Abstract：
BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a biomarker of airway inflammation associated with airway hyper-responsiveness and type-2 inflammation. Its role in the management of severe asthmatic patients undergoing biologic treatment, as well as FeNO dynamics during biologic treatment, is largely unexplored.
OBJECTIVE: The aim was to evaluate published data contributing to the following areas: (1) FeNO as a predictive biomarker of response to biologic treatment; (2) the influence of biologic treatment in FeNO values; (3) FeNO as a biomarker for the prediction of exacerbations in patients treated with biologics.
METHODS: The systematic search was conducted on the Medline database through the Pubmed search engine, including all studies from 2009 to the present.
RESULTS: Higher baseline values of FeNO are associated with better clinical control in patients treated with omalizumab, dupilumab, and tezepelumab. FeNO dynamics during biologic treatment highlights a clear reduction in FeNO values in patients treated with anti-IL4/13 and anti-IL13, as well as in patients treated with tezepelumab. During the treatment, FeNO may help to predict clinical worsening and to differentiate eosinophilic from non-eosinophilic exacerbations.
CONCLUSIONS: Higher baseline FeNO levels appear to be associated with a greater benefit in terms of clinical control and reduction of exacerbation rate, while FeNO dynamics during biologic treatment remains a largely unexplored issue since few studies have investigated it as a primary outcome. FeNO remains detectable during biologic treatment, but its potential utility as a biomarker of clinical control is still unclear and represents an interesting research area to be developed.
OBJECTIVE: The aim was to evaluate published data contributing to the following areas: (1) FeNO as a predictive biomarker of response to biologic treatment; (2) the influence of biologic treatment in FeNO values; (3) FeNO as a biomarker for the prediction of exacerbations in patients treated with biologics.
METHODS: The systematic search was conducted on the Medline database through the Pubmed search engine, including all studies from 2009 to the present.
RESULTS: Higher baseline values of FeNO are associated with better clinical control in patients treated with omalizumab, dupilumab, and tezepelumab. FeNO dynamics during biologic treatment highlights a clear reduction in FeNO values in patients treated with anti-IL4/13 and anti-IL13, as well as in patients treated with tezepelumab. During the treatment, FeNO may help to predict clinical worsening and to differentiate eosinophilic from non-eosinophilic exacerbations.
CONCLUSIONS: Higher baseline FeNO levels appear to be associated with a greater benefit in terms of clinical control and reduction of exacerbation rate, while FeNO dynamics during biologic treatment remains a largely unexplored issue since few studies have investigated it as a primary outcome. FeNO remains detectable during biologic treatment, but its potential utility as a biomarker of clinical control is still unclear and represents an interesting research area to be developed.
摘要：
背景：呼出气一氧化氮（FeNO）是与气道高反应性和2型炎症相关的气道炎症的生物标志物。它在接受生物治疗的严重哮喘患者的管理中的作用，以及生物治疗过程中的FeNO动力学，基本上是未经探索的。
目的：目的是评估已发表的有助于以下领域的数据：（1）FeNO作为生物治疗反应的预测生物标志物；（2）生物治疗对FeNO值的影响；（3）FeNO作为生物标志物用于预测使用生物制剂治疗的患者的恶化。
方法：通过Pubmed搜索引擎在Medline数据库上进行了系统搜索，包括2009年至今的所有研究。
结果：在接受奥马珠单抗治疗的患者中，较高的FeNO基线值与更好的临床控制相关，dupilumab,和Tezepelumab.生物治疗期间的FeNO动力学突出显示用抗IL4/13和抗IL13治疗的患者以及用替齐单抗治疗的患者的FeNO值明显降低。在治疗过程中,FeNO可能有助于预测临床恶化和区分嗜酸性粒细胞和非嗜酸性粒细胞加重。
结论：较高的基线FeNO水平似乎在临床控制和降低加重率方面具有更大的益处。尽管生物治疗期间的FeNO动力学仍是一个尚未探索的问题，因为很少有研究将其作为主要结局进行调查。FeNO在生物治疗期间仍然可检测到，但其作为临床控制生物标志物的潜在效用仍不清楚，代表了一个有趣的研究领域有待开发。
目的：目的是评估已发表的有助于以下领域的数据：（1）FeNO作为生物治疗反应的预测生物标志物；（2）生物治疗对FeNO值的影响；（3）FeNO作为生物标志物用于预测使用生物制剂治疗的患者的恶化。
方法：通过Pubmed搜索引擎在Medline数据库上进行了系统搜索，
结果：在接受奥马珠单抗治疗的患者中，较高的FeNO基线值与更好的临床控制相关，
结论：较高的基线FeNO水平似乎在临床控制和降低加重率方面具有更大的益处。
