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Defining response to therapy with biologics in severe asthma: from global evaluation to super response and remission. 定义严重哮喘的生物制剂治疗反应:从全球评估到超级反应和缓解。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-19 DOI: 10.1080/17476348.2023.2226392
Andriana I Papaioannou, Evangelia Fouka, Konstantinos Bartziokas, Maria Kallieri, Angelos Vontetsianos, Konstantinos Porpodis, Nikoletta Rovina, Stelios Loukides, Petros Bakakos

Introduction: In recent years, monoclonal antibodies targeting Type-2 inflammatory pathways have been developed for severe asthma treatment. However, even when patients are carefully selected, the response to treatment varies.

Areas covered: Different studies have evaluated response to therapy with biologics such as exacerbation reduction, symptom improvement, pulmonary function increase, improvement in QoL, or decrease of oral corticosteroids, showing that all patients do not respond to all disease aspects and leading to an extensive debate regarding the definition of response.

Expert opinion: Assessing response to therapy is of great importance, but since there is no uniform definition of treatment response, the recognition of patients who really benefit from these therapies remains an unmet need. In the same context, identifying non-responding patients in which biologic therapy should be switched or substituted by alternative treatment options is of paramount importance. In this review, we present the road trip of the definition of therapeutic response to biologics in severe asthmatics by presenting the current relevant medical literature. We also present the suggested predictors of response, with an emphasis on the so-called super-responders. Finally, we discuss the recent insights regarding asthma remission as a feasible treatment goal and provide a simple algorithm for the evaluation of response.

引言:近年来,针对2型炎症途径的单克隆抗体已被开发用于严重哮喘的治疗。然而,即使仔细选择了患者,对治疗的反应也各不相同。涵盖领域:不同的研究评估了生物制剂治疗的反应,如病情恶化减轻、症状改善、肺功能增加、生活质量改善或口服皮质类固醇减少,表明所有患者对所有疾病方面都没有反应,并导致了关于反应定义的广泛争论。专家意见:评估对治疗的反应非常重要,但由于对治疗反应没有统一的定义,承认真正从这些治疗中受益的患者仍然是一个未满足的需求。在同样的背景下,确定无反应的患者,在这些患者中,生物治疗应该被替代治疗方案所取代,这一点至关重要。在这篇综述中,我们通过介绍当前的相关医学文献,介绍了严重哮喘患者对生物制剂治疗反应的定义。我们还提出了反应的预测因素,重点是所谓的超级反应者。最后,我们讨论了最近关于哮喘缓解作为可行治疗目标的见解,并为评估反应提供了一个简单的算法。
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引用次数: 0
The role of biomarkers in stage III non-small cell lung cancer. 生物标志物在癌症III期非小细胞肺癌中的作用。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-15 DOI: 10.1080/17476348.2023.2223985
Rafael Rosell, María González-Cao, Masaoki Ito, Mariacarmela Santarpia, Andrés Aguilar, Jordi Codony-Servat

Introduction: Stage III non-small cell lung cancer (NSCLC) is a composite of the regional spread of lung cancer with different levels of potential lymph node involvement and tumor size that often deem the stage at time of diagnosis to be unresectable and suitable for chemoradiation plus consolidation immunotherapy with durvalumab for 12 months. Chemoradiation plus durvalumab consolidation yielded a landmark 49.2% 5-year overall survival in unresectable NSCLC.

Areas covered: Sub-optimal results lead us to focus on the mechanisms of resistance responsible for intractability in a significant proportion of cases that fail with chemoradiation and immunotherapy. In stage III NSCLC it is opportune to explore the accumulated evidence on ferroptosis resistance that can lead to cancer progression and metastasis. Strong data shows that three anti-ferroptosis pathways are principally involved in resistance to chemotherapy, radiation, and immunotherapy.

Expert opinion: Because a large part of stage III NSCLCs is resistant to chemoradiation and durvalumab consolidation, a ferroptosis-based therapeutic approach, combined with standard-of-care therapy, can lead to improved clinical outcomes in patients diagnosed with stage III and possibly stage IV NSCLCs.

简介:III期非小细胞肺癌癌症(NSCLC)是癌症区域扩散的复合物,具有不同程度的潜在淋巴结受累和肿瘤大小,通常认为诊断时的阶段是不可切除的,适合放化疗加杜伐鲁单抗巩固免疫治疗12 月。化疗加杜伐单抗联合治疗在不可切除的NSCLC中获得了里程碑式的49.2%的5年总生存率。所涵盖的领域:次优结果使我们关注在化疗和免疫治疗失败的很大一部分病例中导致难治性的耐药性机制。在III期NSCLC中,探索铁蛋白脱羧酶耐药性的积累证据是合适的,铁蛋白脱氨酶耐药性可导致癌症进展和转移。强有力的数据表明,三种抗脱铁性贫血途径主要涉及对化疗、放疗和免疫疗法的耐药性。专家意见:由于III期NSCLC的很大一部分对放化疗和杜伐单抗合并具有耐药性,因此基于脱铁性贫血的治疗方法与标准护理治疗相结合,可以改善诊断为III期和IV期NSCLC患者的临床结果。
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引用次数: 1
Respiratory comorbidities in severe asthma: focus on the pediatric age. 严重哮喘的呼吸合并症:重点关注儿科年龄。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2168261
Amelia Licari, Beatrice Andrenacci, Maria Elisa Di Cicco, Maddalena Leone, Gian Luigi Marseglia, Mariangela Tosca

Introduction: Asthma comorbidities are a frequent cause of adverse outcomes, such as poor asthma control, frequent asthma attacks, reduced quality of life, and higher healthcare costs. Comorbidities are well-known treatable traits whose proper management can help achieve optimal asthma control. Although multimorbidity is frequent among asthmatics, comorbidities are still a potential cause of misdiagnosis and under or over treatments, and little is known about their impact on severe pediatric asthma.

Areas covered: We provided a comprehensive, 5-year updated review focusing on the main respiratory comorbidities in severe asthma, particularly in epidemiology, pathogenesis, and current and future therapies.

Expert opinion: Respiratory comorbidities have unique characteristics in childhood. Their management must be multidisciplinary, age-specific, and integrated. Further longitudinal studies are needed to understand better the mutual interrelation and synergistic effect between asthma and its respiratory comorbidities, the identification of common, treatable risk factors leading to potential asthma prevention, the effectiveness of actual and future target-therapies, and the correlation between long-lasting respiratory comorbidities and poor lung function trajectories.

哮喘合并症是不良结局的常见原因,如哮喘控制不佳、哮喘发作频繁、生活质量下降和医疗保健费用增加。合并症是众所周知的可治疗的特征,适当的管理可以帮助实现最佳的哮喘控制。虽然哮喘患者中多病很常见,但合并症仍然是误诊和治疗不足或过度的潜在原因,并且对其对严重儿童哮喘的影响知之甚少。涵盖领域:我们提供了一项全面的、为期5年的最新综述,重点关注严重哮喘的主要呼吸道合并症,特别是流行病学、发病机制以及当前和未来的治疗方法。专家意见:呼吸道合并症在儿童时期具有独特的特点。他们的管理必须是多学科的、针对年龄的和综合的。需要进一步的纵向研究来更好地了解哮喘及其呼吸合并症之间的相互关系和协同效应,确定导致潜在哮喘预防的常见可治疗危险因素,实际和未来靶向治疗的有效性,以及长期呼吸合并症与肺功能不良轨迹之间的相关性。
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引用次数: 2
Identification and management of connective tissue disease-associated interstitial lung disease: evidence-based Japanese consensus statements. 结缔组织病相关间质性肺病的识别与管理:循证日本共识声明。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-02-20 DOI: 10.1080/17476348.2023.2176303
Masataka Kuwana, Masashi Bando, Yutaka Kawahito, Shinji Sato, Takafumi Suda, Yasuhiro Kondoh

Background: Interstitial lung disease (ILD) is a common complication of connective tissue diseases (CTD), but there are few clinical trials to guide disease management. We aimed to develop expert consensus statements and an algorithm for CTD-ILD management.

Research design and methods: Based on a targeted literature review, we developed 109 statements on managing CTD-ILD across six domains. We used a modified Delphi process to survey 22 physicians in Japan involved in managing CTD-ILD (specialists in pulmonology, rheumatology, pathology, and radiology). These panelists participated in two rounds of web-based survey to establish consensus statements, which were used to define an algorithm. Consensus was defined as a mean value ≥70 on a scale of 0 (strong disagreement) to 100 (strong agreement).

Results: Between May-August 2022, consensus was reached on 93 statements on CTD-ILD management. The most important consensus statements included screening CTD patients for ILD (typically with high-resolution computed tomography), using imaging, pulmonary function testing and serum biomarkers for diagnosis and severity assessment, regularly following up patients, and multidisciplinary management of CTD-ILD. Consensus statements were interpreted into an algorithm for clinical guidance.

Conclusions: Using the Delphi process, we have developed consensus statements and an algorithm to guide clinical decision-making for CTD-ILD.

背景:间质性肺病(ILD)是结缔组织病(CTD)的常见并发症,但指导疾病管理的临床试验却很少。我们旨在制定专家共识声明和 CTD-ILD 管理算法:根据有针对性的文献综述,我们制定了 109 份关于 CTD-ILD 管理的声明,涉及六个领域。我们采用改良德尔菲法对日本 22 名参与 CTD-ILD 管理的医生(肺病学、风湿病学、病理学和放射学专家)进行了调查。这些专家小组成员参加了两轮网络调查,以确定共识声明,并用于定义算法。共识的定义是,在0(非常不同意)到100(非常同意)的范围内,平均值≥70:结果:2022 年 5 月至 8 月间,就 93 项 CTD-ILD 管理声明达成了共识。最重要的共识包括对 CTD 患者进行 ILD 筛查(通常使用高分辨率计算机断层扫描),使用影像学、肺功能检测和血清生物标志物进行诊断和严重程度评估,定期随访患者,以及 CTD-ILD 的多学科管理。共识声明被解释为一种用于临床指导的算法:通过德尔菲法,我们制定了共识声明和算法,用于指导 CTD-ILD 的临床决策。
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引用次数: 0
Pulmonary recovery after COVID-19 - a review. 新冠肺炎后的肺部恢复-综述。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-07-14 DOI: 10.1080/17476348.2023.2210837
Thomas Sonnweber, Sailer Birgit, Günter Weiss, Judith Löffler-Ragg

Introduction: COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). As the respiratory tract is the primary site of infection and host-mediated inflammatory responses, pathologies and dysfunction of the respiratory system characterize the severe disease and are typically associated with the need for oxygen supply or even ventilator support. In survivors of severe COVID-19, computed tomography follow-up frequently reveals structural lung abnormalities, and one-third of individuals who were hospitalized during acute COVID-19 demonstrate persisting lung abnormalities for at least 12 months after disease onset.

Areas covered: This review summarizes current evidence on pulmonary recovery after COVID-19, focusing on adult patients who suffered from COVID-19 pneumonia.

Expert opinion: Severe COVID-19 is associated with a high frequency of persisting lung abnormalities at follow-up. The long-term consequences of these findings remain elusive and urge further evaluation to identify individuals at risk for COVID-19 long-term consequences.

简介:新冠肺炎是由感染严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的。由于呼吸道是感染和宿主介导的炎症反应的主要部位,呼吸系统的病理和功能障碍是严重疾病的特征,通常与氧气供应甚至呼吸机支持的需要有关。在严重新冠肺炎的幸存者中,计算机断层扫描随访经常显示肺部结构异常,三分之一在急性新冠肺炎期间住院的患者表现出至少12年的持续肺部异常 发病数月后。涵盖的领域:本综述总结了新冠肺炎后肺部恢复的最新证据,重点关注患有新冠肺炎肺炎的成年患者。专家意见:严重的新冠肺炎与随访中持续肺部异常的高频率相关。这些发现的长期后果仍然难以捉摸,并敦促进一步评估,以确定有新冠肺炎长期后果风险的个人。
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引用次数: 0
Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management. 老年哮喘患者的诊断和治疗方法:多学科和多层面管理的重要性。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-05-18 DOI: 10.1080/17476348.2023.2215432
Alida Benfante, Alessandra Tomasello, Enrico Gianquinto, Maria Noemi Cicero, Nicola Scichilone

Introduction: Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management.

Areas covered: The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease.

Expert opinion: The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.

引言:哮喘通常被认为是一种年轻人的疾病;然而,在老年人中诊断这种疾病并不罕见。尽管目前的建议在诊断和治疗方法方面没有区分年轻和老年哮喘患者,但老年哮喘可能表现出特殊的特征,导致其管理复杂化。涵盖的领域:目前的综述重点关注在接近疑似哮喘的老年人时出现的挑战。与年龄相关的肺部变化可能会使诊断方法复杂化。前6秒用力呼气量(FEV6)的测量是FVC估计的一种更简单、更快的替代方法,应始终评估残余量。老年人经常受到伴随疾病的影响,包括年龄和药物相关疾病,在治疗老年哮喘时需要考虑这些疾病,因为它们会影响治疗效果和疾病控制。专家意见:应定期调查潜在的药物间相互作用,并将其记录在医疗记录中。应探讨衰老对老年哮喘患者药物治疗反应的影响。因此,强烈鼓励对老年哮喘患者采取多学科和多层面的治疗方法。
{"title":"Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management.","authors":"Alida Benfante,&nbsp;Alessandra Tomasello,&nbsp;Enrico Gianquinto,&nbsp;Maria Noemi Cicero,&nbsp;Nicola Scichilone","doi":"10.1080/17476348.2023.2215432","DOIUrl":"10.1080/17476348.2023.2215432","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management.</p><p><strong>Areas covered: </strong>The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease.</p><p><strong>Expert opinion: </strong>The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel Consensus. 神经肌肉疾病的间歇性腹压通气管理:德尔菲小组共识。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-21 DOI: 10.1080/17476348.2023.2226391
Anna Annunziata, Paola Pierucci, Paolo Innocente Banfi, Annalisa Carlucci, Antonietta Coppola, Fabrizio Rao, Matteo Schisano, Francesca Simioli, Claudia Crimi, Antonio M Esquinas, Zuhal Karakurt, Alessio Mattei, Antonella Marotta, John R Bach, Giuseppe Fiorentino

Background: Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD.

Method: A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders.

Results: In the first round, 34 statements were circulated. Panel members marked 'agree' or 'disagree' for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements.

Conclusions: Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV.

背景:间歇性腹压通气机(IAPV)于20世纪30年代开始用于肌营养不良患者的通气辅助。后来,该装置被完善并扩展用于其他神经肌肉疾病(NMD)。近年来,气管切开术和气管插管相关的发病率和死亡率重新引起了人们对IAPV的兴趣。然而,没有关于其使用的指导方针。本研究旨在在参与其实践的医生中建立共识,为NMD患者的治疗提供IAPV建议。方法:采用三步改进德尔菲法建立共识。14名呼吸科医生和一名在IAPV使用方面有丰富经验和/或发表过该主题手稿的精神病学家参加了小组讨论。根据PRISMA对文献进行了系统回顾,以确定神经肌肉疾病患者IAPV的现有证据。结果:在第一轮会议上,分发了34份声明。小组成员对每一项发言都标明“同意”或“不同意”,并提供了意见。该协议是在对所有34项发言进行第二次投票后达成的。结论:小组成员一致同意,并对IAPV适应症、参数设置(包括手术方案)、潜在局限性、禁忌症、并发症、监测和随访进行了描述。这是首次就IAPV达成专家共识。
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引用次数: 0
Advantages and drawbacks of helmet noninvasive support in acute respiratory failure. 头盔无创支持在急性呼吸衰竭中的优缺点。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2174974
Filippo Bongiovanni, Teresa Michi, Daniele Natalini, Domenico L Grieco, Massimo Antonelli
ABSTRACT Introduction Non-invasive ventilation (NIV) represents an effective strategy for managing acute respiratory failure. Facemask NIV is strongly recommended in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnia and acute cardiogenic pulmonary edema (ACPE). Its role in managing acute hypoxemic respiratory failure (AHRF) remains a debated issue. NIV and continuous positive airway pressure (CPAP) delivered through the helmet are recently receiving growing interest for AHRF management. Areas covered In this narrative review, we discuss the clinical applications of helmet support compared to the other available noninvasive strategies in the different phenotypes of acute respiratory failure. Expert opinion Helmets enable the use of high positive end-expiratory pressure, which may protect from self-inflicted lung injury: in AHRF, the possible superiority of helmet support over other noninvasive strategies in terms of clinical outcome has been hypothesized in a network metanalysis and a randomized trial, but has not been confirmed by other investigations and warrants confirmation. In AECOPD patients, helmet efficacy may be inferior to that of face masks, and its use prompts caution due to the risk of CO2 rebreathing. Helmet support can be safely applied in hypoxemic patients with ACPE, with no advantages over facemasks.
无创通气(NIV)是治疗急性呼吸衰竭的有效策略。口罩NIV强烈推荐用于慢性阻塞性肺疾病(AECOPD)急性加重伴高碳酸血症和急性心源性肺水肿(ACPE)。它在治疗急性低氧性呼吸衰竭(AHRF)中的作用仍然是一个有争议的问题。最近,通过头盔输送的NIV和持续气道正压通气(CPAP)越来越受到AHRF管理的关注。涉及领域:在这篇叙述性综述中,我们讨论了头盔支持与其他可用的无创策略在不同表型急性呼吸衰竭中的临床应用。专家意见:头盔可以使用高呼气末正压,这可以保护自己免受肺损伤:在AHRF中,头盔支持在临床结果方面可能优于其他非侵入性策略,这已经在一项网络meta分析和一项随机试验中得到了假设,但尚未得到其他调查的证实,需要确认。在AECOPD患者中,头盔的效果可能不如口罩,并且由于有二氧化碳再呼吸的风险,使用时应谨慎。头盔支持可以安全地应用于低氧血症ACPE患者,与面罩相比没有优势。
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引用次数: 2
Criteria to evaluate efficacy of biologics in asthma: a Global Asthma Association survey. 评估生物制剂治疗哮喘疗效的标准:全球哮喘协会调查。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-26 DOI: 10.1080/17476348.2023.2223986
Angelica Tiotiu, Andras Bikov, Francisco-Javier Gonzalez-Barcala, Sylvia Novakova, Plamena Novakova, Chong-Neto Herberto, Santus Pierachille, Ansotegui Ignacio, Ivancevich Juan Carlos, Kowal Krzysztof, Mihaicuta Stefan, Nedeva Denislava, Canonica Giorgio Walter, Bernstein Jonathan, Boulet Louis Philippe, Braido Fulvio

Background: Currently, there are no universally accepted criteria to measure the response to biologics available as treatment for severe asthma. This survey aims to establish consensus criteria to use for the evaluation of response to biologics after 4 months of treatment.

Method: Using Delphi methodology, a questionnaire including 10 items was validated by 13 international experts in asthma. The electronic survey circulated within the Interasma Scientific Network platform. For each item, five answers were proposed graduated from 'no importance' to 'very high importance' and by a score (A = 2 points; B = 4 points; C = 6 points; D = 8 points; E = 10 points). The final criteria were selected if the median score for the item was ≥7 and > 60% of responses according 'high importance' and 'very high importance'. All selected criteria were validated by the experts.

Results: Four criteria were identified: reduce daily systemic corticosteroids dose by ≥50%; decrease the number of asthma exacerbations requiring systemic corticosteroids by ≥50%; have no/minimal side effects; and obtain asthma control according validated questionnaires. The consensual decision was that ≥3 criteria define a good response to biologics.

Conclusions: Specific criteria were defined by an international panel of experts and could be used as tool in clinical practice.

背景:目前,还没有公认的标准来衡量对可用于治疗严重哮喘的生物制剂的反应。本调查旨在建立共识标准,用于评估治疗4个月后对生物制品的反应。方法:采用德尔菲法,由13位国际哮喘专家对10个项目的问卷进行验证。电子调查在内部科学网络平台内分发。对于每个项目,提出了五个答案,从“不重要”到“非常重要”,并以分数(a = 2分;B = 4分;C = 6分;D = 8分;E = 10分)。如果项目的中位得分为 ≥7和 > 60%的回答符合“高度重要性”和“非常高度重要性”。所有选定的标准都经过了专家的验证。结果:确定了四个标准:通过 ≥50%;通过 ≥50%;无副作用/最小副作用;并根据经验证的问卷获得哮喘控制。双方同意的决定是 ≥3个标准定义了对生物制剂的良好反应。结论:具体标准由国际专家小组确定,可作为临床实践的工具。
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引用次数: 0
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS? 针对不同ARDS表型的个性化药物治疗:ARDS药物治疗的未来?
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2176302
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin

Introduction: Acute respiratory distress syndrome (ARDS) still represents a major challenge with high mortality rates and altered quality of life. Many well-designed studies have failed to improve ARDS outcomes. Heterogeneity of etiologies, mechanisms of lung damage, different lung mechanics, and different treatment approaches may explain these failures. At the era of personalized medicine, ARDS phenotyping is not only a field of research, but a bedside consideration when implementing therapy. ARDS has moved from being a simple syndrome to a more complex area of subgrouping. Intensivists must understand these phenotypes and therapies associated with a better outcome.

Areas covered: After a brief sum-up of the different type of ARDS phenotypes, we will present some relevant therapy that may be impacted by phenotyping. A focus on pharmacotherapy will be realized before a section on non-pharmaceutical strategies. Eventually, we will highlight the limits of our knowledge of phenotyping and the pitfalls of personalized medicine.

Expert opinion: Biological and morphological ARDS phenotypes are now well studied. The future of ARDS therapy will go through phenotyping that allows a personalized medication for each patient. However, a better assessment of these phenotypes is required, and clinical trials should be conducted with an ad-hoc phenotyping before randomization.

简介:急性呼吸窘迫综合征(ARDS)仍然是一个具有高死亡率和生活质量改变的主要挑战。许多精心设计的研究未能改善ARDS的结果。病因的异质性、肺损伤机制、不同的肺力学和不同的治疗方法可能解释这些失败。在个性化医疗时代,ARDS表型不仅是一个研究领域,而且是实施治疗时的床边考虑因素。ARDS已经从一个简单的综合征转变为一个更复杂的亚组领域。强化医生必须了解这些表型和治疗与更好的结果相关。涵盖领域:在简要总结了不同类型的ARDS表型后,我们将介绍一些可能受表型影响的相关治疗。在非药物策略部分之前,将重点介绍药物治疗。最后,我们将强调我们对表型的知识的局限性和个性化医疗的陷阱。专家意见:目前对ARDS的生物学和形态学表型进行了很好的研究。未来的ARDS治疗将通过表型分析,为每个患者提供个性化的药物治疗。然而,需要对这些表型进行更好的评估,并且在随机化之前应该使用特设表型进行临床试验。
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引用次数: 1
期刊
Expert Review of Respiratory Medicine
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