Long-Term Clinical Outcomes of High-Dose Mepolizumab Treatment for Hypereosinophilic Syndrome.
Long-Term Clinical Outcomes of High-Dose Mepolizumab Treatment for Hypereosinophilic Syndrome.
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DOI：
10.1016/j.jaip.2018.04.033
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Klion AD
中科院分区：
文献类型：
--
作者：
Kuang FL;Fay MP;Ware J;Wetzler L;Holland-Thomas N;Brown T;Ortega H;Steinfeld J;Khoury P;Klion AD
高嗜酸性粒细胞综合征（HES）的常规治疗方法疗效不一，并具有显著的长期毒性。抗il -5 （mepolizumab）治疗在GC敏感的HES中具有糖皮质激素（GC）节约作用，但mepolizumab治疗难治性重症HES患者的疗效迄今尚未得到研究。确定严重难治性HES患者对mepolizumab反应的预测因素，并将这些患者与接受常规治疗的HES患者的长期预后进行比较。回顾性分析35例接受mepolizumab治疗的HES患者和55例接受常规治疗的HES患者的临床和实验室数据，所有患者均在单一中心随访。嗜酸性粒细胞峰值、GC敏感性、肺部受累、HES临床亚型和预处理血清IL-5与美珠单抗应答相关。尽管有证据表明在基线时疾病更严重，但mepolizumab治疗的受试者与接受常规治疗的HES受试者具有相当的长期临床结果，并报告了治疗相关合并症的改善。接受美珠单抗单药治疗的患者比接受常规治疗的HES患者或需要额外HES治疗的美珠单抗治疗的HES患者的疾病发作次数更少。该研究证实，mepolizumab是一种有效且耐受性良好的HES治疗方法，但表明在特发性或重叠形式HES的gc反应性受试者中更有可能产生反应。治疗的一个主要好处是减少了因停止或减少传统HES治疗而引起的合并症。虽然完全停用GC的受试者获益最大，但对于严重的难治性HES，大剂量美波珠单抗是一种安全有效的补救性治疗。由爱思唯尔公司代表美国过敏、哮喘和免疫学学会发表（J Allergy clinimmunopractice 2018; * *: * * - * *）
Conventional therapies for hypereosinophilic syndromes (HES) have variable efficacy and carry significant long-term toxicities. Anti-IL-5 (mepolizumab) therapy has a glucocorticoid (GC)-sparing effect in GC-sensitive HES, but the efficacy of mepolizumab in treatment-refractory HES patients with severe disease has not been examined to date. To identify predictors of response to mepolizumab in subjects with severe treatment-refractory HES and compare long-term outcomes in these subjects with HES subjects treated with conventional therapies. Retrospective analysis of clinical and laboratory data from 35 HES subjects treated with mepolizumab and 55 HES subjects on conventional therapy, all followed at a single center, was performed. Peak eosinophilia, GC sensitivity, pulmonary involvement, HES clinical subtype, and pretreatment serum IL-5 were correlated with mepolizumab response. Despite evidence of more severe disease at baseline, mepolizumab-treated subjects had comparable long-term clinical outcomes to HES subjects treated with conventional therapies and reported improvements in therapy-related comorbidities. Subjects managed with mepolizumab monotherapy had fewer disease flares than HES subjects on conventional therapies or mepolizumab-treated HES subjects requiring additional HES therapies. This study confirms that mepolizumab is an effective and well-tolerated therapy for HES, but suggests that response is more likely in GC-responsive subjects with idiopathic or overlap forms of HES. A primary benefit of treatment is the reduction of comorbidity due to discontinuation or the reduction of conventional HES therapies. Although subjects who completely discontinued GC had the most benefit, high-dose mepolizumab was a safe and effective salvage therapy for severe, treatment-refractory HES. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2018;∎:∎-∎)
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影响因子：
14.2
作者：
Garrett, JK;Jameson, SC;Rothenberg, ME
通讯作者：
Rothenberg, ME
DOI：
10.1016/j.jaip.2017.06.006
发表时间：
2018-01-01
影响因子：
9.4
作者：
Khoury, Paneez;Abiodun, Annalise O.;Klion, Amy D.
通讯作者：
Klion, Amy D.
影响因子：
12.4
作者：
Khoury P;Desmond R;Pabon A;Holland-Thomas N;Ware JM;Arthur DC;Kurlander R;Fay MP;Maric I;Klion AD
通讯作者：
Klion AD
DOI：
10.1056/nejmoa0808991
发表时间：
2009-03-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Haldar P;Brightling CE;Hargadon B;Gupta S;Monteiro W;Sousa A;Marshall RP;Bradding P;Green RH;Wardlaw AJ;Pavord ID
通讯作者：
Pavord ID
影响因子：
158.5
作者：
Rothenberg, Marc E.;Klion, Amy D.;Gleich, Gerald J.
通讯作者：
Gleich, Gerald J.