Eficácia da terapia Anti-IgE no controle da asma
Effectiveness of anti-IgE therapy for asthma control
Faradiba Sarquis Serpa; Mariana Pandolfi Piana; Firmino Braga Neto; Fernanda Lugão Campinhos; Marina Gaburro da Silveira; Joseane Chiabai; Eliana Zandonade
Resumo
Objetivo: Avaliar parâmetros de resposta à terapia anti-IgE com omalizumabe em pacientes com asma de difícil controle. Métodos: Foram avaliados 24 pacientes com asma de difícil controle, em uso de omalizumabe há pelo menos 32 semanas e considerados como respondedores à terapia. Avaliou-se a pontuação do teste de controle de asma (TCA), a presença de sintomas de asma, a frequência de uso de ß2-agonista de curta ação, as doses de corticoide inalatório e oral e o percentual previsto do volume expiratório forçado no 1° minuto (VEF1), antes e com 16 e 32 semanas de tratamento. Resultados: Na avaliação da pontuação do TCA foram obtidas as médias 12,4 para o momento inicial, 15,7 e 17,9 para a 16ª semana e 32ª semana respectivamente (p < 0,0001). A dose média de corticoide inalatório diminuiu ao longo das 32 semanas, de 1.416 mcg para 1.250 mcg na 32ª semana (p = 0,0797). O número de idas à emergência e de sintomas noturnos também diminuíram. Observou-se redução da dose de corticoide oral, sendo inicialmente a dose média de 17,4 mg e após 16 e 32 semanas 6,7 mg e 4,4 mg, respectivamente (p < 0,0001). Houve aumento na média do VEF1 (% do previsto), de 37,5% no início do tratamento para 44,0% na 16ª semana (p = 0,007). Conclusões: O omalizumabe como terapia adjuvante no tratamento de pacientes com asma de difícil controle foi eficaz na melhora de parâmetros clínicos e funcionais, contribuindo para o controle da asma e diminuição dos riscos futuros.
Palavras-chave
Abstract
Objective: To assess parameters of response to anti-IgE therapy with omalizumab in patients with difficult-to-control asthma. Methods: Twenty four patients with difficult-to-control asthma using omalizumab for at least 32 weeks and considered as treatment responders were assessed. The Asthma Control Test (ACT) was used to assess the presence of asthma symptoms, frequency of use of short-acting beta2-agonists, inhaled and oral corticosteroid doses, and percentage of predicted forced expiratory volume in 1 second (FEV1) before treatment and after 16 and 32 weeks of treatment. Results: Mean ACT scores were 12.4 before treatment and 15.7 and 17.9 at 16 and 32 weeks post-treatment, respectively (p < 0.0001). Mean dose of inhaled corticosteroid decreased over the 32 weeks, from 1,416 mcg to 1,250 mcg (p = 0.0797). The number of visits to emergency services and nocturnal symptoms also decreased. There was a reduction in the mean dose of oral corticosteroids, from 17.4 mg at baseline to 6.7 mg and 4.4 mg after 16 and 32 weeks of treatment, respectively (p < 0.0001). Finally, an increase was found in the mean percentage values of predicted FEV1, from 37.5% at baseline to 44.0% at week 16 (p = 0.007). Conclusions: Omalizumab as adjunctive therapy in the treatment of patients with difficult-to-control asthma was effective in improving clinical and functional parameters, contributing to the control of asthma and to the reduction of future risks.
Keywords
Referências
1. Holgate ST, Polosa R. Treatment strategies for allergy and asthma. Nat Rev Immunol. 2008;8(3):218-30.
2. Global Initiative for Asthma [home page na internet]. GINA report, global strategy for asthma management and prevention. Update 2012. Disponível em: http://ginasthma.org/guidelines-gina-reportglobal-strategy-for-asthma.html. [Acesso em 2014 Mar 10].
3. Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes da Sociedade Brasileira de Pneumologia e Tisiologia para o manejo da asma – 2012. J Bras Pneumol. 2012;38(Supl 1):S1-46.
4. Consenso Latinoamericano sobre el Asma de Difícil Control. Actualización 2008. Drugs of Today. 2008;44(Suppl 3):1-43.
5. Brusselle G, Michils A, Louis R, Dupont L, Can de Maele B, Delobbe A, et al. “Real-life” effectiveness of omalizumab in patients with severe persistent allergic asthma: the PERSIST study. Respir Med. 2009;103:1633-42.
6. Grimaldi-Bensouda L, Zureik M, Aubier M, Humbert M, Levy J, Benichou J, et al. Does omalizumab make a difference to the real-life treatment of asthma exacerbations?: results from a large cohort of patients with severe uncontrolled asthma. Chest. 2013;143:398‑405.
7. Humbert M, Busse W, Hanania NA, Lowe PJ, Canvin J, Erpenbeck VJ, et al. Omalizumab in Asthma: An Update on Recent Developments. J Allergy Clin Immunol Pract. 2014;2:525-36.
8. Thomson N, Niven R, Heaney L, Greening A. Development of an algorithm for the assessment of response to treatment with omalizumab. Thorax. 2007;62:(A99, P94).
9. Holgate S, Buhl R, Bousquet J, Smith N, Panahloo Z, Jimenez P. The use of omalizumab in the treatment of severe allergic asthma: A clinical experience update. Respir Med. 2009;103(8):1098-113.
10. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995. Disponível em:http://www.who.int/childgrowth/publications/physical_status/en/. [Acesso em 2014 Mar 10].
11. Barnes N, Menzies-Gow A, Mansur AH, Spencer D, Percival F, Radwan A, et al. Effectiveness of omalizumab in severe allergic asthma: a retrospective UK real-world study. J Asthma. 2013;50(5):529-36.
12. Korn S, Thielen A, Seyfried S, Taube C, Kornmann O, Buhl R. Omalizumab in patients with severe persistent allergic asthma in a real-life setting in Germany. Respir Med. 2009;103(11):1725-31.
13. Bousquet J, Cabrera P, Berkman N, Buhl R, Holgate S, Wenzel S, et al. The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma. Allergy. 2005;60(3):302-8.
14. Braunstahl GJ, Chen CW, Maykut R, Georgiou P, Peachey G, Bruce J. The eXpeRience registry: the 'real-world' effectiveness of omalizumab in allergic asthma. Respir Med. 2013;107(8):1141-51.
15. López Tiro JJ, Contreras EA, Del Pozo ME, Gómez Vera J, Larenas Linnemann D. Real life study of three years omalizumab in patients with difficult-to-controlasthma. Allergol Immunopathol (Madr). 2014 Apr 26. [Epub ahead of print] PubMed PMID: 24780091.
16. Bousquet J, Siergiejko Z, Swiebocka E, Humbert M, Rabe KF, Smith N, et al. Persistency of response to omalizumab therapy in severe allergic (IgE-mediated) asthma. Allergy. 2011;66(5):671-8.
17. Vennera MC, Llano LP, Bardagí S, Ausin P, Sanjuas C, González H, et al. Omalizumab Therapy in Severe Asthma: Experience from the Spanish Registry-Some New Approaches. J Asthma. 2012;49(4):416‑22.
18. Korn S, Schumann C, Ktopf C, Stoiber K, Thielen A, Taube C, et al. Effectiveness of omalizumab in patients 50 years and older with severe persistent allergic asthma. Ann Allergy Asthma Immunol. 2010;105(4):313-9.
19. Tzortzaki EG, Georgiou A, Kampas D, Lemessios M, Markatos M, Adamidi T, et al. Long-term omalizumab treatment in severe allergic asthma: The South–Eastern Mediterranean “real-life” experience. Pulm Pharmacol Ther. 2012;25:77-82.
20 Verma P, Randhawa I, Klautesmayer WB. Clinical efficacy of omalizumab in an elderly veteran population with severe asthma. Allergy Asthma Proc. 2011;32:346-50.
21. Molimard M, Buhl R, Niven R, Le Gros V, Thielen A, Thirlwell J, et al. Omalizumab reduces oral corticosteroid use in patients with severe allergic asthma: real-life data. Respir Med. 2010;104:1381-5.
22. Niven R, Chung KF, Panahloo Z, Blogg M, Ayre G. Effectiveness of omalizumab in patients with inadequately controlled severe persistent allergic asthma: an open-label study. Respir Med. 2008;102:1371-8.
23. Humbert M, Beasley R, Ayres J, Slavin R, Hébert J, Bousquet J, et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNOVATE. Allergy. 2005;60:309-16.
24. Weber EJ, Silverman RA, Callaham ML, Pollack CV, Woodruff PG, Clark S, et al. A prospective multicenter study of factors associated with hospital admission among adults with acute asthma. Am J Med. 2002;113:371‑8.
25. Nowak D. Management of asthma with anti-immunoglobulin E: a review of clinical trials of omalizumab. Respir Med. 2006;100:1907‑17.
26. Rubin AS, Souza-Machado A, Andradre-Lima M, Ferreira F, Honda A, Matozo TM; QUALITX Study Investigators. Effect of omalizumab as add-on therapy on asthma-related quality of life in severe allergic asthma: a Brazilian study (QUALITX). J Asthma. 2012;49:288-93.
27. Corren J, Casale TB, Lanier B, Buhl R, Holgate S, Jimenez P. Safety and tolerability of omalizumab. Clin Exp Allergy. 2009;39:188-97.
28. Vignola AM, Humbert M, Bousquet J, Boulet LP, Hedgecock S, Blogg M, et al. Efficacy and tolerability of anti-immunoglobulin E therapy with omalizumab in patients with concomitant allergic asthma and persistent allergic rhinitis: SOLAR. Allergy. 2004;59:709-17.
29. Molinard M, de Blay F, Didier A, Le Gros V. Effectiveness of omalizumab (Xolair®) in the first patients treated in real-life practice in France. Resp Med. 2008;102:71-6.
Submetido em:
22/03/2015
Aceito em:
10/04/2015
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email