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Reale M, Licci G, Orlando P, Matucci A, Trabalzini F, Maggiore G, Gallo O. Efficacy and safety of dupilumab in the treatment of CRSwNP in the real-life setting: a review of the literature. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08725-7. [PMID: 38762844 DOI: 10.1007/s00405-024-08725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION The recent approval of Dupilumab has profoundly revolutionized the management of patients affected by severe and recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). However, a review that summarizes the results of real-life studies and compares them to phase 3 studies SINUS-24 and 52 is still lacking. MATERIALS AND METHODS A search of all real-life studies published from 2019 to 2023 was performed. Patients characteristics at baseline and 6 and 12 months after starting Dupilumab were extracted and compared to those from phase 3 trials: age, sex, smoking habits, comorbid asthma and aspirin-exacerbated respiratory disease (AERD), previous endoscopic sinus surgery (ESS), hematic eosinophils and total IgE, NasalAQ2 Polyps Score (NPS), smell, SNOT-22, adverse events (AEs), and response to treatment. RESULTS 15 papers were included with an overall number of 1658 patients. A higher rate of comorbidities and previous ESS was found in patients from real-life studies. In addition, they had worse smell and SNOT-22 at baseline compared to patients from SINUS-24 and 52. Comorbid and post-ESS patients tended to have a faster NPS and SNOT-22 improvement, although the absolute values were not clinically relevant. A more extensive surgery and a number of ESS ≥ 2 were related to worse olfactory outcomes, probably due to iatrogenic damage. No correlation was found between hematic eosinophils and outcomes. AEs were reported by 12.4% of patients and 2.2% had to discontinue dupilumab. Weight gain was an emergent AE (0.8%), probably related to the restored sense of smell and taste. Non-responders were 3.5% and they were switched to systemic steroid, ESS, or another biologic. CONCLUSION Despite some differences in prescription criteria between countries, dupilumab was demonstrated to be effective even in the real-life scenario. However, emerging AEs and possible unknown long-term AEs of a likely lifelong therapy should be considered.
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Affiliation(s)
- Marella Reale
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Andrea Matucci
- Department of Immunology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Zhang Z, Kong L, Lv M, Yao Y, Gao L, Zhou R, Ma W, Li J. PVA enema ameliorates DSS-induced acute colitis in mice. BMC Gastroenterol 2023; 23:368. [PMID: 37904100 PMCID: PMC10617076 DOI: 10.1186/s12876-023-03005-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Ulcerative colitis (UC) represents a clinically challenging condition characterized by persistent damage to the colonic epithelial mucosa as the principal pathological feature. Polyvinyl alcohol (PVA) solution, primarily composed of glue, is a biodegradable polymer material that has found utility in the medical field. This research endeavors to investigate the therapeutic potential of PVA water solution in ameliorating UC in mice. METHODS UC was induced in 48 C57BL/6 mice by administering 2.5% DSS in their diet for 6 days. Mice were treated with different concentrations of PVA (0.1 mg/ml PVA, 0.3 mg/ml PVA, 1 mg/ml PVA, 3 mg/ml PVA, 10 mg/ml PVA) enemas (n = 6). Disease Activity Index (DAI) and histologic score were evaluated for inflammation degree. Furthermore, mouse colon organoids were cultured, which were used to assess the effects of PVA on expansion in vitro. RESULTS PVA aqueous solutions (1 mg/ml and 3 mg/ml) were able to alleviate the DAI in mice. By DAY 6, there was a significant 3/5-fold decrease in DAI within the 1 mg/ml PVA group (p = 0.02). Histopathology scores demonstrated improvements, while the levels of inflammatory factors in the intestinal mucosal tissue were reduced. Additionally, it was confirmed that PVA could promote the expansion of colonic organoids in vitro. CONCLUSIONS In summary, our investigation has yielded findings indicating that PVA holds the potential to ameliorate symptoms associated with colitis in murine subjects afflicted by DSS-induced colitis, primarily through its facilitation of intestinal stem cell expansion. This study might provide a new candidate for the clinical treatment of ulcerative colitis.
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Affiliation(s)
- Zhiyong Zhang
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Pathology, Zibo Central Hospital, 54 Gongqingtuan Xi Road, Zibo, 255036, Shandong, China
| | - Lingnan Kong
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Pathology, Zibo Central Hospital, 54 Gongqingtuan Xi Road, Zibo, 255036, Shandong, China
| | - Ming Lv
- Zibo Central Hospital, Zibo, China
| | - Yukuan Yao
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Pathology, Zibo Central Hospital, 54 Gongqingtuan Xi Road, Zibo, 255036, Shandong, China
| | - Li Gao
- Department of Outpatient, Zibo Central Hospital, Zibo, China
| | - Ruchen Zhou
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenlong Ma
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Li
- Department of Pathology, Zibo Central Hospital, 54 Gongqingtuan Xi Road, Zibo, 255036, Shandong, China.
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Prakash VB, Rao YK, Prakash S, Sati ST, Mohapatra A, Negi N. Proof of Efficacy Study to Evaluate an Ayurvedic Formulation in the Treatment of Allergic Rhinitis: An Open Label Randomized Controlled Clinical Trial. Cureus 2023; 15:e46663. [PMID: 37942368 PMCID: PMC10628601 DOI: 10.7759/cureus.46663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Allergic rhinitis is largely treated by using antihistamines and nasal sprays, either alone or in combination. However, these measures ease out the symptoms but do not address causative factors, and have their share of side effects and limitations. An Ayurvedic herbo-mineral formulation, IMMBO, has been reported to be effective in treating allergic rhinitis. OBJECTIVE The present study was carried out to evaluate the efficacy, safety, and tolerability of the Ayurvedic herbo-mineral formulation in comparison with a fixed-dose combination of levocetirizine and montelukast. METHOD This was a randomized, comparative, clinical study carried out on 250 patients at a medical college in India. The patients were enrolled according to the eligibility criteria of the study and randomized into two groups, to receive either Ayurvedic herbo-mineral formulation, IMMBO, or a combination of levocetirizine and montelukast for 28 days. Total nasal symptom score (TNSS) and Immunoglobulin E (IgE) were calculated for evaluation of efficacy parameters. Result: At the end of therapy both IMMBO and levocetirizine and montelukast combination showed significant improvement in TNSS in both treated population and per protocol population. The IMMBO group had a statistically higher reduction in TNSSs compared to the levocetirizine + montelukast group (-5.70 vs. -3.31; p<0.01). There was a statistically significant difference in the reduction of IgE levels between the groups (-351.54 vs. -208.79; p<0.05). Conclusion: The findings of this study establish prima facie evidence about the efficacy and safety of Ayurvedic formulation. However, the said Ayurvedic formulation needs to be further developed scientifically.
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Affiliation(s)
- Vaidya B Prakash
- Ayurveda, Vaidya Chandra Prakash Cancer (VCPC) Research Foundation, Rudrapur, IND
| | - Yashwant K Rao
- Pediatrics, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Shikha Prakash
- Medicine, Padaav - A Specialty Ayurvedic Treatment Centre, Rudrapur, IND
| | - Sneha T Sati
- Clinical Research, Vaidya Chandra Prakash Cancer (VCPC) Research Foundation, Rudrapur, IND
| | - Ankita Mohapatra
- Clinical Research, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Neha Negi
- Clinical Research, Padaav - A Specialty Ayurvedic Treatment Centre, Rudrapur, IND
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Dahan P, de Oliveira PMN, Brum AR, Ribeiro ACP, Figueiredo AA, de Bessa J, Murillo B. J. Treating asthma in patients with enuresis: repercussions on urinary symptoms. Int Braz J Urol 2023; 49:590-598. [PMID: 37450772 PMCID: PMC10482458 DOI: 10.1590/s1677-5538.ibju.2023.0101] [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: 03/05/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.
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Affiliation(s)
- Patricia Dahan
- Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de PediatriaJuiz de ForaMGBrasilDepartamento de Pediatria, Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
| | - Pricila Mara Novais de Oliveira
- Universidade Federal de Juiz de ForaHospital UniversitárioDepartamento de Fisioterapia PediátricaJuiz de ForaMGBrasilDepartamento de Fisioterapia Pediátrica do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Aparecida Regina Brum
- Hospital Evandro RibeiroJuiz de ForaMGBrasilServiço de Otorrinolaringologia do Hospital Evandro Ribeiro, Juiz de Fora, MG, Brasil
| | - André Costa Pinto Ribeiro
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia do Hospital UniversitárioDepartamento de OtorrinolaringologiaJuiz de ForaMGBrasilDepartamento de Otorrinolaringologia, Departamento de Cirurgia do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - André Avarese Figueiredo
- Universidade Federal de Juiz de ForaDepartamento de CirurgiaDivisão de UrologiaJuiz de ForaMGBrasilDepartamento de Cirurgia- Divisão de Urologia, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de CirurgiaDivisão de UrologiaFeira de SantanaBahiaBrasilDepartamento de Cirurgia - Divisão de Urologia, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil
| | - José Murillo B.
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de CirurgiaJuiz de ForaMGBrasilDepartamento de Cirurgia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
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Zhang M, Ao T, Cheng L. Highlights of the treatment of allergic rhinitis according to Chinese guidelines. Curr Opin Allergy Clin Immunol 2023; 23:334-340. [PMID: 37357787 DOI: 10.1097/aci.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines. RECENT FINDINGS Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients. SUMMARY This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.
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Affiliation(s)
- Min Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Tian Ao
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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