🎉 很高興分享我們最新發表於《European Journal of Internal Medicine》2025 Journal Impact Factor 8.1；Medicine, General & Internal 排名 24/336，JCR Q1（前 7%）的研究！
對於接受抗 IL-5／IL-5Rα 生物製劑後療效不佳的重度氣喘患者，下一步應該選擇 tezepelumab，還是 dupilumab？目前兩者之間幾乎沒有直接比較證據。
我們利用 TriNetX US Collaborative Network，以模擬目標試驗（target trial emulation）進行真實世界、頭對頭比較。經傾向分數配對後，共納入 118 對患者，追蹤一年。
🔍 主要結果：
一年內氣喘惡化複合結局發生率：
• Tezepelumab：76.3%
• Dupilumab：78.0%
• HR 0.97（95% CI 0.72–1.29）
急診或住院、ICD 編碼氣喘惡化，以及全身性類固醇使用等次要結局，兩組同樣未見明確差異。四項預先設定的敏感度分析也得到一致結果。
據我們所知，這是第一項針對抗 IL-5／IL-5Rα 治療後轉換策略，直接比較 tezepelumab 與 dupilumab 的真實世界研究。
值得強調的是：「未發現明確差異」並不等於證明兩種藥物療效相等。由於樣本數有限、信賴區間較寬，且資料庫缺乏 FeNO、肺功能、氣喘控制分數及縱向嗜酸性球等重要表型資訊，目前仍不宜據此認定某一藥物較佳。
臨床選擇仍應依患者的氣喘表型、共病、既往療效、安全性及整體臨床情境個別化決定。
衷心感謝所有共同作者與研究夥伴的投入！
🔗 閱讀全文：
https://www.sciencedirect.com/science/article/pii/S095362052600419X
#SevereAsthma #Tezepelumab #Dupilumab #Biologics #TargetTrialEmulation #TriNetX #RealWorldEvidence #ComparativeEffectiveness #精準醫療 #重度氣喘
I am pleased to share our latest publication in the European Journal of Internal Medicine. 2025 Journal Impact Factor 8.1；Medicine, General & Internal 排名 24/336，JCR Q1（前 7%）
Which biologic should be considered for patients with severe asthma who respond inadequately to anti–IL-5/IL-5Rα therapy: tezepelumab or dupilumab?
To address this clinically relevant evidence gap, we conducted an active-comparator target trial emulation using the TriNetX US Collaborative Network. After 1:1 propensity-score matching, 118 patient pairs were followed for one year.
Key findings:
• The primary composite exacerbation outcome occurred in 76.3% of the tezepelumab group and 78.0% of the dupilumab group
• HR 0.97 (95% CI 0.72–1.29)
• No clear between-group differences were observed in healthcare utilization, ICD-coded exacerbations, status asthmaticus, or systemic corticosteroid bursts
• Findings remained consistent across four prespecified sensitivity analyses
To our knowledge, this is the first head-to-head comparative-effectiveness study of tezepelumab versus dupilumab as switching strategies after prior anti–IL-5/IL-5Rα therapy.
Importantly, the absence of a clear difference should not be interpreted as proof of equivalence. The modest sample size, wide confidence intervals, and lack of phenotype-rich variables—including FeNO, longitudinal lung function, asthma control scores, and eosinophil trajectories—limit definitive conclusions.
For now, biologic selection should remain individualized according to phenotype, comorbidities, previous treatment response, safety considerations, access, and the overall clinical context. Larger phenotype-rich registries and randomized comparative trials are needed.
My sincere appreciation goes to all co-authors and collaborators who contributed to this work.
Read the article:
https://www.sciencedirect.com/science/article/pii/S095362052600419X
#SevereAsthma #Tezepelumab #Dupilumab #BiologicTherapy #TargetTrialEmulation #TriNetX #RealWorldEvidence #ComparativeEffectiveness #PrecisionMedicine
European Journal of Internal Medicine 2025 Journal Impact Factor 8.1；Medicine, General & Internal 排名 24/336，JCR Q1（前 7%）
