Anti-IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison
Anti-IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison
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DOI：
10.1016/j.jaci.2018.08.031
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发表时间：
2019-01-01
影响因子：
14.2
通讯作者：
Gunsoy, Necdet B.
中科院分区：
文献类型：
--
作者：
Busse, William;Chupp, Geoffrey;Gunsoy, Necdet B.
背景资料：三种抗IL-5通路导向疗法被批准用于重度嗜酸性粒细胞性哮喘（SEA）患者;然而，没有头对头比较数据可用。目的：我们试图根据基线血嗜酸性粒细胞计数，比较许可剂量的美泊利珠单抗、贝那利珠单抗和瑞利珠单抗在SEA患者中的疗效。方法：该间接治疗比较（ITC）使用了来自科克伦综述和独立检索的数据。符合条件的研究是在12岁或以上SEA患者中进行的随机对照试验。终点包括有临床意义的急性加重的年发生率以及哮喘控制问卷评分和FEV 1较基线的变化。在哮喘控制问卷评分为1.5或更高的患者中进行ITC，并按基线血嗜酸性粒细胞计数进行分层。在所有血嗜酸性粒细胞计数亚组中，与安慰剂相比，所有治疗均显著降低了临床显著急性发作的发生率，并改善了哮喘控制。与贝那利珠单抗相比，美泊利珠单抗在各亚组中将临床显著加重降低了34%至45%（比率比>= 400个细胞/μ L：0.55 [95%CI，0.35-0.87]; >= 300个细胞/μ L：0.61 [95%CI，0.37-0.99];和>= 150个细胞/μ L：0.66 [95% CI，0.49-0.89];所有P
Background: Three anti-IL-5 pathway-directed therapies are approved for use in patients with severe eosinophilic asthma (SEA); however, no head-to-head comparison data are available.Objective: We sought to compare the efficacy of licensed doses of mepolizumab, benralizumab, and reslizumab in patients with SEA, according to baseline blood eosinophil counts.Methods: This indirect treatment comparison (ITC) used data from a Cochrane review and independent searches. Eligible studies were randomized controlled trials in patients aged 12 years or greater with SEA. End points included annualized rate of clinically significant exacerbations and change from baseline in Asthma Control Questionnaire score and FEV1. An ITC was performed in patients with Asthma Control Questionnaire scores of 1.5 or greater and stratified by baseline blood eosinophil count.Results: Eleven studies were included. All treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control versus placebo in all blood eosinophil count subgroups. Mepolizumab reduced clinically significant exacerbations by 34% to 45% versus benralizumab across subgroups (rate ratio >= 400 cells/mu L: 0.55 [95% CI, 0.35-0.87]; >= 300 cells/mu L: 0.61 [95% CI, 0.37-0.99]; and >= 150 cells/mu L: 0.66 [95% CI, 0.49-0.89]; all P