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Randomized Controlled Trial
. 2006 Feb 16;354(7):697-708.
doi: 10.1056/NEJMoa050580.

Evidence of a role of tumor necrosis factor alpha in refractory asthma

Mike A Berry1, Beverley Hargadon, Maria Shelley, Debbie Parker, Dominick E Shaw, Ruth H Green, Peter Bradding, Christopher E Brightling, Andrew J Wardlaw, Ian D Pavord
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Free article
Randomized Controlled Trial

Evidence of a role of tumor necrosis factor alpha in refractory asthma

Mike A Berryet al. N Engl J Med. .
Free article

Abstract

Background:The development of tumor necrosis factor alpha (TNF-alpha) antagonists has made it feasible to investigate the role of this cytokine in refractory asthma.

Methods:We measured markers of TNF-alpha activity on peripheral-blood monocytes in 10 patients with refractory asthma, 10 patients with mild-to-moderate asthma, and 10 control subjects. We also investigated the effects of treatment with the soluble TNF-alpha receptor etanercept (25 mg twice weekly) in the patients with refractory asthma in a placebo-controlled, double-blind, crossover pilot study.

Results:As compared with patients with mild-to-moderate asthma and controls, patients with refractory asthma had increased expression of membrane-bound TNF-alpha, TNF-alpha receptor 1, and TNF-alpha-converting enzyme by peripheral-blood monocytes. In the clinical trial, as compared with placebo, 10 weeks of treatment with etanercept was associated with a significant increase in the concentration of methacholine required to provoke a 20 percent decrease in the forced expiratory volume in one second (FEV1) (mean difference in doubling concentration changes between etanercept and placebo, 3.5; 95 percent confidence interval, 0.07 to 7.0; P=0.05), an improvement in the asthma-related quality-of-life score (by 0.85 point; 95 percent confidence interval, 0.16 to 1.54 on a 7-point scale; P=0.02), and a 0.32-liter increase in post-bronchodilator FEV1 (95 percent confidence interval, 0.08 to 0.55; P=0.01).

Conclusions:Patients with refractory asthma have evidence of up-regulation of the TNF-alpha axis. (ClinicalTrials.gov number,NCT00276029.).

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