Targeted therapy for asthma: from theory to clinical practice

The aim of the study was to evaluate the possibility of reducing doses of systemic glucocorticosteroids in patients with severe bronchial asthma receiving standard stage V therapy in combination with genetically engineered biological therapy.
Methods and materials. An open observational, single-center prospective study was conducted in the conditions of the pulmonary allergy center of the KKB Krasnoyarsk, which included 66 patients with severe bronchial asthma. Among the studied patients, women were found in 75% (46 people), men in 25% (17 people) of cases; the average age was 55 [48; 62] years, the duration of the disease was 21 [14.5; 34] years, and the age of onset corresponded to 34 [30.5; 50] years. The duration of treatment with the immunobiological drug Dupilumab was 4 years in 6 (9%) patients, 3 years in 13 (20%) patients, 28 (42%) patients received genetically engineered biological therapy for 2 years, and 19 (29%) patients had an allergic phenotype of asthma for 12 months. 49 (74%) patients, non-allergic phenotype was determined in 17 (26%) patients.
Results. At the time of the appointment of genetically engineered therapy, all patients had daily ASTHMA symptoms, which ensured a regular need for CDBA. Clinical symptoms were objectified by the AST and ACQ-5 tests, the results of which also confirmed the absence of AD control (Median ACQ-5 – 3 points, AST-test – 15 points). After 12 months of additional therapy, the number of seizures and the need for short-term medications decreased (p<0.005). When studying the functional parameters, a significant increase in the FEV1 index and the FEV1/FVC ratio was noted against the background of 12 months of Dupilumab therapy, it is worth noting that the increase in FEV1 was 390 ml. When assessing the volume of basic therapy, it was determined that all respondents received high-dose ICS/DDBA therapy. Additional therapy with Tiotropium bromide was detected in 34% of patients, and antileukotriene drugs were used in 21% of patients. 12 people registered regular intake of SGCS. Against the background of immunobiological therapy with Dupilumab, it was possible to reduce the volume of basic therapy: DDAX to 14% and antileukotriene drugs to 14%. Complete withdrawal from the use of OCS was achieved in 9 patients. After 12 months of therapy, 3 patients took 2.5 mg of prednisone daily.

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