Yıl: 2021 Cilt: 69 Sayı: 1 Sayfa Aralığı: 84 - 93 Metin Dili: Türkçe DOI: 10.5578/tt.20219910 İndeks Tarihi: 25-05-2022

ABPA’lı hastalarda biyolojik tedaviler

Öz:
Alerjik Bronkopulmoner Aspergillozis (ABPA); Aspergillus fumigatus’a karşı Tip 1 aşırı duyarlılığın neden olduğu tekrarlayan pulmoner opasiteler ve bronşektazi ile karakterize bir akciğer hastalığıdır. Astım hastalığın önemli bir parçasıdır ve genelde ağır seyreder. Hastalığın patogenezinde A. fumigatus’a karşı immünoglobulinler, Th2 kaynaklı IL-4, IL-5 ve IL-13 gibi sitokinler ve eozinofilik inflamasyonun rol oynadığı düşünülmektedir. Patogenezde yer alan IL-4, IL-5, IL-13 ve IgE’yi hedef alan monoklonal antikorlar daha önce astımlı hastalarda kullanılmıştır. Alevlenmeler ve remisyonlarla seyreden ABPA’nın temel tedavisi oral kortikosteroidlerdir (OKS). Ancak kortikosteroid dozunun azaltılamadığı ya da yan etkisinin geliştiği durumlarda monoklonal antikorlar tedaviye eklenebilir. Buradan yola çıkarak tüm bu sitokin ve mediatörleri hedefleyen; omalizumab, mepolizumab, benralizumab ve dupilumab gibi monoklonal antikorlar ABPA’lı hastalarda uygulanmıştır. Omalizumab ile alevlenmelerde ve OKS gereksiniminde azalma, astım semptomlarında iyileşme ve solunum fonksiyon parametrelerinde düzelme gösterilmiştir. Mepolizumab ile OKS dozunda azalma, kan eozinofil sayısında azalma, klinik iyileşme ve radyolojik düzelme görülmüştür. Benralizumab ile eozinofil sayısında azalma hatta sıfırlanma, klinik ve radyolojik düzelme saptanmıştır. Dupilumab ile ise semptomlarda düzelme, OKS kesilmesi ancak tedavi başlangıcında eozinofil sayısında artış bildirilmiştir. Sonuç olarak ABPA’lı hastalarda monoklonal antikorlar genel olarak başarılı ve güvenli bulunmuştur.
Anahtar Kelime:

Biological Treatments in patients with ABPA

Öz:
Allergic Bronchopulmonary Aspergillosis (ABPA) is a pulmonary disease characterized by recurrent pulmonary opacities and bronchiectasis caused by Type 1 hypersensitivity to A. fumigatus. Asthma is an important part of the disease and is generally in severe form. It is thought that immunoglobulins against A. fumigatus, Th2-derived cytokines such as IL-4, IL-5 and IL-13 and eosinophilic inflammation play a role in the pathogenesis of the disease. Monoclonal antibody treatments targeting IL-4, IL-5, IL-13 and IgE, which are involved in pathogenesis, have been used in asthmatic patients before. The main treatment of ABPA for exacerbations and remissions is oral corticosteroids (OCS). However, in cases where the corticosteroid dose cannot be reduced or side effects develop, monoclonal agents may be added to the treatment. Monoclonal agents such as omalizumab, mepolizumab, benralizumab and dupilumab targeting cytokines involved to the patogenesis have been used in patients with ABPA. Omalizumab has shown a reduction in exacerbations and OCS requirements, improvement in asthma symptoms and improvement in pulmonary function parameters. With mepolizumab, a decrease in OCS dose, decrease in blood eosinophil count, clinical improvement and radiological improvement were observed. Benralizumab reduced, the number of eosinophil or even almost nullified as well as clinical recovery alongside with radiological improvement. With dupilumab, improvement in symptoms, discontinuation of OCS, but increase in eosinophil count at the beginning of treatment was reported. As a result, monoclonal antibodies were generally found to be successful and safe in patients with ABPA.
Anahtar Kelime:

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APA ERKOÇ M, aydin o, Bavbek S (2021). ABPA’lı hastalarda biyolojik tedaviler. , 84 - 93. 10.5578/tt.20219910
Chicago ERKOÇ Merve,aydin omur,Bavbek Sevim ABPA’lı hastalarda biyolojik tedaviler. (2021): 84 - 93. 10.5578/tt.20219910
MLA ERKOÇ Merve,aydin omur,Bavbek Sevim ABPA’lı hastalarda biyolojik tedaviler. , 2021, ss.84 - 93. 10.5578/tt.20219910
AMA ERKOÇ M,aydin o,Bavbek S ABPA’lı hastalarda biyolojik tedaviler. . 2021; 84 - 93. 10.5578/tt.20219910
Vancouver ERKOÇ M,aydin o,Bavbek S ABPA’lı hastalarda biyolojik tedaviler. . 2021; 84 - 93. 10.5578/tt.20219910
IEEE ERKOÇ M,aydin o,Bavbek S "ABPA’lı hastalarda biyolojik tedaviler." , ss.84 - 93, 2021. 10.5578/tt.20219910
ISNAD ERKOÇ, Merve vd. "ABPA’lı hastalarda biyolojik tedaviler". (2021), 84-93. https://doi.org/10.5578/tt.20219910
APA ERKOÇ M, aydin o, Bavbek S (2021). ABPA’lı hastalarda biyolojik tedaviler. Tüberküloz ve Toraks, 69(1), 84 - 93. 10.5578/tt.20219910
Chicago ERKOÇ Merve,aydin omur,Bavbek Sevim ABPA’lı hastalarda biyolojik tedaviler. Tüberküloz ve Toraks 69, no.1 (2021): 84 - 93. 10.5578/tt.20219910
MLA ERKOÇ Merve,aydin omur,Bavbek Sevim ABPA’lı hastalarda biyolojik tedaviler. Tüberküloz ve Toraks, vol.69, no.1, 2021, ss.84 - 93. 10.5578/tt.20219910
AMA ERKOÇ M,aydin o,Bavbek S ABPA’lı hastalarda biyolojik tedaviler. Tüberküloz ve Toraks. 2021; 69(1): 84 - 93. 10.5578/tt.20219910
Vancouver ERKOÇ M,aydin o,Bavbek S ABPA’lı hastalarda biyolojik tedaviler. Tüberküloz ve Toraks. 2021; 69(1): 84 - 93. 10.5578/tt.20219910
IEEE ERKOÇ M,aydin o,Bavbek S "ABPA’lı hastalarda biyolojik tedaviler." Tüberküloz ve Toraks, 69, ss.84 - 93, 2021. 10.5578/tt.20219910
ISNAD ERKOÇ, Merve vd. "ABPA’lı hastalarda biyolojik tedaviler". Tüberküloz ve Toraks 69/1 (2021), 84-93. https://doi.org/10.5578/tt.20219910