Uso de corticoide inalado e sua implicação no nível de eosinófilos periféricos
Inhaled corticosteroid use and its implications for peripheral blood eosinophil levels
Grazielly de Fatima Pereira; Priscila de Abreu Franco; Larissa de Queiroz Mamede; Lais Souza Gomes; Iandra Leite Perez; Amanda Brolio de Souza; Allyne Moura Fé E. S. Araujo; Jorge Kalil; Pedro Giavina-Bianchi; Rosana Câmara Agondi
Resumo
Introdução: Um dos efeitos do corticoide sistêmico é a redução do número e da ação dos eosinófilos. O objetivo deste estudo foi avaliar a ação do corticoide inalatório (CI) sobre os eosinófilos periféricos (EoP). Métodos: Trata-se de um estudo retrospectivo de prontuários eletrônicos de pacientes adultos com asma grave, steps 4 e 5 da GINA 2019, acompanhados em um centro terciário de referência. Os pacientes em uso recente ou atual de corticoide oral foram excluídos. Foram avaliados dados demográficos, dose de budesonida inalada, sensibilização a aeroalérgenos, IgE total, cortisol sérico e EoP, no período de 2010 a 2019. Resultados: Foram avaliados 58 pacientes, sendo 81,0% do sexo feminino, com médias de idade de 61,0 anos, de início da asma aos 17,4 anos e de tempo de doença de 43,6 anos. A média de CI foi de 1682,8 µg/dia, e a média de IgE sérica total do grupo foi de 398,9 UI/mL. A IgE específica para aeroalérgenos estava positiva em 40 pacientes (69%), sendo 85% destes pacientes sensibilizados para ácaros. A média do cortisol sérico foi de 5,6 µg/dL, e dos EoP de 252,1 cel/mm3. Neste estudo não foi observada correlação entre a dose de CI e o cortisol sérico. Entretanto, 41,4% dos pacientes apresentaram EoP < 150 cel/mm3, e houve uma correlação inversa significante entre as doses de CI e os níveis de EoP, (p = 0,011 r2 = 0,11), ou seja, quanto maior a dose de CI, menor o nível de EoP. Conclusões: A GINA 2019 recomenda o uso de anticorpos monoclonais (mAbs), no step 5, direcionados pelo fenótipo de asma. Alguns destes mAbs incluem como critério de tratamento os EoP acima de 150 ou 300 cel/mm³. Neste estudo, o CI em doses elevadas estava relacionado a níveis mais baixos de EoP, portanto, alguns pacientes em uso de doses elevadas de CI poderiam apresentar EoP reduzida pelo uso de CI, interferindo na recomendação de alguns mAbs.
Palavras-chave
Abstract
Introduction: One of the effects of systemic corticosteroids is to reduce the number and action of eosinophils. The aim of this study was to evaluate the action of inhaled corticosteroids (ICS) on peripheral blood eosinophils (PBE). Methods: We retrospectively reviewed the medical records of adult patients with severe asthma, steps 4-5 (GINA 2019), treated at a tertiary referral center. Patients on current or recent oral corticosteroid therapy were excluded. Data on demographics, ICS dose, sensitization to aeroallergens, total serum IgE, serum cortisol, and PBE counts were evaluated for the period from 2010 to 2019. Results: Fifty-eight patients were evaluated, 81% were women. Mean age was 61 years, with the onset of asthma at 17.4 years of age and disease duration of 43.6 years. The mean ICS dose was 1682.8 µg/day, and the mean total serum IgE was 398.9 IU/mL. Specific IgE for aeroallergens was positive in 40 patients (69%); of these, 85% were sensitized to mites. The mean serum cortisol level was 5.6 µg/dL, and the mean PBE count was 252.1 cells/mm3. There was no correlation between ICS dose and serum cortisol, but 41.4% of patients had PBE counts <150 cells/mm3. There was a significant inverse correlation between ICS doses and PBE counts (p=0.011, r2=0.11), i.e., the higher the ICS dose, the lower the PBE count. Conclusions: GINA 2019 recommends the use of monoclonal antibodies (mAbs) in asthma step 5, directed by phenotype. Some of these mAbs have as a treatment criterion PBE count above 150 or above 300 cells/mm3. In this study, high-dose ICS was correlated with lower PBE levels. Therefore, patients using high-dose ICSs could have their PBE levels reduced by ICS use, interfering with the recommendation of some mAbs.
Keywords
Referências
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Submetido em:
16/12/2019
Aceito em:
23/12/2019
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