原標(biāo)題：利布利克珠治療成人哮喘
　?、貱orren等人(本刊9月22期)報(bào)道，在哮喘患者中，使用利布利克珠單抗治療與肺功能的改善有關(guān)，而在治療前血清骨膜蛋白水平高或呼出的一氧化氮(FENO)比例高的的患者中，改善效果顯著。②作者合理地強(qiáng)調(diào)了骨膜蛋白，因?yàn)樗脑诓煌∪酥g的差異較小，但同時(shí)，他們提出了一個(gè)重要的問題：個(gè)體患者在基線時(shí)，骨膜蛋白和呼出的一氧化氮(FENO)比例之間的關(guān)系是什么? 利布利克珠單抗治療12周后, 高FENO水平組1秒用力呼氣量(FEV1)提高8.6%,與安慰劑相比(P = 0.02),高骨膜蛋白水平組提高8.2%,與安慰劑相比(P = 0.03)。③在治療24周時(shí)，高FENO水平組FEV1的 改善比高骨膜蛋白組大 40% (5.9%比4.2%)(利布利克珠單抗治療組與安慰劑組相比，高FENO 組，P = 0.09,高骨膜蛋白組 P = 0.26)(見補(bǔ)充附錄表S4, 在NEJM.org可獲得Corren等人全文)。④這些數(shù)據(jù)表明，一些同時(shí)具有低骨膜蛋白水平和高FENO水平的患者可能與骨膜蛋白水平高的患者一樣受益于利布利珠單抗治療。如果是這樣，這將增加被認(rèn)為可能對(duì)利布利單抗有應(yīng)答的患者數(shù)量。研究骨膜蛋白和FENO之間的關(guān)系也可能為了解利布利克珠單抗的作用機(jī)制提供線索。
延伸閱讀
T h e  NEW ENGLAND  JOUR NAL o f  MEDICINE
N ENGL J MED 365;25 NEJM.ORG  DECEMBER 22, 2011
Corren et al. (Sept. 22 issue)1 report that treatment with lebrikizumab was associated with improved lung function in patients with asthma, and that improvement wasgreater in patients with high pretreatment levels of serum periostin or of the fraction of exhaled nitric oxide (FENO). The authors justifiably emphasize periostin because of its lower intra-patient variability, but in doing so, they raise an important question: what is the relationship between periostin and FENO at baseline in individual patients? After 12 weeks of lebrikizumab therapy, forced expiratory volume in 1 second (FEV1) improved by 8.6 percentage points in the group with high FENO levels, as compared with placebo (P?=?0.02), and by 8.2 percentage points in the group with high periostin levels, as compared with placebo (P?=?0.03). At 24 weeks, improvement in FEV1 was 40% greater in the FENO-high group than in the periostin-high group (5.9% vs. 4.2%) (P?=?0.09 in the FENO-high group and P?=?0.26 in the periostin-high group for the comparison of lebrikizumab with placebo) (see Table S4 in the Supplementary Appendix, available with the full text of the article by Corren et al. at NEJM.org). These data suggest that some patients who have both low-periostin levels and high FENO levels may benefit from lebrikizumab treatment as much as patients in the periostin-high group do. If so, this would increase the number of patients considered likely to respond to lebrikizumab. Investigating the re-lationship between periostin and FENO may also provide insight into the mechanism of action of lebrikizumab.
All Author:
Benjamin Zeskind, Ph.D.
　　創(chuàng)建過敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。