Asthma is a chronic inflammatory disease that produces a bronchial hiperreponsiveness and variable airflow obstruction, totally or partially reversible, and that without treatment, may eventually produce a phenomenon of remodelling of the bronchial wall leading to a rapid and progressive loss of pulmonary function., The first international consensus for asthma treatment was published in 1992. Based on the existing drug treatments it recommended a stepwise therapeutic approach. This consensus stated the progressive addition of different treatments according to the disease severity. In the last step, which included the more severe asthma patients, only oral corticosteroids (CO) were accepted. Several immunosuppressive drugs have been tested during the last fifty years for GINA step V asthma looking for a corticosteroid sparing agent which included metrotrexate (MTX), whose use has been limited due to its side effects. In our study we have evaluated the effectiveness and tolerance of long-term MTX treatment (up to 12 years), verifying that this drug helps to reduce the dose of oral corticosteroids in all patients and in 56% of the cases allowed to remove them with a very low rate of side effects. The most common hepatic toxicity was mild and transient in all cases. In 2006, the international guidelines approved omalizumab, a monoclonal antibody, for allergic GINA step V asthma patients treatment. Although there are many published studies on the effectiveness and good tolerance of omalizumab in allergic asthma, there are few of them on allergic steroid-dependent asthma. Our study like the previous with MTX assesses the effectiveness and long-term tolerance of omalizumab in allergic steroid-dependent GINA step V asthma patients. Our study has shown that omalizumab is a drug with an excellent safety profile, with virtually no side effects and achieves a good control of the disease. It helped to reduce the dose of oral steroids and even remove them in 74% of the patients. Our experience with omalizumab and MTX illustrates that both drugs are useful as alternatives to oral coreticosteroids. They have shown to be effective in a long-term follow up and a good safety profile. According to our results, we believe that MTX should be incorporated in the International guidelines as an alternative to corticosteroid in the GINA step V asthma while Omalizumab has shown to be useful in the more severe GINA step V asthma patients, that is those who are oral steroid-dependent. If needed both drugs can be administrated at the same time.
Tractaments alternatius als corticoides orals en asmàtics en estadi V de la GINA.
Moreno Gomez De Bonilla, A. (Author). 24 Oct 2012
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis