Asma grave de endótipo misto com resposta a
tezepelumabe: relato de caso de um adolescente

Gabriela Spessatto; Aline Didoni Fajardo; Juliana Gonçalves Primon; Thalita Gonçalves Picciani; Guilherme da Silva Martins; Bruno Hernandes David João; Larissa Machado Carvalho; Angelica Fonseca Noriega; Maitê Milagres Saab; Tayna Padilha Miranda; Cristine Secco Rosário; Laura Maria Lacerda Araujo; Carlos Antônio Riedi; Roberta Corrêa da Cunha; Denise Eli; Débora Carla Chong Silva; Herberto J. Chong-Neto; Nelson Augusto Rosário Filho

doi:10.5935/2526-5393.20230089

Clinical and Experimental Communication

Asma grave de endótipo misto com resposta a tezepelumabe: relato de caso de um adolescente

Severe mixed-endotype asthma responsive to tezepelumab: a case report of an adolescent

Gabriela Spessatto; Aline Didoni Fajardo; Juliana Gonçalves Primon; Thalita Gonçalves Picciani; Guilherme da Silva Martins; Bruno Hernandes David João; Larissa Machado Carvalho; Angelica Fonseca Noriega; Maitê Milagres Saab; Tayna Padilha Miranda; Cristine Secco Rosário; Laura Maria Lacerda Araujo; Carlos Antônio Riedi; Roberta Corrêa da Cunha; Denise Eli; Débora Carla Chong Silva; Herberto J. Chong-Neto; Nelson Augusto Rosário Filho

http://dx.doi.org/10.5935/2526-5393.20230089 Arq Asma Alerg Imunol, vol.8, n2, p.156-161, 2024

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Resumo

A maioria das crianças e adolescentes com asma grave apresenta fenótipo de inflamação eosinofílica, com risco de exacerbações, uso de corticosteroides sistêmicos e redução na qualidade de vida. Crianças com inflamação tipo 2 respondem bem aos tratamentos convencionais, no entanto, há um grupo pequeno que falha na resposta terapêutica habitual e necessita medicamentos adicionais, como imunobiológicos, para o controle da doença. O conhecimento da fisiopatologia da inflamação brônquica e a avaliação de seus biomarcadores é fundamental para escolha adequada do imunobiológico. Relatamos o caso de um paciente de 13 anos, com asma grave do tipo 2 alérgico, sem indicação de omalizumabe, e que em uso de mepolizumabe não apresentou controle da doença depois de 12 meses de tratamento. A avaliação do endótipo com citologia de escarro identificou fenótipo inflamatório misto, direcionando a substituição por outro imunobiológico, o tezepelumabe, atingindo o controle das exacerbações, por provável redução da hiper-responsividade brônquica. A avaliação do endótipo da asma com os biomaracadores disponíveis permitiu um tratamento preciso e individualizado para o paciente.

Palavras-chave

Asma grave, hiper-responsividade brônquica, Inflamação tipo 2, linfopoietina do estroma tímico.

Abstract

Most children and adolescents with severe asthma have an eosinophilic inflammatory phenotype and are at risk of exacerbations, systemic corticosteroid use, and reduced quality of life. Children with type 2 inflammation respond well to conventional treatment; however, there is a small group that is unresponsive to conventional therapy and requires additional medication for disease control, such as immunobiologic agents. Knowledge of the pathophysiology of bronchial inflammation and biomarker assessment are essential for the appropriate choice of an immunobiologic agent. We report the case of a 13-year-old patient with severe type 2 allergic asthma, with no indication for omalizumab, who did not respond to mepolizumab after 12 months of treatment. The sputum cytology identified a mixed inflammatory endotype that led to replacement with another immunobiologic agent, tezepelumab, achieving control of exacerbations by probable reduction in bronchial hyperresponsiveness. Assessment of asthma endotype with the available biomarkers allowed precise and personalized treatment for this patient.

Keywords

Severe asthma, bronchial hyperresponsiveness, type 2 inflammation, thymic stromal lymphopoietin.

References

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Submitted date:
05/15/2024

Accepted date:
05/23/2024