Прямое сравнительное исследование эффективности меполизумаба и дупилумаба у пациентов с тяжелой неаллергической эозинофильной бронхиальной астмой

Введение. Генно-инженерные биологические препараты (ГИБП) для лечения тяжелой бронхиальной астмы (ТБА) достаточно широко используются в реальной клинической практике. Но прямых сравнительных исследований на данный момент крайне мало.

Цель. Сравнить эффективность меполизумаба и дупилумаба у пациентов с неаллергической эозинофильной ТБА в реальной клинической практике на примере территориального регистра Свердловской области.

Материалы и методы. Проанализированы данные пациентов с неаллергической эозинофильной ТБА, получавших дупилумаб (n = 23) и меполизумаб (n = 19). Определялась эффективность терапии по системе BARS и доле пациентов, достигших ремиссии ТБА, динамике АСТ-теста, опроснику AQLQ, уровню ОФВ₁, эозинофилов крови, кратности применения короткодействующих бронходилататоров (КДБД) и потребности в системных глюкокортикостероидах (СГКС), частоте обострений БА и госпитализаций.

Результаты. За 12 месяцев таргетной терапии хороший ответ на терапию по BARS выявлен у 77,8% пациентов на дупилумабе и у 82,4% пациентов на меполизумабе (р = 1,000). Ремиссии ТБА без учета ОФВ₁ достигли 62,5% пациентов группы дупилумаба и 68,8% пациентов группы меполизумаба (р = 1,000). Ремиссия ТБА с учетом ОФВ₁ достигнута у 43,8% пациентов на дупилумабе и у 56,2% пациентов на меполизумабе (р = 0,724). По всем отдельно анализируемым показателям установлены статистически значимые улучшения в каждой группе наблюдения. Статистически значимые различия через год терапии между группами зарегистрированы по уровню эозинофилов (р < 0,001) и по назальным симптомам, оцененным с помощью опросника SNOT-22 (р = 0,048) в пользу меполизумаба.

Выводы. Пациенты с неаллергической эозинофильной ТБА одинаково хорошо отвечают на терапию дупилумабом и меполизумабом. Препараты в равной степени улучшают контроль над заболеванием, качество жизни, уменьшают потребность в КДБД и СГКС, показывают сходный уровень безопасности.

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