Concurrent Blood Eosinophils and FeNO as Biological Therapy Indicators in Severe Asthma: Findings from the PRISM study.

IF 8.2 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-03-18 DOI:10.1016/j.jaip.2025.03.011

Duong Duc Pham, Ji-Hyang Lee, Hyouk-Soo Kwon, Woo-Jung Song, You Sook Cho, Hyunkyoung Kim, Jae-Woo Kwon, So-Young Park, Sujeong Kim, Gyu Young Hur, Byung Keun Kim, Young-Hee Nam, Min-Suk Yang, Mi-Yeong Kim, Sae-Hoon Kim, Byung-Jae Lee, Taehoon Lee, So Young Park, Min-Hye Kim, Young-Joo Cho, ChanSun Park, Jae-Woo Jung, Han Ki Park, Joo-Hee Kim, Ji-Yong Moon, Pankaj Bhavsar, Ian Adcock, Kian Fan Chung, Tae-Bum Kim

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Abstract

Background: The combination of pre-treatment peripheral blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO) levels for optimizing the therapeutic response of T2-biologics in patients with severe eosinophilic asthma (SEA) remains unclear.

Objective: We aimed to compare the longitudinal clinical outcome changes across subgroups stratified by the combination of high and low levels of BEC and FeNO.

Methods: Overall, 278 patients with SEA (anti-IL-5/IL-5Rα users: n=82; anti-IL-4Rα users: n=196) were stratified based on pre-treatment BEC and FeNO levels and followed up for 6-12 months. Group differences in exacerbation rate, lung function, asthma control test (ACT), BEC, FeNO, and clinical remission over time were compared.

Results: Approximately 75% and 63% of patients presented with concurrent high BEC (≥300 cells/μL) and high FeNO (≥25 ppb) in the anti-IL-5/IL-5Rα and anti-IL-4Rα groups, respectively. Among anti-IL-5/IL-5Rα users, no significant differences were observed among BEC-FeNO groups regarding exacerbation rates or clinical remission. Patients with concurrent high BEC and FeNO levels demonstrated more pronounced reductions in both markers and greater FEV1 and ACT score improvements compared to those with high FeNO but low BEC. In the anti-IL-4Rα group, patients with low BEC and FeNO, and those with high BEC but low FeNO, exhibited a significantly lower likelihood of achieving clinical remission (OR [95% CI]: 0.08 [0.00-0.46] and 0.11 [0.01-0.63], respectively) and a slower rate of FEV1 improvement (all P for slope < 0.05) compared to those with concurrent high BEC and FeNO.

Conclusion: Concurrently elevated BEC and FeNO levels ensure optimal therapeutic response in SEA patients treated with T2-biologics.

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.