BACKGROUND Atopic dermatitis and asthma are two diseases whose pathogenesis is largely attributable to the activation,at least in the initial stages,of T helper(Th)-2 Lymphocytes,the related cytokine axis,and B lympho...BACKGROUND Atopic dermatitis and asthma are two diseases whose pathogenesis is largely attributable to the activation,at least in the initial stages,of T helper(Th)-2 Lymphocytes,the related cytokine axis,and B lymphocytes with antibody production.Psoriasis is conversely a pathology resulting from a recruitment of Th-17 and Th-1 lymphocytes,after an initial role of innate immunity.Mepolizumab is a humanized monoclonal antibody directed against interleukin(IL)-5,a central cytokine in the Th-2 axis,therefore involved in the pathogenesis of asthma.Several authors have described the appearance of psoriatic lesions in patients with asthma or atopic dermatitis following the therapy with dupilumab,a monoclonal antibody that blocks the interleukin(IL)-4,another Th-2 cytokine.CASE SUMMARY We present the case of a 59-year-old patient who developed psoriasiform lesions on the palms after mepolizumab therapy for asthma,for the activation of the parallel cytokine cascade after the blockade of IL-5.We successfully treated the patient with a topical calcipotriol and betamethasone ointment.CONCLUSION We should investigate with further attention the possible impact on the human immunological ecosystem put in place by the inhibition of the activity of individual inflammatory mediators,so as to be able to recognize the initial adverse effects early.展开更多
目的评估美泊利珠单抗治疗难治性慢性鼻窦炎伴鼻息肉的有效性、安全性及经济性,为临床合理用药提供依据。方法采用快速卫生技术评估,检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、WanFang Data、VIP、SinoMed数据库及...目的评估美泊利珠单抗治疗难治性慢性鼻窦炎伴鼻息肉的有效性、安全性及经济性,为临床合理用药提供依据。方法采用快速卫生技术评估,检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、WanFang Data、VIP、SinoMed数据库及国外卫生技术评估(HTA)机构官网,搜集美泊利珠单抗治疗难治性慢性鼻窦炎伴鼻息肉的HTA报告、系统评价/Meta分析及药物经济学研究文献,检索时限均从建库至2025年7月1日,经资料提取与质量评价后,对纳入研究的结果进行描述性分析。结果最终纳入11篇文献,包括1篇HTA报告、8篇系统评价/Meta分析及2篇药物经济学研究。有效性方面,与安慰剂相比,美泊利珠单抗可显著改善鼻息肉评分、影像学评分、嗅觉功能及生活质量;与其他生物制剂相比,美泊利珠单抗的鼻息肉评分改善效果最优,嗅觉功能改善效果次于度普利尤单抗,而生活质量评估结果并不统一。安全性方面,美泊利珠单抗的不良反应和严重不良反应发生率,与安慰剂及其他生物制剂相比差异均无统计学意义。经济性方面,美泊利珠单抗相较于其他生物制剂不具有经济性优势。结论美泊利珠单抗展现出良好的有效性和安全性,可为难治性慢性鼻窦炎伴鼻息肉患者治疗提供新的选择,但其经济性仍需基于我国医疗环境进一步研究。展开更多
BACKGROUND Eosinophilic granulomatosis polyangiitis(EGPA)is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma;however,it can rarely manifest with cardiac involvement su...BACKGROUND Eosinophilic granulomatosis polyangiitis(EGPA)is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma;however,it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade.Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare.Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.CASE SUMMARY 52-year-old woman with no past medical history presented with progressive dyspnea and dry cough.On physical exam she had a pericardial friction rub and bilateral rales.Vital signs were notable for tachycardia at 119 beats per minute and hypoxia with 89%oxygen saturation.On laboratory exam,she had 45%peripheral eosinophilia,troponin elevation of 1.1 ng/mL and N-terminal prohormone of brain natriuretic peptide of 2101 pg/mL.TTE confirmed a large pericardial effusion and tamponade physiology.She underwent urgent pericardial window procedure.Pericardial and lung biopsy demonstrated eosinophilic infiltration.Based on the American College of Radiology guidelines,the patient was diagnosed with EGPA which manifested in its rare form of cardiac tamponade.She was treated with steroid taper and mepolizumab.CONCLUSION This case highlights that when isolated pericardial involvement occurs in EGPA,diagnosis is recognized by performing pericardial biopsy demonstrating histopathologic evidence of eosinophilic infiltration.展开更多
目的系统评价美泊利单抗治疗嗜酸性粒细胞性哮喘的疗效与安全性。方法计算机检索PubMed、Embase、ISI Web of Science、Cochrane CENTRAL、MEDLINE、VIP、CNKI等数据库,收集美泊利单抗治疗嗜酸性粒细胞性哮喘的随机对照试验(RCT),检索...目的系统评价美泊利单抗治疗嗜酸性粒细胞性哮喘的疗效与安全性。方法计算机检索PubMed、Embase、ISI Web of Science、Cochrane CENTRAL、MEDLINE、VIP、CNKI等数据库,收集美泊利单抗治疗嗜酸性粒细胞性哮喘的随机对照试验(RCT),检索时限均为从建库至2016年10月,并追溯纳入研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入了9个RCT,2 273例患者。Meta分析结果显示,与对照组比较,试验组治疗期间哮喘急性发作率降低[RR=0.67,95%CI(0.53,0.85),P=0.000 9],血液中嗜酸性粒细胞计数明显减少[MD=–0.22,95%CI(–0.29,–0.15),P<0.000 01],痰中嗜酸性粒细胞计数明显减少[MD=–6.37,95%CI(–9.68,–3.06),P<0.000 2],哮喘相关生活质量(ACQ)总分提高的患者比例也明显增加。两组间总不良反应发生率相似[RR=0.90,95%CI(0.71,1.14),P=0.39];严重不良反应发生率方面,美泊利单抗优于安慰剂[RR=0.45,95%CI(0.23,0.89),P=0.02];总心血管事件发生率方面,美泊利单抗与安慰剂治疗相当[RR=0.95,95%CI(0.40,2.22),P=0.90]。对于能否改善肺功能,美泊利单抗可能有一定作用,但目前观察到的效果不明显。结论美泊利单抗在哮喘治疗中可降低哮喘患者血液及痰中嗜酸性粒细胞数,减轻哮喘患者急性发作率,提高生活质量,且有较好的安全性。展开更多
文摘BACKGROUND Atopic dermatitis and asthma are two diseases whose pathogenesis is largely attributable to the activation,at least in the initial stages,of T helper(Th)-2 Lymphocytes,the related cytokine axis,and B lymphocytes with antibody production.Psoriasis is conversely a pathology resulting from a recruitment of Th-17 and Th-1 lymphocytes,after an initial role of innate immunity.Mepolizumab is a humanized monoclonal antibody directed against interleukin(IL)-5,a central cytokine in the Th-2 axis,therefore involved in the pathogenesis of asthma.Several authors have described the appearance of psoriatic lesions in patients with asthma or atopic dermatitis following the therapy with dupilumab,a monoclonal antibody that blocks the interleukin(IL)-4,another Th-2 cytokine.CASE SUMMARY We present the case of a 59-year-old patient who developed psoriasiform lesions on the palms after mepolizumab therapy for asthma,for the activation of the parallel cytokine cascade after the blockade of IL-5.We successfully treated the patient with a topical calcipotriol and betamethasone ointment.CONCLUSION We should investigate with further attention the possible impact on the human immunological ecosystem put in place by the inhibition of the activity of individual inflammatory mediators,so as to be able to recognize the initial adverse effects early.
文摘目的评估美泊利珠单抗治疗难治性慢性鼻窦炎伴鼻息肉的有效性、安全性及经济性,为临床合理用药提供依据。方法采用快速卫生技术评估,检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、WanFang Data、VIP、SinoMed数据库及国外卫生技术评估(HTA)机构官网,搜集美泊利珠单抗治疗难治性慢性鼻窦炎伴鼻息肉的HTA报告、系统评价/Meta分析及药物经济学研究文献,检索时限均从建库至2025年7月1日,经资料提取与质量评价后,对纳入研究的结果进行描述性分析。结果最终纳入11篇文献,包括1篇HTA报告、8篇系统评价/Meta分析及2篇药物经济学研究。有效性方面,与安慰剂相比,美泊利珠单抗可显著改善鼻息肉评分、影像学评分、嗅觉功能及生活质量;与其他生物制剂相比,美泊利珠单抗的鼻息肉评分改善效果最优,嗅觉功能改善效果次于度普利尤单抗,而生活质量评估结果并不统一。安全性方面,美泊利珠单抗的不良反应和严重不良反应发生率,与安慰剂及其他生物制剂相比差异均无统计学意义。经济性方面,美泊利珠单抗相较于其他生物制剂不具有经济性优势。结论美泊利珠单抗展现出良好的有效性和安全性,可为难治性慢性鼻窦炎伴鼻息肉患者治疗提供新的选择,但其经济性仍需基于我国医疗环境进一步研究。
文摘BACKGROUND Eosinophilic granulomatosis polyangiitis(EGPA)is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma;however,it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade.Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare.Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.CASE SUMMARY 52-year-old woman with no past medical history presented with progressive dyspnea and dry cough.On physical exam she had a pericardial friction rub and bilateral rales.Vital signs were notable for tachycardia at 119 beats per minute and hypoxia with 89%oxygen saturation.On laboratory exam,she had 45%peripheral eosinophilia,troponin elevation of 1.1 ng/mL and N-terminal prohormone of brain natriuretic peptide of 2101 pg/mL.TTE confirmed a large pericardial effusion and tamponade physiology.She underwent urgent pericardial window procedure.Pericardial and lung biopsy demonstrated eosinophilic infiltration.Based on the American College of Radiology guidelines,the patient was diagnosed with EGPA which manifested in its rare form of cardiac tamponade.She was treated with steroid taper and mepolizumab.CONCLUSION This case highlights that when isolated pericardial involvement occurs in EGPA,diagnosis is recognized by performing pericardial biopsy demonstrating histopathologic evidence of eosinophilic infiltration.
文摘目的系统评价美泊利单抗治疗嗜酸性粒细胞性哮喘的疗效与安全性。方法计算机检索PubMed、Embase、ISI Web of Science、Cochrane CENTRAL、MEDLINE、VIP、CNKI等数据库,收集美泊利单抗治疗嗜酸性粒细胞性哮喘的随机对照试验(RCT),检索时限均为从建库至2016年10月,并追溯纳入研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入了9个RCT,2 273例患者。Meta分析结果显示,与对照组比较,试验组治疗期间哮喘急性发作率降低[RR=0.67,95%CI(0.53,0.85),P=0.000 9],血液中嗜酸性粒细胞计数明显减少[MD=–0.22,95%CI(–0.29,–0.15),P<0.000 01],痰中嗜酸性粒细胞计数明显减少[MD=–6.37,95%CI(–9.68,–3.06),P<0.000 2],哮喘相关生活质量(ACQ)总分提高的患者比例也明显增加。两组间总不良反应发生率相似[RR=0.90,95%CI(0.71,1.14),P=0.39];严重不良反应发生率方面,美泊利单抗优于安慰剂[RR=0.45,95%CI(0.23,0.89),P=0.02];总心血管事件发生率方面,美泊利单抗与安慰剂治疗相当[RR=0.95,95%CI(0.40,2.22),P=0.90]。对于能否改善肺功能,美泊利单抗可能有一定作用,但目前观察到的效果不明显。结论美泊利单抗在哮喘治疗中可降低哮喘患者血液及痰中嗜酸性粒细胞数,减轻哮喘患者急性发作率,提高生活质量,且有较好的安全性。
