Şiddetli Astımda Yeni Tedavi Yaklaşımları ve Biyobelirteçler: Güncel Bir İnceleme

Öz

Bu çalışmanın amacı, şiddetli astımda biyolojik tedavilerin etkinliğini değerlendirmek ve hastalık yönetiminde kullanılan temel biyobelirteçlerin klinik karar verme sürecindeki rolünü ortaya koymaktır. 2015–2024 yılları arasında PubMed, Web of Science, Cochrane ve Google Scholar veri tabanlarında “severe asthma”, “biomarker”, “biologic therapy” anahtar kelimeleri kullanılarak taranan çalışmalar sistematik olarak incelendi. Tip 2 yüksek ve Tip 2 düşük astım alt tipleri; kullanılan biyobelirteçler (kan eozinofil sayısı, FeNO, periostin, IgE) ve uygulanan biyolojik tedaviler (omalizumab, mepolizumab, benralizumab, dupilumab, tezepelumab) klinik sonuçlara göre değerlendirildi. Literatür analizi, Tip 2 yüksek astımda biyobelirteçlerin tedavi yanıtını öngörmede güçlü belirteçler olduğunu göstermiştir. Özellikle yüksek eozinofil düzeyi ve artmış FeNO değerleri, IL-5 ve IL-4/IL-13 hedefli biyolojik ajanlara olumlu yanıt ile ilişkili bulundu. Tip 2 düşük astım hastalarında ise mevcut biyolojik tedavilere yanıt sınırlı olup, alarmin hedefli tedaviler (tezepelumab) ve azitromisin gibi alternatif yaklaşımlar öne çıkmıştır. Biyolojik tedaviler, şiddetli astım yönetiminde önemli bir ilerleme sağlamış olsa da, doğru tedavi seçimi için fenotip ve biyobelirteç temelli yaklaşım kritik öneme sahiptir. Tip 2 yüksek astımda biyobelirteçler tedavi yanıtını değerlendirmede etkili olurken, Tip 2 düşük astım için yeni hedeflere yönelik araştırmalara ihtiyaç duyulmaktadır. Kişiselleştirilmiş tedavi stratejilerinin geliştirilmesi, ileri dönem astım yönetiminin temelini oluşturacaktır.

Anahtar Kelimeler

• Şiddetli Astım
• Biyobelirteç
• Biyolojik Tedavi
• Tip 2 Yüksek Astım
• Tip 2 Düşük Astım
• Kişiselleştirilmiş Tıp.

New Treatment Approaches and Biomarkers in Severe Asthma: An Updated Review

Öz

This study aims to evaluate the effectiveness of biological treatments in severe asthma and to reveal the role of basic biomarkers used in disease management in the clinical decision-making process. A systematic review was conducted using the keywords "severe asthma," "biomarker," and "biologic therapy" in PubMed, Web of Science, Cochrane, and Google Scholar databases between 2015 and 2024. Type 2 high and Type 2 low asthma subtypes were evaluated based on the biomarkers used (blood eosinophil count, FeNO, periostin, and IgE), as well as the biological treatments applied (omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab), and their corresponding clinical outcomes. Literature analysis has shown that biomarkers are strong predictors of treatment response in patients with Type 2 asthma. In particular, high eosinophil counts and increased FeNO levels were associated with a favorable response to biologic agents targeting IL-5 and IL-4/IL-13. In patients with Type 2 low asthma, the response to existing biologic therapies is limited, and alternative approaches such as alarmin-targeted therapies (tezepelumab) and azithromycin have emerged. While biologic therapies have made significant progress in the management of severe asthma, a phenotype- and biomarker-based approach is critical for accurate treatment selection. While biomarkers are effective in assessing treatment response in Type 2 high asthma, research is needed to identify new targets for Type 2 low asthma. The development of personalized treatment strategies will form the basis of future asthma management.

Anahtar Kelimeler

• Severe Asthma
• Biomarker
• Biological Therapy
• Type 2 High Asthma
• Type 2 Low Asthma
• Personalized Medicine.

Kaynakça

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