, guided by established narrative review frameworks. PubMed/Medline, ScienceDirect, and ClinicalTrials.gov were searched for studies reporting clinical outcomes in AERD/NERD or clearly defined AERD/NERD subgroups. This review synthesizes current evidence and presents an evidence-informed clinical framework to support biologic selection in patients with AERD.
RESULTS: Eighteen studies identified, including randomized controlled trials, observational studies, and real-world studies. Across these studies, dupilumab was most consistently associated with improvements in both upper and lower airway outcomes. Anti-IL-5 and anti-IL-5Rα therapies reduced eosinophilia and asthma exacerbations, with variable sinonasal benefit. Omalizumab demonstrated efficacy in selected atopic phenotypes and in conjunction with aspirin therapy following desensitization. Emerging subgroup data suggests that Tezepelumab may reduce asthma exacerbations in AERD.
CONCLUSIONS: Current evidence suggests biologic therapies provide meaningful benefit in AERD, although available evidence is limited by small sample sizes and heterogeneous designs. Prospective comparative studies are needed to inform optimal biologic selection and sequencing.