重度糖皮质激素依赖性哮喘抗免疫球蛋白E和抗白介素-5靶向治疗1例报告  

Anti-immunoglobulin E and anti-interleukin-5 targeted therapy for severe glucocorticoid-dependent asthma:a case report

作　　者：周文博 金美玲[3] 李晓宇 叶晓芬 ZHOU Wenbo;JIN Meiling;LI Xiaoyu;YE Xiaofen(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pharmacy,Wuxi People’s Hospital of Nanjing Medical University,Wuxi 214023,China;Department of Allergy,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]南京医科大学附属无锡人民医院药学部,江苏无锡214023 [3]复旦大学附属中山医院变态(过敏)反应科,上海200032

出　　处：《上海医药》2023年第19期31-34,55,共5页Shanghai Medical & Pharmaceutical Journal

基　　金：上海市临床重点专科项目(shslczdzk06504)。

摘　　要：本文报告1例血清免疫球蛋白E水平增高和外周血嗜酸性粒细胞增多且经哮喘分级治疗第5级治疗仍未控制的重度糖皮质激素依赖性哮喘患者的靶向治疗过程。患者2018年3月底开始接受抗免疫球蛋白E治疗(奥马珠单抗,每2周1次600 mg),后哮喘发作次数有所减少,所需口服糖皮质激素(oral corticosteroid,OCS)剂量有所降低,但病情不稳定,哮喘时有发作,且OCS维持治疗剂量仍较高,并已出现长期OCS治疗相关的不良反应如高血压等。为此,2022年7月下旬起对患者换用抗白介素-5治疗(美泊利珠单抗,每4周1次100 mg),患者外周血嗜酸性粒细胞计数明显下降,哮喘控制水平较好,急性发作次数明显减少,泼尼松维持治疗剂量也逐渐降低至5 mg/d。This paper described the selection of biotargeted drugs in a patient with severe glucocorticoid-dependent asthma who had elevated serum immunoglobulin E(IgE)and peripheral blood eosinophils and remained uncontrolled after stage 5 therapy.After anti-IgE treatment(omalizumab 600 mg,once every two weeks)which was started in March 2018,the number of asthma attacks was reduced,and the dose of oral corticosteroid(OCS)was decreased.However,the condition was not stable enough with repeated asthma attacks and the maintenance dose of OCS was still high,and long-term adverse reactions of OCS such as hypertension had appeared.Therefore,since late July 2022,the patient had been switched to anti-interleukin-5 treatment(mepolizumab 100 mg,once every four weeks),his peripheral blood eosinophils count significantly decreased,asthma control level was better,the number of acute attacks was significantly reduced,and prednisone maintenance dose was gradually reduced to 5 mg/d.

关 键 词：重度糖皮质激素依赖性哮喘 嗜酸性粒细胞增多 靶向治疗 

分 类 号：R974.3[医药卫生—药品] R562.25[医药卫生—药学]