Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline
Six questions about the asthma that stays uncontrolled on maximal inhaled therapy, and six answers that are all conditional: the document suggests, it does not recommend, and it says so in every one. Anti-IL-5 and anti-IL-5 receptor antibodies are suggested for severe uncontrolled eosinophilic asthma in adults, with a blood eosinophil count of at least 150 cells per microlitre as the threshold to start. Anti-IgE gets its own cut-offs for picking a responder: eosinophils of at least 260 cells per microlitre and a fraction of exhaled nitric oxide of at least 19.5 ppb. Anti-IL-4/13 is suggested both for severe eosinophilic asthma and for the corticosteroid-dependent patient, and there the eosinophil count no longer decides. Two older options survive alongside the biologics: inhaled tiotropium at GINA step 4 to 5, and a trial of chronic macrolide therapy in the patient who stays symptomatic, whatever their phenotype. The register's biologic trials are grouped below by the pathway each one blocks.
Esta norma cita 4 dos 35 ensaios marcantes do nosso registo de Pneumologia.
Anti-IL-5: mepolizumab2
- 2014MENSAPneumo · Asma · Biológico anti-IL-5Em 576 doentes com asma eosinófila grave, o mepolizumab subcutâneo 100 mg de 4 em 4 semanas reduziu as exacerbações em comparação com placebo.
- 2014SIRIUSPneumo · Asma · Poupança de COCEm 135 doentes com asma eosinófila grave dependente de COC, o mepolizumab 100 mg s.c. de 4 em 4 semanas reduziu a dose de corticosteroides orais de manutenção em comparação com placebo.
Anti-IL-5 receptor: benralizumab1
- 2016SIROCCOPneumo · Asma · Biológico anti-IL-5RαEm 1.205 doentes com asma eosinófila grave sob CIE/LABA em dose elevada, o benralizumab 30 mg de 4 ou 8 em 8 semanas reduziu a taxa anual de exacerbações em comparação com placebo.
Anti-IL-4/13: dupilumab1
- 2018LIBERTY ASTHMA QUESTPneumo · Asma · Biológico anti-IL-4RαEm 1.902 doentes com asma moderada a grave não controlada, o dupilumab 200 ou 300 mg de 2 em 2 semanas reduziu as exacerbações graves e melhorou o FEV1 em comparação com placebo.
Published since the guideline1
- 2021NAVIGATORPneumo · Asma · Biológico anti-TSLPEm 1.061 doentes com asma grave não controlada, o tezepelumab 210 mg s.c. de 4 em 4 semanas reduziu a taxa anualizada de exacerbações asmáticas em comparação com placebo.