Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma
Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma
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DOI：
10.1164/rccm.201701-0120oc
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发表时间：
2017-10-15
影响因子：
24.7
通讯作者：
Gern, James E.
中科院分区：
文献类型：
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作者：
Esquivel, Ann;Busse, William W.;Gern, James E.
基本原理：过敏性炎症与病毒性疾病的易感性增加有关，但尚不清楚这种关联是否是因果关系。目的：检测奥马珠单抗治疗降低IgE是否会缩短过敏性哮喘儿童鼻病毒（RV）疾病的频率和持续时间。方法：散文中（抑制性奥马珠单抗或递增疗法治疗严重跌倒加重）研究中，我们检查了过敏性哮喘儿童（年龄6-17岁; n = 478），我们分析了随机分配到基于指南的哮喘治疗组（n = 89）或添加奥马珠单抗治疗组（n = 259）的病毒学。在2012年或2013年秋季，每周对鼻粘液样本进行RV分析，并在90天内记录呼吸道症状和哮喘急性发作。测量和主要结果：在171例急性加重样本中有97例（57%）检测到RV，在5，959例非急性加重样本中有2，150例（36%）检测到RV（OR，2.32; P < 0.001）。急性发作与鼻病毒C（OR，2.85; P，0.001）和鼻病毒A（OR，2.92; P，0.001）的检测显著相关，以及鼻病毒B（OR，1.98; P = 0.019）的检测程度较低。奥马珠单抗缩短了RV感染的持续时间（11.2 d vs. 12.4 d; P = 0.03），并使RV脱落峰值降低了0.4 log单位（95%置信区间，-0.77至-0.02; P = 0.04）。最后，奥马珠单抗降低了RV疾病的频率（风险比，0.64; 95%置信区间，0.49-0.84）结论：在过敏性哮喘儿童中，奥马珠单抗治疗降低了RV感染的持续时间，病毒脱落和RV疾病的风险。这些发现提供了直接证据，阻断IgE可降低对RV感染和疾病的易感性。
Rationale: Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal.Objectives: To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma.Methods: In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression.Measurements and Main Results: RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P, 0.001) and rhinovirus A (OR, 2.92; P, 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, -0.77 to -0.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84).Conclusions: In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility to RV infections and illness.