Targeted therapy of bronchial asthma in children: clinical experience
D.F. Sergienko (1), A.A. Shilova (1), N.A. Ilyenkova (2)
1) Astrakhan State Medical University, Department of Faculty Pediatrics, Astrakhan, Russia;
2) Krasnoyarsk State Medical University n.a. Prof. V.F. Voino-Yasenetsky, Department of Childhood Diseases with Course of Postgraduate Education, Krasnoyarsk, Russia
Background. Despite significant progress in studying the pathogenesis of bronchial asthma (BA), the emergence of knowledge about the disease phenotypes and the development of new pharmacological drugs with the formation of a personalized approach to the therapy, there is a steady trend towards an increase in patients with an uncontrolled course of the disease. According to the guidelines (GINA 2019), in order to achieve control in patients with moderate and severe asthma in the absence of effectiveness of medium-to-high dose of inhaled glucocorticosteroids (IGCS) in combination with long-acting β2-agonists and/or antileukotriene drugs, the inclusion of genetically engineered anti-IgE drug omalizumab is recommended.
Objective. Evaluation of the effectiveness of the use of the genetically engineered drug omalizumab in baseline therapy in children with moderate and severe BA in the city of Astrakhan
Methods. The study included 14 patients aged 6 to 17 years (mean age 10.8±2.1 years) with BA who were treated with genetically engineered drug omalizumab in baseline therapy. The study was carried out on the basis of an analysis of medical records and a survey of patients and their parents according to the developed questionnaire. The questionnaire consisted of three blocks of questions.
Results. The data obtained indicate that 69.2% of patients achieved stable disease control the in the form of the absence of both nocturnal and daytime asthma attacks (for several months to year), satisfactory exercise tolerance and low demand for short-acting β2-agonists. In 30.8% of patients, partial disease control was observed, which was expressed in the persistence of mild daytime and nocturnal symptoms 1–2 times per month. The disease control was reflected by indicators of the ACT test, which ranged from 18 to 25 points in all patients. Against the background of treatment with omalizumab, a decrease in the volume of baseline anti-inflammatory therapy in the form of a reduction in the dose of IGCS due to long-term drug remission and a high level of disease control was performed in 11 patients (84.6%). The following local and general adverse reactions were noted against the background of use of omalizumab: mild headache and dizziness, mild hyperemia and edema at the injection site.
Conclusion. The results of study proved that the use of recombinant humanized monoclonal antibody omalizumab as part of the baseline anti-inflammatory therapy for moderate and severe BA leads to significant decrease in the frequency of exacerbations and the number of emergency calls for medical care, allows to reduce the dose of IGCS, to increase the parameters of pulmonary function, which characterizes achieving asthma control and improving the quality of life of patients.
Keywords: bronchial asthma, children, omalizumab
About the Autors
Corresponding author: Diana F. Sergienko, Dr. Sci. (Med.), Professor, Department of Faculty Pediatrics, Astrakhan State Medical University, Astrakhan, Russia; email@example.com
Address: 121 Bakinskaya St., Astrakhan 414000, Russian Federation