PT -期刊文章盟穆克吉,这里离马纳利市盟——Forero,大卫·菲利普AU - Tran斯蒂芬妮AU -布雷,Marie-Eve AU -伯特兰,玛丽莲AU -巴拉,Anurag盟——Cherukat Jayant盟——Al-Hayyan哈贾尔盟——Ayoub Anmar AU - Revill,斯宾塞d . AU - Javkar Tanvi AU -雷德福,凯瑟琳盟——Kjarsgaard梅勒妮盟——黄,Chynna盟——Dvorkin-GhevaAnna AU - Ask, Kjetil AU - Olivenstein, Ronald AU - Dendukuri, Nandini AU - Lemiere, Catherine AU - Boulet, Louis-Philippe AU - Martin, James G. AU - Nair，Parameswaran TI - anti-IL-5单克隆抗体治疗反应不佳的严重与气道嗜酸性哮喘病患者自身免疫现象援助- 10.1183/13993003.00117 -2020 DP - 2020年10月01 TA -欧洲呼吸杂志》第六PG - 2000117 - 56 IP - 4 4099 - //www.qdcxjkg.com/content/56/4/2000117.short 4100//www.qdcxjkg.com/content/56/4/2000117.full SO - Eur Respir J2020 10月1日;在临床试验中，两种抗白细胞介素(IL)-5单克隆抗体(单克隆抗体:mepolizumab和reslizumab)被批准用于治疗严重的嗜酸性粒细胞性哮喘(eosinophilic asthma)，使病情恶化减少了50-60%。目的观察实际临床环境中抗il -5单克隆抗体的反应，并评价亚最佳反应的预测因子。方法在4个加拿大学术中心，前瞻性地收集250名经仔细鉴定的中-重度哮喘患者的预先确定的临床终点，以评估对两种抗il -5单克隆抗体的反应。亚优反应的确定是基于未能减少维持皮质类固醇(MCS)或哮喘症状评分(哮喘控制问卷(ACQ))或恶化，以及持续的痰/血嗜酸性粒细胞。根据肺功能降低25%或MCS/ACQ增加来评估亚优反应者的恶化。以39例患者为代表，通过ELISA检测痰液中炎症介质、自身抗体和补体激活，并通过免疫染色法检测福尔马林固定石蜡包埋痰栓中的免疫复合物沉积。结果在接受mepolizumab或reslizumab治疗的患者中，42.8%(250人中107人)观察到不良反应。每日强的松需量、窦性疾病和晚发性哮喘诊断是亚最佳反应的最强预测因子。 Asthma worsened in 13.6% (34 out of 250) of these patients. The majority (79%) of them were prednisone-dependent. Presence of sputum anti-eosinophil peroxidase immunoglobulin (Ig)G was a predictor of suboptimal response to an anti-IL-5 mAb. An increase in sputum C3c (marker of complement activation) and deposition of C1q-bound/IL-5-bound IgG were observed in the sputa of those patients who worsened on therapy, suggesting an underlying autoimmune-mediated pathology.Conclusion A significant number of patients who meet currently approved indications for anti-IL5 mAbs show suboptimal response to them in real-life clinical practice, particularly if they are on high doses of prednisone. Monitoring blood eosinophil count is not helpful to identify these patients. The concern of worsening of symptoms associated with immune-complex mediated complement activation in a small proportion of these patients highlights the relevance of recognising airway autoimmune phenomena and this requires further evaluation.Severe asthmatics with adult-onset asthma, sinus disease and requiring daily prednisone, are at higher risk for responding suboptimally to current doses of anti-IL-5 mAbs, with further risk of worsening on an IgG1 mAb if they have sputum autoantibodies https://bit.ly/2Ahpvsm