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Buendía JA, Guerrero Patiño D, Zuluaga Salazar AF. Cost effectiveness of omalizumab for severe asthma in Colombia. J Asthma 2024; 61:292-299. [PMID: 37815886 DOI: 10.1080/02770903.2023.2267129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Omalizumab is a humanized monoclonal antibody that specifically binds to free human immunoglobulin E. The introduction of this drug raises concerns about economic impact in scenarios with constrained. This study aimed to estimate the cost utility of omalizumab in adults with severe asthma uncontrolled in Colombia. METHODS We used a Markov state-transition model to estimate the cost and QALYs associated with omalizumab compared to standard of care; from a third payer perspective over a lifetime horizon. This model used local costs while utilities were derived from international literature. Cost and transition probabilities were obtained from a mixture of Colombian-specific and internationally published data. RESULTS The mean incremental cost of omalizumab versus standard of care is US$3 481. The mean incremental benefit of omalizumab versus standard of care 0.094 QALY. The incremental expected cost per unit of benefit is estimated at US$36846 per QALY. There is only a probability of 0.032 that Omalizumab is more cost-effective than standard of care at a threshold of US$5180 per QALY. CONCLUSION Omalizumab is not cost-effective in adults with severe asthma uncontrolled in Colombia. If the cost of Omalizumab is reduced by 83%, this treatment would be cost-effective in our country. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.
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Affiliation(s)
- Jefferson Antonio Buendía
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Research group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
| | - Diana Guerrero Patiño
- Research group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
| | - Andrés Felipe Zuluaga Salazar
- Research group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
- Laboratorio Integrado de Medicina Especializada (LIME), Facultad de Medicina, IPS Universitaria, Universidad de Antioquia, Antioquia, Colombia
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2
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Imanirad D, Tabatabaian F. Current Biologics in Asthma Treatment. Semin Respir Crit Care Med 2022; 43:627-634. [DOI: 10.1055/s-0042-1753486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractUncontrolled asthma and/or severe asthma causes significant impairments in quality of life and is often a huge health care burden. Monoclonal antibodies have been an important addition to the therapeutic management of patients with moderate to severe asthma who do not respond to conventional asthma management. Currently the majority of Food and Drug Administration (FDA) approved biologics target T2 high inflammation. However, with the expanding knowledge of asthma pathogenesis, novel therapeutics targeting T2 low inflammation are in development. In this article we will focus on the current understanding of T2 inflammation and approved biologics for moderate to severe asthma.
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Affiliation(s)
- Donya Imanirad
- Department of Allergy, Immunology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Farnaz Tabatabaian
- Division of Allergy and Immunology in Medicine and Pediatrics, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
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3
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Ali Z, Egeberg A, Thyssen JP, Sørensen JA, Vestergaard C, Thomsen SF. No association between omalizumab use and risk of cancer: a nationwide registry-based cohort study. Br J Dermatol 2021; 186:746-748. [PMID: 34878656 DOI: 10.1111/bjd.20941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Z Ali
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - A Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - J P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - J A Sørensen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - C Vestergaard
- The Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Uzzo M, Regola F, Trezzi B, Toniati P, Franceschini F, Sinico RA. Novel Targets for Drug Use in Eosinophilic Granulomatosis With Polyangiitis. Front Med (Lausanne) 2021; 8:754434. [PMID: 34796188 PMCID: PMC8593004 DOI: 10.3389/fmed.2021.754434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare autoimmune disease characterized by medium and small vessels inflammation. Cardiac vasculitic involvement is one of the most severe manifestations with a significant impact on patients' long-term prognosis: anyway, a specific therapeutic approach for heart involvement in EGPA has not been explored yet. Current regimen consists of a long-term therapy with high dose of glucocorticoids, causing the well-known related-adverse events; immunosuppressive drugs are used in patients with severe manifestations, with some limitations. New therapeutic approaches are needed for patients with refractory disease or contraindications to conventional therapies. The quest for the ideal therapy is going toward a more and more personalized approach: on the one hand, efforts are made to use already existing therapies in the most appropriate way; on the other hand, new insights into EGPA pathogenesis allow the discovery of new targets, as demonstrated by mepolizumab and rituximab, targeting eosinophils, and B-cell compartments. This review summarizes the emerging therapies used in EGPA, focusing on the most recent studies on biologics and analyzing their efficacy and safety.
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Affiliation(s)
- Martina Uzzo
- Department of Clinical and Experimental Sciences, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, Ospedale San Gerardo di Monza, Monza, Italy
| | - Francesca Regola
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Trezzi
- Department of Clinical and Experimental Sciences, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, Ospedale San Gerardo di Monza, Monza, Italy
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Renato Alberto Sinico
- Department of Clinical and Experimental Sciences, University of Milano-Bicocca, Monza, Italy.,Nephrology and Dialysis Unit, Ospedale San Gerardo di Monza, Monza, Italy
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5
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Buendia JA, Guerrero Patiño D, Cossio-Giraldo YE. Cost‑effectiveness of tiotropium versus omalizumab for uncontrolled allergic asthma. J Asthma 2021; 59:2016-2023. [PMID: 34551659 DOI: 10.1080/02770903.2021.1984527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In patients with uncontrolled asthma, despite management with high doses of inhaled corticosteroids, the additional use of omalizumab and tiotropium is recommended. Omalizumab is an expensive medication and doubts arise as to whether the benefit of this drug outweighs the additional expense of the drug. The purpose of this study was to assess the cost-effectiveness of tiotropium versus omalizumab as add-on therapies to ICS + LABA for patients with uncontrolled allergic asthma. METHODS A probabilistic Markov model was created to estimate the cost and quality-adjusted life years (QALYs) of patients with uncontrolled allergic asthma in Colombia. Total costs and QALYs of three interventions including standard therapy (ICS + LABA), add-on therapy with tiotropium, and add-on therapy with omalizumab, were calculated over a 10-year time horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. RESULTS The model showed that tiotropium was associated with lower cost than standard therapy and omalizumab (US$5590 vs. US$5693 vs. U$18,154 average annual cost per patient), and higher QALYs (11.8 vs. 11.3 vs. 11.9) average per patient), showing dominance respect to standard therapy. The probability that tiotropium provides a more cost-effective use of resources compared with standard therapy exceeds 99% for willingness-to-pay threshold. CONCLUSION Add-on therapy with tiotropium was a cost-effective alternative to omalizumab and standard therapy for uncontrolled allergic asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.
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Affiliation(s)
- Jefferson Antonio Buendia
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Antioquia, Medellin, Colombia
| | - Diana Guerrero Patiño
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Antioquia, Medellin, Colombia
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6
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Efficacy predictors of omalizumab in Chinese patients with moderate-to-severe allergic asthma: Findings from a post-hoc analysis of a randomised phase III study. World Allergy Organ J 2021; 13:100469. [PMID: 34611470 PMCID: PMC8461112 DOI: 10.1016/j.waojou.2020.100469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background Omalizumab has demonstrated efficacy as an add-on therapy in Chinese patients with moderate-to-severe allergic asthma. This post-hoc analysis assessed the potential predictors for the efficacy of omalizumab in these patients. Methods A post-hoc analysis was performed on a Phase III, randomised, controlled study conducted in Chinese patients with moderate-to-severe persistent allergic asthma (NCT01202903). We evaluated if levels of pre-treatment serum total immunoglobulin-E (IgE) and blood eosinophil (EOS), asthma severity, allergen profile, history of perennial allergic rhinitis (PAR), and free IgE level during omalizumab treatment were predictive of omalizumab's efficacy. Results This analysis included 608 patients (omalizumab, N = 306; placebo, N = 302). Improvements in forced expiratory volume in 1 s (FEV1), standardized Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), and Global Evaluation of Treatment Effectiveness (GETE) scores with omalizumab treatment compared with placebo were observed in patients with baseline IgE levels ≥76 IU/mL (irrespective of the EOS count). Relatively greater improvements with omalizumab treatment was also noted in patients with both moderate or severe allergic asthma (regardless of asthma severity), and patients sensitised to >3 allergens and with a history of PAR. All patients who were treated with omalizumab achieved free IgE levels below 50 ng/mL by Week 1. Similar clinical outcomes were observed in the subset of patients who achieved free IgE levels of <25 and ≥ 25 ng/mL. Conclusions In Chinese patients with moderate-to-severe allergic asthma, baseline IgE and allergen profile (number/PAR history) are potential predictors of treatment response to omalizumab. Trial registration NCT01202903 (www.clinicaltrials.gov).
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Key Words
- ACQ, Asthma Control Questionnaire
- ANCOVA, Analysis of covariance
- AQLQ, Asthma Quality of Life Questionnaire
- Allergic
- Asthma
- CMH, Cochran-Mantel-Haenszel
- China
- EOS, Eosinophil
- Eosinophils
- FAS, Full analysis set
- FCεR1, High affinity IgE binding receptor 1
- FEV1, Forced expiratory volume in 1 s
- GETE, Global Evaluation of Treatment Effectiveness
- ICS, Inhaled corticosteroid
- IL-5, Interleukin-5
- IgE, Immunoglobulin-E
- Immunoglobulin E
- LABA, Long-acting β agonist
- LSM, Least squares mean
- LSM-TD, Least squares mean treatment differences
- OMA, Omalizumab
- Omalizumab
- PAR, Perennial allergic rhinitis
- PBO, Placebo
- PD, Pharmacodynamics
- PEF, Peak expiratory flow
- PK, Pharmacokinetic
- QoL, Quality of life
- RAST, Radio-allergosorbent test
- RMU, Rescue medication use
- SAR, Seasonal allergic rhinitis
- ULOQ, Upper limit of quantification
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7
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The Current State of Biologic Therapies for Treatment of Refractory Asthma. Clin Rev Allergy Immunol 2021; 59:195-207. [PMID: 31981048 DOI: 10.1007/s12016-020-08776-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Asthma is a heterogeneous disease, with the immune processes behind the chronic inflammation underlying this disorder differing between the various identified asthma endotypes. In addition to heterogeneity in underlying disease pathophysiology, asthmatics fall across a broad spectrum of disease severity and can vary greatly in their response to convention asthma therapies. A small percentage of patients with severe persistent asthma will remain uncontrolled despite treatment with high-dose inhaled corticosteroids and a long-acting beta-agonist. Less than two decades ago, there were few options for these treatment-refractory asthmatics beyond chronic systemic steroids, with their myriad of treatment-limiting side effects. However, in recent years, there have been a growing number of Food and Drug Administration (FDA)-approved biologic medications with targets that include immunoglobulin E (IgE), interleukin-5 (IL-5), the IL-5 receptor and the IL-4/IL-13 receptor-alpha subunit. The current FDA-approved biologics for severe persistent asthma are omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab. These monoclonal antibodies have been shown to improve asthma control, decrease asthma exacerbations and decrease glucocorticoid dependence in certain subsets of patients with asthma. The optimal biologic for treatment of severe asthma varies from patient to patient, depending on the underlying pathophysiology of the patient's disease. For each of these medications, there are certain biomarkers that can help predict whether a patient is likely to respond favorably to the medication. This review will discuss the currently approved biologics for severe persistent asthma, including their indications, efficacy and side effects.
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8
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Cremades-Jimeno L, de Pedro MÁ, López-Ramos M, Sastre J, Mínguez P, Fernández IM, Baos S, Cárdaba B. Prioritizing Molecular Biomarkers in Asthma and Respiratory Allergy Using Systems Biology. Front Immunol 2021; 12:640791. [PMID: 33936056 PMCID: PMC8081895 DOI: 10.3389/fimmu.2021.640791] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/15/2021] [Indexed: 01/29/2023] Open
Abstract
Highly prevalent respiratory diseases such as asthma and allergy remain a pressing health challenge. Currently, there is an unmet need for precise diagnostic tools capable of predicting the great heterogeneity of these illnesses. In a previous study of 94 asthma/respiratory allergy biomarker candidates, we defined a group of potential biomarkers to distinguish clinical phenotypes (i.e. nonallergic asthma, allergic asthma, respiratory allergy without asthma) and disease severity. Here, we analyze our experimental results using complex algorithmic approaches that establish holistic disease models (systems biology), combining these insights with information available in specialized databases developed worldwide. With this approach, we aim to prioritize the most relevant biomarkers according to their specificity and mechanistic implication with molecular motifs of the diseases. The Therapeutic Performance Mapping System (Anaxomics’ TPMS technology) was used to generate one mathematical model per disease: allergic asthma (AA), non-allergic asthma (NA), and respiratory allergy (RA), defining specific molecular motifs for each. The relationship of our molecular biomarker candidates and each disease was analyzed by artificial neural networks (ANNs) scores. These analyses prioritized molecular biomarkers specific to the diseases and to particular molecular motifs. As a first step, molecular characterization of the pathophysiological processes of AA defined 16 molecular motifs: 2 specific for AA, 2 shared with RA, and 12 shared with NA. Mechanistic analysis showed 17 proteins that were strongly related to AA. Eleven proteins were associated with RA and 16 proteins with NA. Specificity analysis showed that 12 proteins were specific to AA, 7 were specific to RA, and 2 to NA. Finally, a triggering analysis revealed a relevant role for AKT1, STAT1, and MAPK13 in all three conditions and for TLR4 in asthmatic diseases (AA and NA). In conclusion, this study has enabled us to prioritize biomarkers depending on the functionality associated with each disease and with specific molecular motifs, which could improve the definition and usefulness of new molecular biomarkers.
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Affiliation(s)
- Lucía Cremades-Jimeno
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María Ángeles de Pedro
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María López-Ramos
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Joaquín Sastre
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain.,Center for Biomedical Network of Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Pablo Mínguez
- Department of Genetics, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | | | - Selene Baos
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Blanca Cárdaba
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Center for Biomedical Network of Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
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9
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Wang J, Li T, Cai H, Jin L, Li R, Shan L, Cai W, Jiang J. Protective effects of total flavonoids from Qu Zhi Qiao (fruit of Citrus paradisi cv. Changshanhuyou) on OVA-induced allergic airway inflammation and remodeling through MAPKs and Smad2/3 signaling pathway. Biomed Pharmacother 2021; 138:111421. [PMID: 33752061 DOI: 10.1016/j.biopha.2021.111421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/06/2021] [Accepted: 02/16/2021] [Indexed: 12/24/2022] Open
Abstract
Allergic asthma is one of the inflammatory diseases, which has become a major public health problem. Qu zhi qiao (QZQ), a dry and immature fruit of Citrus paradisi cv. Changshanhuyou, has various flavonoids with pharmacological properties. However, there is a knowledge gap on the pharmacological properties of QZQ on allergic asthma. Therefore, here, we explored the efficacy and mechanism of total flavonoids from QZQ (TFCH) on allergic asthma. We extracted and purified TFCH and conducted animal experiments using an Ovalbumin (OVA)-induced mice model. Bronchoalveolar lavage fluid and Swiss-Giemsa staining were used to count different inflammatory cells in allergic asthma mice. We conducted histopathology and immunohistochemistry to evaluate the changes in the lungs of allergic asthma mice. Moreover, we used ELISA assays to analyze chemokines and inflammatory cytokines. Furthermore, western blot analyses were conducted to elucidate the mechanism of TFCH on allergic asthma. We established that TFCH has anti-inflammatory effects and inhibits airway remodeling, providing a potential therapeutic strategy for allergic asthma.
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Affiliation(s)
- Jianping Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, China; Songyang County People's Hospital, Lishui 323400, China
| | - Ting Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Haiying Cai
- Shaoxing people's Hospital, Shaoxing 312000, China
| | - Liangyan Jin
- Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310023, China
| | - Run Li
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Letian Shan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, China.
| | - Wei Cai
- Department of Chinese Materia Medica, Zhejiang Pharmaceutical College, Ningbo 315100, China
| | - Jianping Jiang
- Zhejiang You-du Biotech Limited Company, Quzhou 324200, China; Department of Pharmacy, School of Medicine, Zhejiang University City College, 310015 China.
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10
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Raffray L, Guillevin L. Updates for the treatment of EGPA. Presse Med 2020; 49:104036. [PMID: 32652104 DOI: 10.1016/j.lpm.2020.104036] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 05/19/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is the least frequent antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). Major advances of our knowledge on its pathophysiology have revealed features of both AAV and eosinophilic disorders. The development of targeted biotherapies for both diseases opened new possibilities for EGPA management. In this review, we highlight the rationale underlying the routine treatment strategy, which relies mainly on corticosteroids, with immunosuppressant adjunction for severe disease. However, novel therapies are still needed for refractory/relapsing disease and to alleviate the corticosteroid-dependence of asthma and chronic rhinosinusitis. At present, the most promising biotherapies target either eosinophil biology, like mepolizumab, an anti-interleukin-5, or the B-cell compartment, with rituximab. Recent clinical data on new treatment options are discussed and therapeutic strategies are proposed.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, CS11021, Saint Denis, Reunion
| | - Loïc Guillevin
- Referral Center for Rare Systemic and Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris Cedex 14, France.
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11
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Okayama Y, Matsumoto H, Odajima H, Takahagi S, Hide M, Okubo K. Roles of omalizumab in various allergic diseases. Allergol Int 2020; 69:167-177. [PMID: 32067933 DOI: 10.1016/j.alit.2020.01.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
IgE and mast cells play a pivotal role in various allergic diseases, including asthma, allergic rhinitis, and urticaria. Treatment with omalizumab, a monoclonal anti-IgE antibody, has significantly improved control of these allergic diseases and introduced a new era for the management of severe allergic conditions. About 10 years of experience with omalizumab treatment for severe allergic asthma confirmed its effectiveness and safety, reducing symptoms, frequency of reliever use, and severe exacerbations in patients with intractable conditions. Omalizumab is particularly useful in childhood asthma, where atopic conditions often determine clinical courses of asthma. Recently, omalizumab is approved for the treatment of chronic spontaneous urticaria (CSU) with the fixed dose of 300 mg. Although the mechanisms underlying the actions of omalizumab in CSU are not fully clarified, nearly 90% of patients with CSU showed a complete or a partial response to omalizumab treatment. Furthermore, omalizumab is just approved for the treatment of severe Japanese cedar pollinosis (JC) based on the successful results of an add-on study of omalizumab for inadequately controlled severe pollinosis despite antihistamines and nasal corticosteroids. For proper use of omalizumab to treat severe JC, co-administration of antihistamines is necessary, while patients should meet the criteria including strong sensitization to Japanese cedar pollen (≥class 3) and poor control under standard treatment. In the management of severe allergic diseases using omalizumab, issues including cost and concerns about relapse after its discontinuation should be overcome. At the same time, possibilities for application to other intractable allergic diseases should be considered.
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12
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Canonica GW, Colombo GL, Rogliani P, Santus P, Pitotti C, Di Matteo S, Martinotti C, Bruno GM. Omalizumab for Severe Allergic Asthma Treatment in Italy: A Cost-Effectiveness Analysis from PROXIMA Study. Risk Manag Healthc Policy 2020; 13:43-53. [PMID: 32158289 PMCID: PMC6986414 DOI: 10.2147/rmhp.s211321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/28/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Inadequately controlled severe asthma patients require additional therapy accounting for significant clinical and economic burden. Our analysis aims to determine the cost-effectiveness of omalizumab in the management of severe allergic asthma in Italy based on observational data from the PROXIMA study. Methods Observational data on efficacy, healthcare resource utilization and changes in quality of life at 12 months after the initiation of omalizumab were examined to estimate the cost-effectiveness compared to pre-omalizumab period and results were expressed with Incremental Cost-Effectiveness Ratio (ICER). The cost–utility analysis estimated the cost per quality-adjusted life-year (QALY) gained. Direct health costs were assessed from the perspective of the Italian National Health Service (NHS). Results Omalizumab reduced the incidence of exacerbations, number of hospitalizations, physician visits, and improved quality of life after 12 months of treatment. Omalizumab had a greater effectiveness than pre-omalizumab treatment involving 0.132 QALYs gained and led to a €3729 per patient reduction in direct healthcare costs, excluding the add-on treatment cost. Nevertheless, the addition of omalizumab cost led to €7478 increase in total direct costs with respect to pre-omalizumab period. Based on difference in total direct cost and difference in QALY between post and pre-omalizumab period, the ICER was €56,847. According to sensitivity analysis, omalizumab provided a cost-effective use of NHS resources, already at 20% discounted price. Conclusion This study offers a real-world evidence of omalizumab effectiveness in Italy. Despite the high acquisition cost of the innovative drug, omalizumab is a sustainable treatment option for patients with uncontrolled severe allergic asthma.
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Affiliation(s)
| | - Giorgio Lorenzo Colombo
- S.A.V.E. S.r.l. Studi Analisi Valutazioni Economiche Health Economics & Outcomes Research - Research Center, Milan, Italy.,Drug Science Department, Pavia University, Pavia, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
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13
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Raffray L, Guillevin L. Treatment of Eosinophilic Granulomatosis with Polyangiitis: A Review. Drugs 2019; 78:809-821. [PMID: 29766394 DOI: 10.1007/s40265-018-0920-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) is a rare type of anti-neutrophil cytoplasm antibody-associated vasculitis. Nevertheless, eosinophilic granulomatosis with polyangiitis stands apart because it has features of vasculitis and eosinophilic disorders that require targeted therapies somewhat different from those used for other anti-neutrophil cytoplasm antibody-associated vasculitides. Considerable advances have been made in understanding the underlying pathophysiology of eosinophilic granulomatosis with polyangiitis that have highlighted the key role of eosinophils and opened new therapeutic opportunities. Its conventional treatment relies mainly on agents that decrease inflammation: corticosteroids and immunosuppressant adjunction for severe manifestations. New therapeutic approaches are needed for refractory disease, relapses and issues associated with corticosteroid dependence, especially for asthma manifestations. Drugs under evaluation mostly target eosinophils and B cells. Results of low-evidence-based trials suggested possible efficacies of biologicals: B-cell-blocking rituximab and anti-immunoglobulin E omalizumab. Recently, the first large-scale randomised controlled trial on eosinophilic granulomatosis with polyangiitis proved the efficacy of anti-interleukin-5 mepolizumab. That finding opens a new era in eosinophilic granulomatosis with polyangiitis management, with mepolizumab approval but also in future drug evaluations and trial designs for eosinophilic granulomatosis with polyangiitis. Additional studies are needed to determine which patients would benefit most from targeted therapies and achieve personalised treatment for patients with eosinophilic granulomatosis with polyangiitis. Herein, we review eosinophilic granulomatosis with polyangiitis characteristics and provide an overview of established and novel pharmacological agents.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, Saint Denis, Réunion Island, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Université Paris Descartes, Paris, France.
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Tortajada-Girbés M, Bousquet R, Bosque M, Carrera Martínez JJ, Ibáñez MD, Moreira A, Nieto A, Plaza AM, Rivas C, Requena G, Sánchez-Solis M, Tabar A, Torres-Borrego J, Zapatero L. Efficacy and effectiveness of omalizumab in the treatment of childhood asthma. Expert Rev Respir Med 2018; 12:745-754. [PMID: 30141696 DOI: 10.1080/17476348.2018.1507740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E, a mediator involved in the clinical manifestations of allergic asthma. Evidence for its efficacy and safety in the treatment of moderate-to-severe allergic asthma is based primarily on studies in adolescents and adults. However, there is increasing evidence of its utility in children with allergic asthma aged 6-12 years. Areas covered: This article reviews efficacy, safety, and effectiveness of omalizumab in the treatment of moderate-to-severe allergic asthma in children aged 6-12 years in clinical trials and in studies in clinical practice. Pharmacoeconomic aspects of its use among this population and the positioning of omalizumab in pediatric asthma management guidelines are also discussed. Additionally, an algorithm for the management of poorly controlled severe pediatric asthma in children older than 6 years is proposed. Electronic databases, such as PubMed, were searched for terms Asthma and Omalizumab and for asthma management guidelines. Expert commentary: Add-on omalizumab is an effective maintenance therapy in children aged 6-12 years with poorly controlled moderate-to-severe allergic asthma treated with medium-high inhaled corticosteroids doses and inhaled long-acting β2-agonists. Omalizumab appears safe in children in both clinical trials and real-life setting and may be cost-effective.
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Affiliation(s)
- Miguel Tortajada-Girbés
- a Department of Pediatrics, Obstetrics and Gynecology , University of Valencia , Valencia , Spain.,b Pediatric Pulmonology and Allergy Unit , Dr. Peset University Hospital , Valencia , Spain
| | - Rosa Bousquet
- c Pediatric Pulmonology and Allergy Unit, Pediatric Service , Hospital del Mar , Barcelona , Spain
| | - Montserrat Bosque
- d Pediatric Allergy and Pulmonology Unit , Hospital Universitario Parc Taulí , Sabadell , Spain
| | | | | | - Ana Moreira
- g Medical Advisor Xolair-Asma, Novartis , Barcelona , Spain
| | - Antonio Nieto
- h Pediatric Pulmonology and Allergy Unit , Children's Hospital la Fe , Valencia , Spain
| | - Ana María Plaza
- i Allergy and Clinical Immunology Service , Hospital Sant Joan de Déu , Barcelona , Spain
| | - Cristina Rivas
- j Pediatric Service , Hospital de Sagunto , Valencia , Spain
| | - Gloria Requena
- k Allergy Department , Hospital Vithas-Xanit Internacional , Málaga , Spain
| | - Manuel Sánchez-Solis
- l Pediatric Pulmonology Unit, University Hospital Virgen de la Arrixaca , IMIB Bio-Health Research Institute , Murcia , Spain
| | - Ana Tabar
- m Allergology Service , Complejo Hospitalario de Navarra , Pamplona , Spain
| | - Javier Torres-Borrego
- n Pediatric Allergy and Pulmonology Unit , Children´s University Hospital Reina Sofía , Córdoba , Spain
| | - Lydia Zapatero
- o Pediatric Allergy Unit , Maternal and Child Hospital Gregorio Marañón , Madrid , Spain
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15
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Adachi M, Kozawa M, Yoshisue H, Lee Milligan K, Nagasaki M, Sasajima T, Miyamoto T, Ohta K. Real-world safety and efficacy of omalizumab in patients with severe allergic asthma: A long-term post-marketing study in Japan. Respir Med 2018; 141:56-63. [PMID: 30053973 DOI: 10.1016/j.rmed.2018.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Omalizumab (anti-IgE monoclonal antibody) is an approved add-on therapy for Japanese patients with severe allergic asthma. As directed by the Ministry of Health, Labor and Welfare Japan, a post-marketing surveillance (PMS) study on omalizumab was conducted between 2009 and 2017. METHODS The PMS observed safety and efficacy of omalizumab in patients treated with open-label omalizumab for 52 weeks (with optional 2-year extension period). Primary safety outcomes included incidence and severity of adverse events (AEs) and adverse drug reactions (ADRs). Primary efficacy outcomes included physician-assessed global evaluation of treatment effectiveness (GETE). Asthma-exacerbation-related events including requirement for additional systemic steroid therapy, hospitalization, emergency room visits, unscheduled doctor visits, and absenteeism were also evaluated. RESULTS Of 3893 patients registered, 3620 (age [mean ± SD] 59.3 ± 16.11 years) were evaluated for 52 weeks; 44.12% were aged ≥65 years and 64.45% were women. Overall, 32.24% reported AEs and 15.30% reported serious AEs. ADRs were seen in 292 (8.07%) patients. GETE results showed that the majority of patients experienced clinical improvements (58.29% at 16 weeks and 62.40% at 52 weeks). Nearly half of all patients (47.96%) were free from asthma exacerbations after therapy. Omalizumab also reduced all events related to asthma exacerbations. No specific ADRs were observed in the elderly population. CONCLUSIONS This post-marketing study confirmed the clinically meaningful benefits of omalizumab in a majority of patients from Japan, and showed safety and efficacy in a real-life clinical setting to be consistent with previous reports.
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Affiliation(s)
- Mitsuru Adachi
- International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Ken Ohta
- Department of Medicine, Division of Allergy and Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
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Snelder SM, Weersink EJM, Braunstahl GJ. 4-month omalizumab efficacy outcomes for severe allergic asthma: the Dutch National Omalizumab in Asthma Registry. Allergy Asthma Clin Immunol 2017; 13:34. [PMID: 28769983 PMCID: PMC5530516 DOI: 10.1186/s13223-017-0206-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background Omalizumab is licensed as add-on therapy for patients with severe allergic asthma. Response is in most studies scored by the physician’s global evaluation of treatment effectiveness (GETE). A good clinical and validated parameter for treatment response is currently missing. Also, there are no established criteria for identifying patients who will respond to omalizumab based on pre-treatment characteristics. The Dutch National Omalizumab in Asthma Registry was developed in 2011 to better evaluate inclusion criteria and measure treatment response after 4 months. Methods This is a “real world” prospectively designed, observational data registry in which the outcomes of patients who received omalizumab between 2012 and 2015 were evaluated. Data were collected from all centers in the Netherlands comprising demographic features, criteria for starting treatment, GETE, FEV1, oral corticosteroid use and ACQ. Results 65.5% of the 403 patients had a good or excellent response to omalizumab after 16 weeks according to the treating physician GETE. 64.5% fulfilled all the criteria for prescribing omalizumab at baseline. The mean ACQ improved from 2.96 at baseline to 1.83 at 16 weeks (p < 0.001). 75.3% of the responders showed more than 0.5 points improvement in the ACQ. The mean FEV1 increased from 71.58 to 79.06 (p < 0.001). There was no relationship between patients with a FEV1 <80 and ≥80% at baseline and response (p = 0.981). Most of the responders had a considerable improvement of FEV1 either/or ACQ or OCS use (88.3%). While 86.7% of the responders had an improvement of either ACQ or FEV1. 75.4% of the responders had an improvement of ACQ, while 50.4% had an improvement of FEV1. Finally 11.7% of the patients with no improvement of FEV1, ACQ or OCS use were considered to have a good response. Conclusions This registry of 403 inadequately controlled severe allergic asthma patients in the Netherlands showed a good or excellent response of 65.5% to omalizumab after 16 weeks, in accordance with previous studies. The assumption that careful registration would lead to higher response rates could not be supported by the data from this registry. Improvement of ACQ appears to be a useful additional assessment tool to measure response in omalizumab treated patients.
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Affiliation(s)
- S M Snelder
- Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | | | - G J Braunstahl
- Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
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Parande Shirvan S, Ebrahimby A, Dousty A, Maleki M, Movassaghi A, Borji H, Haghparast A. Somatic extracts of Marshallagia marshalli downregulate the Th2 associated immune responses in ovalbumin-induced airway inflammation in BALB/c mice. Parasit Vectors 2017; 10:233. [PMID: 28494800 PMCID: PMC5427607 DOI: 10.1186/s13071-017-2159-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/25/2017] [Indexed: 12/26/2022] Open
Abstract
Background Recently the role of gastrointestinal nematodes in modulating the immune responses in inflammatory and immune-mediated conditions such as allergy and autoimmune diseases has been introduced. This is mainly due to the suppressive effects of somatic and excretory secretory (ES) products of nematodes on the immune responses. In this study, we evaluated the immunomodulatory potentials of somatic products of Marshallagia marshalli, a gastrointestinal nematodes of sheep, to suppress the immune-mediated responses in a murine model of allergic airway inflammation. BALB/c mice were intraperitoneally (IP) sensitized with ovalbumin (OVA)/Alum and then challenged with 1% OVA. Somatic products of M. marshalli were administered during each sensitization. The effects of somatic products on development of allergic airway inflammation were evaluated by analyzing inflammatory cells recruitment, histopathological changes, cytokines production (IL-4, IL-13, IL-10, TGF-β) and serum antibody titers (IgG1, IgG2a). Results Somatic products of M. marshalli were able to suppress the induction of allergic airway inflammation in mice. Modulation of Th2 type responses (IL-4, IL-13, IgG1) via upregulations of IL-10 and TGF-β production was observed after injection of somatic products of M. marshalli. In addition, inflammatory cells infiltration and pathological disorders were significantly diminished following administration of somatic products. Conclusions Our data raised the possibility that helminths could be a potential therapeutic candidate to alleviate the inflammatory conditions in allergic asthma. According to these results, we concluded that M. marshalli may contain immune-modulatory molecules that attenuate allergic airway inflammation via induction of regulatory cytokines. Further investigations are required to identify molecules that might have potentials for development of novel therapeutic targets.
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Affiliation(s)
- Sima Parande Shirvan
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran
| | - Azadeh Ebrahimby
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran
| | - Arezoo Dousty
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran
| | - Mohsen Maleki
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran
| | - Ahmadreza Movassaghi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran
| | - Hassan Borji
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran.
| | - Alireza Haghparast
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran. .,Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P. O. Box: 91775-1793, Mashhad, Iran.
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Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements. Allergol Immunopathol (Madr) 2017; 45:134-144. [PMID: 28029407 DOI: 10.1016/j.aller.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/24/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge. OBJECTIVE To explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management. METHODS An online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus. RESULTS The questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic tests should be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second-generation H1-antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1-antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children. CONCLUSIONS This work offers consensus recommendations that may be useful in the management of CSU.
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Nové-Josserand R, Grard S, Auzou L, Reix P, Murris-Espin M, Brémont F, Mammar B, Mely L, Hubert D, Durieu I, Burgel PR. Case series of omalizumab for allergic bronchopulmonary aspergillosis in cystic fibrosis patients. Pediatr Pulmonol 2017; 52:190-197. [PMID: 27717223 DOI: 10.1002/ppul.23612] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Soazic Grard
- CF Adult Center, University Center Hospital Lyon-Sud, Lyon, France
| | - Lila Auzou
- Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France
| | | | - Marlène Murris-Espin
- Pulmonology Unit, Adult CF Center, Rangueil-Larrey University Hospital, Toulouse, France
| | - François Brémont
- University Center Hospital-CF Pediatric Center, Toulouse, France
| | | | | | - Dominique Hubert
- Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France
| | - Isabelle Durieu
- CF Adult Center, University Center Hospital Lyon-Sud, Lyon, France
| | - Pierre-Régis Burgel
- Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Vennera MDC, Valero A, Uría E, Forné C, Picado C. Cost-Effectiveness Analysis of Omalizumab for the Treatment of Severe Persistent Asthma in Real Clinical Practice in Spain. Clin Drug Investig 2016; 36:567-78. [PMID: 27142072 DOI: 10.1007/s40261-016-0402-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Omalizumab is a humanized monoclonal antibody that targets circulating immunoglobulin E molecules to treat severe uncontrolled asthma. The aim of this study was to determine the cost effectiveness of omalizumab compared with standard treatment for the control of severe persistent asthma according to data from patients treated in a specialized asthma unit. METHODS This was an observational, retrospective, single-center study in the setting of the Pulmonology and Respiratory Allergy Service, Thorax Institute, Hospital Clínic de Barcelona, Barcelona, Spain. Data were collected by review of medical records of 86 uncontrolled severe persistent asthma patients treated with omalizumab from January 2005 to April 2014. Effectiveness was assessed by the reduction in asthma exacerbations and 3-point increases in the Asthma Control Test (ACT) score. The economic evaluation was performed from the societal perspective, including direct health costs (resource use and drug treatments) and indirect costs (disease impact on labor productivity) in 2016 Euros. The time horizon was 12 months before and after the initiation of treatment with omalizumab. Results were expressed using the incremental cost-effectiveness ratio (ICER). RESULTS Taking into account only direct costs, the ICERs were €1487.46 (95 % confidence interval [CI] 1241.21-1778.34) per exacerbation avoided and €5425.13 (95 % CI 4539.30-6551.03) per 3-point increase in the ACT. When indirect costs were included, the ICERs were €1130.93 (95 % CI 909.08-1392.86) per exacerbation avoided, and €4124.79 (95 % CI 3281.69-5186.73) per 3-point increase in the ACT. CONCLUSIONS The results of this study confirm the effectiveness of the addition of omalizumab to standard therapy in patients with uncontrolled severe persistent asthma.
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Affiliation(s)
- María Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antonio Valero
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Estefany Uría
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - Carles Forné
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - César Picado
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Plaza A, Ibáñez M, Sánchez-Solís M, Bosque-García M, Cabero M, Corzo J, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. Consensus-based approach for severe paediatric asthma in routine clinical practice. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hoffman S, Nolin J, McMillan D, Wouters E, Janssen-Heininger Y, Reynaert N. Thiol redox chemistry: role of protein cysteine oxidation and altered redox homeostasis in allergic inflammation and asthma. J Cell Biochem 2016; 116:884-92. [PMID: 25565397 DOI: 10.1002/jcb.25017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Abstract
Asthma is a pulmonary disorder, with an estimated 300 million people affected worldwide. While it is thought that endogenous reactive oxygen species (ROS) and reactive nitrogen species (RNS) such as hydrogen peroxide and nitric oxide, are important mediators of natural physiological processes, inflammatory cells recruited to the asthmatic airways have an exceptional capacity for producing a variety of highly reactive ROS and RNS believed to contribute to tissue damage and chronic airways inflammation. Antioxidant defense systems form a tightly regulated network that maintains the redox environment of the intra- as well as extracellular environment. Evidence for an oxidant-antioxidant imbalance in asthmatic airways is demonstrated in a number of studies, revealing decreased total antioxidant capacity as well as lower levels of individual antioxidants. Thiols in the form of GSH and sulfhydryl groups of proteins are among the most susceptible oxidant-sensitive targets, and hence, studies investigating protein thiol redox modifications in biology and disease have emerged. This perspective offers an overview of the combined efforts aimed at the elucidation of mechanisms whereby cysteine oxidations contribute to chronic inflammation and asthma, as well as insights into potential cysteine thiol-based therapeutic strategies.
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Affiliation(s)
- Sidra Hoffman
- Department of Pathology, University of Vermont, Burlington, 05405, Vermont
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23
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Plaza AM, Ibáñez MDP, Sánchez-Solís M, Bosque-García M, Cabero MJ, Corzo JL, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. [Consensus-based approach for severe paediatric asthma in routine clinical practice]. An Pediatr (Barc) 2015; 84:122.e1-122.e11. [PMID: 26515042 DOI: 10.1016/j.anpedi.2015.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines. MATERIAL AND METHODS An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results. RESULTS Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids. CONCLUSIONS This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.
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Affiliation(s)
- A M Plaza
- Alergología Infantil, Hospital Sant Joan de Deu, Barcelona, España
| | - M D P Ibáñez
- Alergología Infantil, Hospital Niño Jesús, Madrid, España
| | - M Sánchez-Solís
- Neumología Infantil, Hospital Virgen de la Arrixaca, Murcia, España
| | - M Bosque-García
- Unidad de Alergia, Neumología e Inmunología Pediátrica, Hospital de Sabadell, Corporación Universitaria Parc Taulí, Barcelona, España
| | - M J Cabero
- Neumología Infantil, Hospital Marqués de Valdecilla, , Santander, España
| | - J L Corzo
- Sección de Alergia Infantil, HMI, Málaga, España
| | - G García-Hernández
- Neumología y Alergia Pediátricas, Hospital Universitario 12 de Octubre, Madrid, España
| | - B de la Hoz
- Alergología Infantil, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Korta-Murua
- Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España
| | | | - J Torres-Borrego
- Unidad de Alergia y Neumología Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España
| | - M Tortajada-Girbés
- Neumología y Alergología Infantil, Hospital Universitario Dr. Peset, Valencia, España
| | - J Valverde-Molina
- Neumología Infantil, Hospital Universitario Los Arcos del Mar Menor, San Javier (Murcia), España
| | - L Zapatero
- Alergología Infantil, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - A Nieto
- Neumología y Alergología Infantil, Hospital La Fe, Valencia, España.
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Canonica GW, Bartezaghi M, Marino R, Rigoni L. Prevalence of perennial severe allergic asthma in Italy and effectiveness of omalizumab in its management: PROXIMA - an observational, 2 phase, patient reported outcomes study. Clin Mol Allergy 2015; 13:10. [PMID: 26155196 PMCID: PMC4494726 DOI: 10.1186/s12948-015-0019-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We designed the PROXIMA study (Patient-Reported Outcomes and Xolair(®) In the Management of Asthma) to determine the proportion of patients with severe asthma sensitive to perennial allergens, and to evaluate asthma control and treatment adherence up to 12 months in patients treated with omalizumab in Italian population. In addition, an ancillary study was designed to explore protein biomarkers and characterize them in relation to severe allergic asthma and treatment effects by proteomic approach. METHODS PROXIMA is an observational, multicenter, cross-sectional and prospective cohort study conducted at 25 centers in Italy, in outpatient settings. The study consists of two phases: 1) a cross-sectional phase plans to enroll 600 patients with severe allergic asthma, in step 4 therapy as per GINA guidelines, aged ≥18 years, needing a step up in therapy, and 2) a longitudinal phase on patients who will start omalizumab add-on therapy per clinician's judgment at baseline visit (approximately 180-240 patients). The primary variable of the cross-sectional phase is the proportion of patients with severe asthma presenting with perennial form of allergy (skin prick test or in vitro test). The primary variable of longitudinal phase is proportion of patients who achieve disease control (assessed by Asthma Control Questionnaire [ACQ]) with omalizumab at 6 months, and maintain it at 12 months. Secondary variables are patient compliance to omalizumab, patient-reported perception of cognitive and emotional impact of the illness, assessed by Brief Illness Perception Questionnaire (Brief IPQ) and the health related quality of life evaluated by the EuroQoL 5D-3 L (EQ-5D-3 L). Safety endpoints will be recorded during the course of the study. Patients participating in the longitudinal phase will be enrolled for ancillary study if they provide additional informed consent. Protein species in complex mixtures will be identified using innovative MudPIT (Multidimensional Protein Identification Technology) method. CONCLUSIONS The results of this observational study will provide estimate of patient population allergic to perennial allergens in Italy and information on patient-reported outcomes with omalizumab therapy in a real-world setting. The exploratory proteomic analysis on asthma biomarkers could eventually provide new data to identify responder patients to anti IgE therapy.
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Affiliation(s)
| | - Marta Bartezaghi
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
| | - Raffaele Marino
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
| | - Laura Rigoni
- />Novartis Farma SpA, Largo U. Boccioni 1, Origgio (VA), 21040 Italy
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Incorvaia C, Moingeon P, Buttafava S, Frati F. Focusing the mechanism of action to dissect the different treatments of respiratory allergy. Expert Rev Clin Immunol 2015; 11:1005-13. [PMID: 26143936 DOI: 10.1586/1744666x.2015.1064768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The treatment of respiratory allergy is based on several drugs with different mechanisms of action, which encompass an effect only on symptoms, limited factors of inflammation or the whole process of inflammation. Dissecting the different treatments by their mechanism of action is relevant for the management of allergic patients. Corticosteroids, administered as nasal sprays in rhinitis or by inhalation devices in asthma, and allergen immunotherapy (AIT) are the most effective treatments for respiratory allergy, achieving the control on inflammation by a number of cellular and molecular mechanisms. What distinguishes corticosteroids from AIT is the duration of clinical outcomes that ends with treatment withdrawal for the former but persists after stopping for AIT, due to its disease-modifying effect.
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Boyman O, Kaegi C, Akdis M, Bavbek S, Bossios A, Chatzipetrou A, Eiwegger T, Firinu D, Harr T, Knol E, Matucci A, Palomares O, Schmidt-Weber C, Simon HU, Steiner UC, Vultaggio A, Akdis CA, Spertini F. EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders. Allergy 2015; 70:727-54. [PMID: 25819018 DOI: 10.1111/all.12616] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 12/22/2022]
Abstract
Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1β, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.
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Affiliation(s)
- O. Boyman
- Department of Immunology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - C. Kaegi
- Department of Immunology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - M. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - S. Bavbek
- Division of Immunology and Allergy; Department of Pulmonary Disease; School of Medicine; Ankara University; Ankara Turkey
| | - A. Bossios
- Krefting Research Centre; Department of Internal Medicine and Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - A. Chatzipetrou
- Allergy Unit ‘D. Kalogeromitros’; 2nd Department of Dermatology and Venereology; ‘Attikon’ University Hospital; Medical School; University of Athens; Athens Greece
| | - T. Eiwegger
- Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - D. Firinu
- Unit of Internal Medicine, Allergy and Clinical Immunology; Department of Medical Sciences ‘M. Aresu’; University of Cagliari; Monserrato Italy
| | - T. Harr
- Service d'Immunologie et d'Allergologie; Spécialités de Médecine; Hôpitaux Universitaires de Genève; Geneva Switzerland
| | - E. Knol
- Departments of Immunology and Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Matucci
- Immunoallergology Unit; Department of Biomedicine; Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - O. Palomares
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - C. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Munich Germany
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - U. C. Steiner
- Division of Allergology and Clinical Immunology; Spitalnetz Bern Tiefenau Ziegler; Bern Switzerland
| | - A. Vultaggio
- Immunoallergology Unit; Department of Biomedicine; Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - F. Spertini
- Division of Immunology and Allergy; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
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Licari A, Marseglia G, Castagnoli R, Marseglia A, Ciprandi G. The discovery and development of omalizumab for the treatment of asthma. Expert Opin Drug Discov 2015; 10:1033-42. [PMID: 25979110 DOI: 10.1517/17460441.2015.1048220] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The evolution in immunological methods used to assess human allergic diseases has led to the identification of immunoglobulin E (IgE) as a diagnostic biomarker and a potential therapeutic target. Innovative technologies in molecular biology and immunogenetics contributed to the development of a selective blocking agent, disclosing new therapeutic perspectives in the treatment of allergic asthma. Omalizumab is the most advanced humanized anti-IgE monoclonal antibody that specifically binds serum-free IgE. Omalizumab also interrupts the allergic cascade by preventing binding of IgE with FcεRI receptors on mast cells, basophils, antigen-presenting cells and other inflammatory cells. AREAS COVERED This review discusses the discovery strategy and preclinical development of omalizumab. Furthermore, it also provides a clinical overview of the key trials leading to its launch and a detailed analysis of safety and post-marketing data. EXPERT OPINION The clinical efficacy of omalizumab in allergic asthma has been well documented in clinical trials, involving adults, adolescents and children with moderate-to-severe and severe allergic asthma. To date, omalizumab has also been approved in chronic idiopathic urticaria for patients 12 years and older who remain symptomatic despite high dosages of H1 antihistamines. Omalizumab has also been investigated in many other different patient populations beyond allergic asthma and may yet have an application to other indications. While omalizumab is the only mAb available for treating allergic asthma, the authors anticipate that new mAbs will emerge in the future that overcome omalizumab's current limitations.
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Affiliation(s)
- Amelia Licari
- University of Pavia, Foundation IRCCS Policlinico San Matteo, Department of Pediatrics , Pavia , Italy
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Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by local inflammation of the upper airways and sinuses which persists for at least 12 weeks. CRS can be divided into two phenotypes dependent on the presence of nasal polyps (NPs); CRS with NPs (CRSwNP) and CRS without NPs (CRSsNP). Immunological patterns in the two diseases are known to be different. Inflammation in CRSsNP is rarely investigated and limited studies show that CRSsNP is characterized by type 1 inflammation. Inflammation in CRSwNP is well investigated and CRSwNP in Western countries shows type 2 inflammation and eosinophilia in NPs. In contrast, mixed inflammatory patterns are found in CRSwNP in Asia and the ratio of eosinophilic NPs and non-eosinophilic NPs is almost 50:50 in these countries. Inflammation in eosinophilic NPs is mainly controlled by type 2 cytokines, IL-5 and IL-13, which can be produced from several immune cells including Th2 cells, mast cells and group 2 innate lymphoid cells (ILC2s) that are all elevated in eosinophilic NPs. IL-5 strongly induces eosinophilia. IL-13 activates macrophages, B cells and epithelial cells to induce recruitment of eosinophils and Th2 cells, IgE mediated reactions and remodeling. Epithelial derived cytokines, TSLP, IL-33 and IL-1 can directly and indirectly control type 2 cytokine production from these cells in eosinophilic NPs. Recent clinical trials showed the beneficial effect on eosinophilic NPs and/or asthma by monoclonal antibodies against IL-5, IL-4Rα, IgE and TSLP suggesting that they can be therapeutic targets for eosinophilic CRSwNP.
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Affiliation(s)
- Atsushi Kato
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Cianferoni A, Spergel JM. Immunotherapeutic approaches for the treatment of eosinophilic esophagitis. Immunotherapy 2015; 6:321-31. [PMID: 24762076 DOI: 10.2217/imt.14.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a clinical pathologic disease characterized by symptoms of esophageal dysfunction and eosinophilia of the esophagus. When the diagnosis is confirmed, it is important to treat the eosinophilic inflammation not only to control the presenting symptoms, but also to prevent acute and chronic complications. The pathogenesis of EoE is most likely a mixed IgE and non-IgE food-mediated reaction, where Th2 cytokines drive esophageal eosinophilia as in other atopic diseases. Hence, it is not surprising that therapy is based on inflammation control, with steroids (oral or topical) and/or food antigen avoidance. However, these treatment options are not specific, reduce the quality of life of patients and have significant side effects, therefore, there is an ongoing effort to design more specific immunotherapies. In this review, we review standard and immunotherapeutic options for EoE treatment, such as anti-IL-5, anti-TNFα, anti-IgE, anti-CRTH, oral allergy desensitization and environmental immunotherapy.
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Affiliation(s)
- Antonella Cianferoni
- Divisions of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, ARC 1216H, 3615 Civic Center Blvd, Philadelphia, PA 19104, USA
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Abstract
PURPOSE OF REVIEW There are a considerable number of patients with moderate-to-severe uncontrolled asthma needing additional therapy. Omalizumab, an anti-IgE monoclonal antibody, improves control while reducing IgE-mediated airway inflammation and potentially interfering in the progressive remodeling process. The clinical implications are reductions in the required doses of inhaled steroids, a decrease in exacerbation number, and a reduction in emergency room visits and hospitalizations. In addition to its use in asthma, there is an increasing interest on the use of omalizumab for other uncontrolled IgE-mediated diseases, supported by the favorable risk-benefit background. The present review explores the most recent publications on the use of omalizumab for allergic asthma and other atopic conditions in children. RECENT FINDINGS Omalizumab has also shown efficacy in allergic rhinitis, and it is being investigated in the treatment of anaphylaxis, food allergy, atopic dermatitis, and chronic spontaneous urticaria, as well as cystic fibrosis and allergic bronchopulmonary aspergillosis. Despite the benefits shown so far, more data are needed for optimal use in these conditions, particularly looking at the safety issues that have to be confirmed. SUMMARY Confirmatory evidence on the efficacy and safety of omalizumab in children is reviewed, as well as newest fields of applicability in which IgE is involved in disease mechanism.
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31
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McCormack PL. Omalizumab: A Review of Its Use in Patients with Chronic Spontaneous Urticaria. Drugs 2014; 74:1693-9. [DOI: 10.1007/s40265-014-0290-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Panasoff J. Eosinophil count and efficacy of omalizumab treatment. J Allergy Clin Immunol 2014; 133:1231. [PMID: 24679472 DOI: 10.1016/j.jaci.2014.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Josef Panasoff
- Allergy Department, Lin Medical Center, Clalit Health Services, Haifa, Israel.
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Observational study in severe asthmatic patients after discontinuation of omalizumab for good asthma control. Respir Med 2014; 108:571-6. [PMID: 24565601 DOI: 10.1016/j.rmed.2014.02.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Severe persistent asthma represents a major and costly public health issue. There is evidence that long-term treatment with omalizumab might have disease-modifying activity but data on the consequences of discontinuing treatment after a positive response are limited. The purpose of this study was to investigate-in real-life prescribing conditions-what happens when omalizumab is discontinued in patients with severe, persistent allergic asthma who have responded well to omalizumab treatment. METHODS An observational, descriptive, cross-sectional, retrospective study to establish the time to loss of asthma control after the discontinuation of courses of omalizumab treatment of varying duration. RESULTS 24 lung specialists reviewed data from 61 responder patients who had discontinued omalizumab after a mean duration of 22.7 ± 13.1 [range: 2.5; 59.5] months of treatment. Loss of asthma control was documented in 34 patients (55.7%) with a median interval between discontinuation and loss of control of 13.0 months (mean 20.4 ± 2.6 [95% CI: 8.3-28.1]). No correlation was detected between time to loss of control and duration of treatment, although control tended to be sustained for longer in patients whose response had been classified as "excellent" as opposed to "good" (median: 17.0 vs. 12.8 months; NS). DISCUSSION The discontinuation of omalizumab was not associated with any rebound effect or exacerbation of the disease, and control was sustained throughout the follow-up period of at least 6 months in nearly half of all patients, including all of those who had been treated for 3.5 years or more. After the reintroduction of omalizumab, 4 out of 20 patients did not respond again.
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Lucendo AJ, Molina-Infante J. Emerging therapeutic strategies for eosinophilic esophagitis. ACTA ACUST UNITED AC 2014; 12:1-17. [PMID: 24370990 DOI: 10.1007/s11938-013-0001-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Eosinophilic esophagitis (EoE) is recognized as an increasingly common cause of chronic and recurrent esophageal symptoms that significantly impact quality of life and may occasionally result in severe complications in both pediatric and adult patients. The disease is triggered and maintained by exposure to food antigens in most patients, with an additional role proposed for airborne allergens. Different diet-based approaches focused on restricting potentially offending foods have proven to be effective long-term therapies for EoE. Dietary therapy is thus an attractive, yet challenging treatment option that should be considered for all pediatric and adult EoE patients. However, limitations related to food restriction, patient willingness to undergo repeated endoscopies and biopsies, and the variable results of allergy testing imply that dietary management is for the most part currently restricted to highly motivated healthcare providers treating highly motivated patients reluctant to utilize drug-based therapy on a chronic basis. Pharmacological therapies for EoE mainly comprise swallowed topical steroids, especially fluticasone propionate and budesonide, which were originally developed to treat bronchial asthma and are now extensively used "off label" in EoE patients. In fact, topical steroids currently constitute the prevailing therapeutic option and will probably continue to do so in the near future; indeed, several randomized clinical trials are currently underway to test these drugs for approval as the first pharmacological agents for EoE patients. Immunomodulators and several anti-allergic agents must be further assessed as therapeutic alternatives for refractory cases or patients with complications. Endoscopic dilation represents the third pillar in the therapeutic management of EoE patients, since they frequently present reductions in the esophageal caliber as a result of collagen deposition and a progressive fibrous remodeling process promoted by chronic eosinophilic infiltration. Dilation provides at least temporary symptom relief with similar complication rates to esophageal strictures from a different origin. However, although repeated endoscopic dilation has sometimes been used as the sole therapy for EoE, it best constitutes an adjuvant therapy along with dietary or pharmacological-based interventions, especially since dilation has no effect on the underlying esophageal inflammation. Current therapeutic management of EoE varies widely, with physician experience being a major explanatory factor. New evidence from ongoing research on EoE should thus seek to define a common treatment algorithm to optimize EoE patient management.
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Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n, 13700, Tomelloso, Ciudad Real, Spain,
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