Hasan ÖZGEN, Fatma Merve TEPETAM, İsmet BULUT, Cihan ÖRÇEN

The significance of eosinophil and eosinophil lymphocyte ratio (ELR) in predicting response to omalizumab treatment in patients with severe allergic asthma

The significance of eosinophil and eosinophil lymphocyte ratio (ELR) in predicting response to omalizumab treatment in patients with severe allergic asthma Introduction: Th2/Th1 mix pathological pathway may be seen as a common set of low eosinophilic phenotype in severe allergic asthma. This may affect omalizumab treatment response. In our study, we aimed to investigate whether eosinophil count (EOS) and percentage (EOS%), eosinophil lymphocyte ratio (ELR) and neutrophil lymphocyte ratio (NLR) may predict omalizumab treatment. Materials and Methods: Patients who received omalizumab treatment at least for one year in our allergy clinic were screened retrospectively. Baseline hemogram parameters, pre- and post-treatment emergency admissions, annual attacks requiring steroid use, hospitalizations, spirometric changes, and asthma control tests (ACT) were recorded. According the global efficacy assessment (phisician’s GETE) scale patients was recorded as responder and nonresponder. By looking at EOS, EOS%, ELR and NLR distributions in these groups, the role of these parameters in representation of the treatment efficacy was investigated. Results: The study was carried out with 83 patients, 77.1% of whom were women with an average age of 50.03 ± 10.7. While ACT scores and FEV FEF25-75 was significantly increased, the number of emergency admissions, annual attacks and hospitalizations decreased significantly (p< 0.05). The rate of patients signed as responder was 75.9%, while the rate of nonresponder was %24.1. When the two groups were compared, it was found that the EOS, EOS% and ELR were significantly higher in the responder group. The cut-off values according to the ROC curve were determined as 0.12, 310/ml and 3.1% respectively. Considering the sensitivity (58.73%); specificity (85.00%); positive predictive value (92.50%), it was determined that ELR was a more valuable test. Conclusion: Instead of expensive and invasive methods for predicting the response of omalizumab therapy in severe allergic asthma, the ELR is correlated with treatment response and giving hope to be easier way to reach.

Ağır alerjik astımı olan hastalarda omalizumab tedavi yanıtı öngörmede eozinofil ve eozinofil lenfosit oranının (ELR) önemi

Giriş: Ağır alerjik astımda, düşük eozinofilik fenotipin ortak alt küme olarak bulunabilmesi nedeniyle, Th2/Th1 karışım patolojik yolağı görülebilir. Bu durum omalizumab tedavisinin yanıtını etkileyebilir. Çalışmamızda eozinofil sayısının (EOS) ve yüzdesinin (EOS%), eozinofil lenfosit oranının (ELR) ve nötrofil lenfosit oranının (NLO) omalizumab tedavi yanıtını öngörrmedeki yerini belirlemeyi amaçladık. Materyal ve Metod: Alerji kliniğimizde en az bir yıl omalizumab tedavisi alan hastalar retrospektif olarak tarandı. Başlangıç hemogram parametreleri, tedavi öncesi ve sonrası acil başvurular, steroid kullanımı gerektiren yıllık ataklar, hastaneye yatışlar, spirometrik değişiklikler ve astım kontrol testleri (ACT) kaydedildi. Global etkinlik değerlendirme (GETE) ölçeğine göre hastalar yanıt alınan ve yanıt alınamayan olarak kaydedildi. Bu gruplarda EOS, EOS%, ELR ve NLR dağılımlarına bakılarak, bu parametrelerin tedavi etkinliğini temsil etmedeki rolü araştırıldı. Bulgular: Çalışma, yaş ortalaması 50,03 ± 10,7 olan %77,1’i kadın 83 hasta ile gerçekleştirildi. ACT puanları ve FEV1, FEF25-75 anlamlı olarak artarken, acil başvuru, yıllık atak sayısı ve hastaneye yatış sayısı anlamlı olarak azaldı (p< 0,05). Tedavi yanıtı alınan hasta oranı %75,9, yanıt alınmayanların oranı ise %24,1 idi. İki grup karşılaştırıldığında, yanıt veren grupta EOS, EOS% ve ELR’nin anlamlı olarak daha yüksek olduğu bulundu. ROC eğrisine göre kestirim değerleri sırasıyla 0,12, 310/ml ve %3,1 olarak belirlendi. Sensitivite (%58,73); spesifite (%85,00); pozitif prediktif değerler (%92,50), göz önüne alındığında ELR’nin daha değerli bir test olduğu belirlenmiştir. Sonuç: Ağır alerjik astımda omalizumab tedavi yanıtını öngörmek için pahalı ve invaziv yöntemler yerine, tedavi yanıtıyla korelasyon gösteren ELR ulaşılabilirliği kolay bir test olarak umut vaat etmektedir.

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