Oleh Admin Kalbe Medical pada February 14, 2017 07:30

Mepolizumab Efektif untuk Pasien Asma Eosinofilik di Jepang

Asma adalah penyakit inflamasi kronik saluran napas bawah yang ditandai oleh episode berulang dari batuk, sesak napas, dada tertekan, dan wheezing. Pada pasien asma dapat terjadi eksaserbasi, atau dikenal juga dengan serangan asma, yaitu kejadian di mana gejala asma yang dialami pasien secara mendadak menjadi lebih berat. Gejala-gejala ini dapat berakibat menurunnya kualitas hidup. Menurut panduan GINA (Global Initiative for Asthma) disebutkan bahwa ada beberapa obat yang dapat digunakan untuk asma, yaitu inhalasi kortikosteroid, inhalasi beta agonis, dan leukotriene inhibitor. Meskipun pasien sudah menggunakan obat-obatan ini, tetap saja sebagian pasien responsnya belum memuaskan karena masih mengalami eksaserbasi dan sesak napas.

Pada kelompok pasien yang tidak berespons ini, ternyata sebagian besar diketahui bahwa kadar eosinofil (sel darah putih yang bertanggungjawab untuk reaksi alergi) pada pasien mengalami peningkatan secara bermakna. Kondisi ini disebut asma eosinofilik. Pasien asma eosinofilik, cenderung kurang memberi respons terhadap pengobatan standar. Biasanya, meskipun mendapatkan pengobatan standar, pasien asma eosiofilik masih bergejala. Oleh karena itu, pada pasien asma eosinofilik, diperlukan pengobatan tambahan. Salah satu pengobatan yang diduga dapat bermanfaat pada pasien asma eosinofilik adalah mepolizumab. Mepolizumab adalah antibodi monoklonal yang bekerja dengan cara menghambat interleukin-5, yaitu suatu mediator inflamasi pada asma.


Untuk mengevaluasi efektivitas dan keamanan mepolizumab pada pasien asma eosinofilik, maka dr. Shimoda dan tim peneliti dari Jepang melakukan sebuah uji klinik yang diterbitkan di jurnal Allergology International bulan Januari 2017. Uji klinik ini adalah bagian dari uji klinik MENSA yang dilakukan secara internasional. Sebanyak 50 pasien Jepang dengan asma eosinofilik, yang tidak terkontrol dengan pengobatan standar, mendapatkan tambahan pengobatan mepolizumab intravena atau subkutan atau plasebo. Parameter yang dievaluasi adalah kejadian eksaserbasi dan PEF (peak expiratory flow) pada ketiga kelompok.


Hasilnya didapatkan kejadian eksaserbasi pada kelompok mepolizumab intravena turun 90% (rate ratio [RR]: 0,10; 95% [CI]: 0,02 s/d 0,57; P = 0,010) dibandingkan dengan plasebo dan pada kelompok mepolizumab subkutan turun 62% (rate ratio [RR]: 0,38; 95% [CI]: 0,12 s/d 1,18; P = 0,094) dibandingkan dengan plasebo. Selain itu, pada parameter PEF, didapatkan hasil bahwa PEF kelompok intravena lebih tinggi 40 L/menit dibandingkan dengan plasebo dan PEF kelompok subkutan lebih tinggi 13 L/menit dibandingkan dengan plasebo.


Kesimpulan:
Pasien asma eosinofilik adalah kelompok pasien asma dengan peningkatan kadar eosinofil yang sering tidak berespons dengan pengobatan standar. Pada kelompok asma ini, tambahan pengobatan menggunakan mepolizumab bermanfaat menurunkan kejadian eksaserbasi serta melancarkan aliran napas. (NNO)

Image : Ilustrasi
Referensi:
1.Asthma: Practice essentials, background, anatomy [Internet]. 2017 Jan 6 [cited 2017 Jan 27]. Available from: http://emedicine.medscape.com/article/296301-overview?pa=K9Qd46yVleda6%2BfI84%2BK7XyyuvNf8mkYwFueNI35XzbIOHSDl402wsWoEJQq78y7JyGvMX%2Fu%2BWdIXoARf%2FT0zw%3D%3D
2.Walford HH, Doherty TA. Diagnosis and management of eosinophilic asthma: A US perspective. J Asthma Allergy. 2014;7:53–65.
3.Shimoda T, Odajima H, Okamasa A, Kawase M, Komatsubara M, Mayer B, et al. Efficacy and safety of mepolizumab in Japanese patients with severe eosinophilic asthma. Allergol Int Off J Jpn Soc Allergol. 2017 Jan 16;

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