The clinical efficacy of type 2 monoclonal antibodies in eosinophil-associated chronic airway diseases: a meta-analysis

Front Immunol. 2023 Apr 11:14:1089710. doi: 10.3389/fimmu.2023.1089710. eCollection 2023.

Abstract

Background: Anti-type 2 inflammation therapy has been proposed as a treatment strategy for eosinophil-associated chronic airway disorders that could reduce exacerbations and improve lung function. We performed a meta-analysis of randomized controlled trials to assess the effectiveness of type 2 monoclonal antibodies (anti-T2s) for eosinophil-associated chronic airway disorders.

Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched from their inception to 21 August 2022. Randomized clinical trials evaluating the effectiveness of anti-T2s versus placebo in the treatment of chronic airway diseases were selected. The outcomes were exacerbation rate and change in pre-bronchodilator forced expiratory volume in 1 s (FEV1) from baseline. The Cochrane Risk of Bias Assessment Tool 1.0 was used to evaluate the risk of bias, and the random-effects or fixed-effect model were used to pool the data.

Results: Thirty-eight articles concerning forty-one randomized clinical trials with 17,115 patients were included. Compared with placebo, anti-T2s therapy yielded a significant reduction in exacerbation rate in COPD and asthma (Rate Ratio (RR)=0.89, 95%CI, 0.83-0.95, I2 = 29.4%; RR= 0.59, 95%CI, 0.52-0.68, I2 = 83.9%, respectively) and improvement in FEV1 in asthma (Standard Mean Difference (SMD)=0.09, 95%CI, 0.08-0.11, I2 = 42.6%). Anti-T2s therapy had no effect on FEV1 improvement in COPD (SMD=0.05, 95%CI, -0.01-0.10, I2 = 69.8%).

Conclusion: Despite inconsistent findings across trials, anti-T2s had a positive overall impact on patients' exacerbation rate in asthma and COPD and FEV1 in asthma. Anti-T2s may be effective in treating chronic airway illnesses related to eosinophils.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022362280.

Keywords: efficacy; eosinophil-associated chronic airway diseases; meta-analysis; randomized controlled trials; type 2 monoclonal antibodies.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal / therapeutic use
  • Asthma* / chemically induced
  • Chronic Disease
  • Disease Progression
  • Eosinophils
  • Humans
  • Pulmonary Disease, Chronic Obstructive* / chemically induced
  • Randomized Controlled Trials as Topic
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal

Supplementary concepts

  • Pulmonary Disease, Chronic Obstructive, Severe Early-Onset

Grants and funding

This work was supported by Guangzhou Key Laboratory of Combined Traditional Chinese and Western Medicine for Prevention and Treatment of Emerging and Sudden Infectious Diseases (202201020382); Basic and Applied Basic Research of Guangzhou City-University Joint Funding Project (202201020475, 2023A03J0227); Guangdong Provincial Bureau of Chinese Medicine (20225020, 20222071); the Fund of Guangzhou University of Chinese Medicine (2021YJZX012, 2022YBA06); the Guangdong Provincial Hospital of Chinese Medicine Fund (YN2019ML11 and YN2019QJ13); Research Fund for Zhaoyang Talents of Guangdong Provincial Hospital of Chinese Medicine (ZY2022KY10, ZY2022YL04).