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Crimi C, Nolasco S, Noto A, Maglio A, Quaranta VN, Di Bona D, Scioscia G, Papia F, Caiaffa MF, Calabrese C, D'Amato M, Pelaia C, Campisi R, Vitale C, Ciampo L, Dragonieri S, Minenna E, Massaro F, Gallotti L, Macchia L, Triggiani M, Scichilone N, Valenti G, Pelaia G, Foschino Barbaro MP, Carpagnano GE, Vatrella A, Crimi N. Long-Term Clinical and Sustained REMIssion in Severe Eosinophilic Asthma Treated With Mepolizumab: The REMI-M Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00852-3. [PMID: 39197750 DOI: 10.1016/j.jaip.2024.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/01/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Biological therapies, such as mepolizumab, have transformed the treatment of severe eosinophilic asthma. Although mepolizumab's short-term effectiveness is established, there is limited evidence on its ability to achieve long-term clinical remission. OBJECTIVE To evaluate the long-term effectiveness and safety of mepolizumab, explore its potential to induce clinical and sustained remission, and identify baseline factors associated with the likelihood of achieving remission over 24 months. METHODS The REMIssion in Severe Eosinophilic Asthma Treated with Mepolizumab (REMI-M) is a retrospective, real-world, multicenter study that analyzed 303 patients with severe eosinophilic asthma who received mepolizumab. Clinical, demographic, and safety data were collected at baseline, 3, 6, 12, and 24 months. The most commonly used definitions of clinical remission, which included no exacerbations, no oral corticosteroid (OCS) use, and good asthma control with or without assessment of lung function parameters, were assessed. Sustained remission was defined as reaching clinical remission at 12 months and maintaining it until the end of the 24-month period. RESULTS Clinical remission rates ranged from 28.6% to 43.2% after 12 months and from 26.8% to 52.9% after 24 months based on the different remission definitions. The proportion of patients achieving sustained remission varied between 14.6% and 29%. Factors associated with the likelihood of achieving clinical remission included the presence of aspirin-exacerbated respiratory disease, better lung function at baseline, male sex, absence of anxiety/depression, gastroesophageal reflux disease, bronchiectasis, and reduced OCS consumption. Adverse events were infrequent. CONCLUSIONS This study demonstrates the real-world effectiveness of mepolizumab in achieving clinical remission and sustained remission in severe eosinophilic asthma over 24 months. The identification of distinct factors associated with the likelihood of achieving clinical remission emphasizes the importance of comprehensive management of comorbidities and timely identification of patients who may benefit from biologics.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy.
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi," Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino," Messina, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Vitaliano Nicola Quaranta
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University "Aldo Moro," Bari, Italy
| | - Danilo Di Bona
- Department of Medical and Surgical Sciences, School of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Maria D'Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Carolina Vitale
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Luigi Ciampo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Silvano Dragonieri
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University "Aldo Moro," Bari, Italy
| | - Elena Minenna
- Department of Medical and Surgical Sciences, School of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Federica Massaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Lorena Gallotti
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University "Aldo Moro," Bari, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | | | - Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University "Aldo Moro," Bari, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Terl M, Diamant Z, Kosturiak R, Jesenak M. Choosing the right biologic treatment for individual patients with severe asthma - Lessons learnt from Picasso. Respir Med 2024; 234:107766. [PMID: 39181277 DOI: 10.1016/j.rmed.2024.107766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/07/2024] [Accepted: 08/10/2024] [Indexed: 08/27/2024]
Abstract
Severe asthma represents a true challenge for clinicians from two basic perspectives, i.e.: a rational assessment of the underlying endo/phenotype and the subsequent selection of the best fitted (personalized) and effective treatment. Even though asthma is a heterogeneous disease, in the majority of therapy-compliant patients, it is possible to achieve (almost) complete disease control or even remission through conventional and quite uniform step-based pharmacotherapy, even without phenotyping. However, the absence of deeper assessment of individual patients revealed its handicap to its fullest extent during the first years of the new millennium upon the launch of biological therapeutics for patients with the most severe forms of asthma. The introduction of differentially targeted biologics into clinical practice became a challenge in terms of understanding and recognizing the etiopathogenetic heterogeneity of the asthmatic inflammation, pheno/endotyping, and, consequently, to choose the right biologic for the right patient. The answers to the following three questions should lead to correct identification of the dominant pheno/endotype: Is it really (severe) asthma? Is it eosinophilic asthma? If eosinophilic, is it (predominantly) allergen-driven? The identification of the best achievable and relevant alliance between endotypes and phenotypes ("euphenotypes") should be based not only on the assessment of the actual clinical characteristics and laboratory biomarkers, but more importantly, on the evaluation of their development and changes over time. In the current paper, we present a pragmatic three-step approach to severe asthma diagnosis and management.
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Affiliation(s)
- Milan Terl
- Department of Pneumology and Phthisiology, University Hospital and Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - Zuzana Diamant
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Dept Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Belgium; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Radovan Kosturiak
- Outpatient Clinic for Clinical Immunology and Allergology, Nitra, Slovak Republic; Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic.
| | - Milos Jesenak
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic; Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic; Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic.
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Kong Y, Wang Z, Yu H, Dong A, Song Y, Guo L, Zhu J, Sun L, Guo Y. YiQi GuBen formula alleviates airway inflammation and airway remodeling in OVA-induced asthma mice through TLR4/NF-κB signaling pathway. J Pharm Pharmacol 2024; 76:1028-1037. [PMID: 38824434 DOI: 10.1093/jpp/rgae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND We aim to investigate the effect of YiQi GuBen formula (YQGB) on airway inflammation and airway remodeling in the ovalbumin (OVA)-induced asthma model to further explore the potential mechanisms of YQGB in treating allergic asthma. METHODS Mice were divided into five groups randomly (n = 10): the control group, OVA group, OVA + Dex (0.1 mg/kg) group, OVA + low-dose (1.1 g/kg) YQGB group, and OVA + high-dose (2.2 g/kg) YQGB group. Inflammatory cell count and IgE were detected in bronchoalveolar lavage fluid (BALF). Lung tissue histopathology was observed by using H&E, PAS, Masson, and immunohistochemistry staining. qRT-PCR and western blot were applied to analyze key genes and proteins associated with TLR4 and NF-κB signaling pathways. RESULTS In OVA-induced asthma mice, YQGB decreased eosinophils and IgE in BALF. YQGB alleviated the OVA-induced inflammatory infiltration and declined IL-4, IL-5, IL-13, Eotaxin, ECP, GM-CSF, LTC4, and LTD4. YQGB attenuated the OVA-induced goblet cell metaplasia and mucus hypersecretion. YQGB mitigated the OVA-induced subepithelial fibrosis and lowered TGF-β1, E-Cadherin, Vimentin, and Fibronectin. YQGB ameliorated the OVA-induced airway smooth muscle thickening and lessened α-SMA and PDGF levels. YQGB reduced the expression of TLR4, MyD88, TRAF6, IκBα, and p65 mRNAs, and IκBα and p-p65 protein levels were also reduced. CONCLUSION YQGB exhibits the anti-asthma effect by reducing airway inflammation and airway remodeling through suppressing TLR4/NF-κB signaling pathway, and is worth promoting clinically.
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Affiliation(s)
- Yibu Kong
- College of Traditional Chinese Medicine, Changchun University of Chinese Medical, No.1035, Boshuo Road, Jingyue District, Changchun 130017, China
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
| | - Zhongtian Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medical, No.1035, Boshuo Road, Jingyue District, Changchun 130017, China
| | - Hongjun Yu
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
| | - Aiai Dong
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
| | - Yongfu Song
- College of Traditional Chinese Medicine, Changchun University of Chinese Medical, No.1035, Boshuo Road, Jingyue District, Changchun 130017, China
| | - Lei Guo
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
| | - Jinpu Zhu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medical, No.1035, Boshuo Road, Jingyue District, Changchun 130017, China
| | - Liping Sun
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
| | - Yinan Guo
- College of Traditional Chinese Medicine, Changchun University of Chinese Medical, No.1035, Boshuo Road, Jingyue District, Changchun 130017, China
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 1478, Gongnong Road, Chaoyang District, Changchun 130021, Jilin, China
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Pavord ID, Casale TB, Corren J, FitzGerald MJ, Deniz Y, Altincatal A, Gall R, Pandit-Abid N, Radwan A, Jacob-Nara JA, Rowe PJ, Busse WW. Dupilumab Reduces Exacerbations Independent of Changes in Biomarkers in Moderate-to-Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1763-1772. [PMID: 38555079 DOI: 10.1016/j.jaip.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Changes from baseline in fractional exhaled nitric oxide (FeNO) and blood eosinophil count (Eos) may be related to efficacy outcomes in dupilumab-treated patients with moderate-to-severe asthma. OBJECTIVE This post hoc analysis investigated biomarker changes in placebo- and dupilumab-treated patients with uncontrolled moderate-to-severe asthma enrolled in QUEST (NCT02414854). METHODS Spline analyses of annualized severe exacerbation rate (AER) and change from baseline in pre-bronchodilator (BD) forced expiratory volume in 1 second (FEV1) at week 52 were performed as a function of the fold change in FeNO at week 52 and the maximum fold change in Eos over weeks 0-12 (also change from baseline in pre-BD FEV1 at week 12). RESULTS The combined placebo and dupilumab groups comprised 638 and 1264 patients, respectively. FeNO levels declined rapidly by week 2 and then gradually to week 52 in patients treated with dupilumab versus placebo; Eos, after initially increasing with dupilumab, declined slightly from baseline in both treatment groups. AER during QUEST showed no significant association with the change in biomarkers in either treatment group. The change from baseline in pre-BD FEV1 at week 52 was inversely associated with the fold change in FeNO in both groups, with a significant difference between the dupilumab and placebo curves (P = .014), and was positively associated with the fold change in Eos in both groups (P = .022). CONCLUSIONS Relative changes in FeNO and Eos were not associated with AER, regardless of treatment arm. However, changes in both biomarkers showed a predictive value for lung function improvement; for FeNO, this was specific to the dupilumab treatment arm.
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Affiliation(s)
- Ian D Pavord
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
| | - Jonathan Corren
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | | | | | | | - Amr Radwan
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | | | | | - William W Busse
- UW Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Raduna O, Oprescu B, Mihaicuta S, Frent S. Relapsing Eosinophilia in a Severe Allergic Asthma Patient on Biological Therapy. J Clin Med 2024; 13:3402. [PMID: 38929930 PMCID: PMC11204118 DOI: 10.3390/jcm13123402] [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: 04/18/2024] [Revised: 05/11/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Severe asthma often remains uncontrolled despite optimized inhaled treatment. The rise of biologic therapy in severe asthma represented a major advance for the disease management. However, correct phenotyping and monitoring of severe asthma patients is key to the success of targeted biologic therapy. Materials and Methods: We present the case of a 63-year-old female, never a smoker, diagnosed with asthma at the age of 45 and associated persistent mild rhinitis, without other notable comorbidities. She was prescribed medium-dose ICS/LABA, administered inconstantly in the first years after the diagnosis, with poor overall control of the disease. After several exacerbation episodes, treatment compliance improved, but the control of the disease remained poor despite adding an antileukotriene. In January 2019, she presented an exacerbation episode requiring treatment with oral corticosteroids (OCS) and she was afterwards put on high-dose ICS/LABA and continued the antileukotriene. She was referred for a skin allergy test, which revealed mild sensitization to Dermatophagoides pteronyssinus and farinae, with a total IgE level of 48.3 IU/mL. The blood eosinophil level was 270 cells/mm3. The lung function was variable, going from mild impairment to severe fixed obstruction during exacerbations. Despite optimized inhaled treatment, good adherence and inhaler technique, and allergen avoidance strategies, asthma control was not achieved, and she continued to experience severe episodes of exacerbation requiring OCS. Results: In October 2019, she was initiated on biologic therapy with omalizumab, which allowed asthma control to be achieved and maintained for 18 months, with preserved lung function, good symptom control, no exacerbations and slightly elevated blood eosinophil level (340-360 cells/mm3). In April 2021, she started experiencing exacerbation episodes requiring OCS (three episodes within 6 months), with a progressive increase in blood eosinophil level (up to 710 cells/mm3), and progressive deterioration of asthma control and lung function, despite continuation of previous therapy. A specific IgE test against Aspergillus was negative, and total IgE level was 122.4 IU/mL. In December 2021, the patient was switched from omalizumab to benralizumab. Asthma control was again achieved, lung function improved significantly and the patient did not experience any other exacerbation episodes up until today, which allowed for a reduction in ICS dose. Intriguingly, a relapsing eosinophilia was also noted under anti-IL5-R treatment prior to the dose administration, but with preserved asthma control. Conclusions: This case underscores the pivotal role of meticulous phenotyping in severe asthma management on one side, and careful monitoring of patient evolution and possible side effects of treatment on the other side. By showcasing how diverse inflammatory pathways can coexist within a single patient and impact treatment outcomes, it highlights the necessity of tailored biologic therapy for sustained control.
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Affiliation(s)
- Oana Raduna
- “Victor Babes” Infectious Diseases and Pulmonology Clinical Hospital Timisoara, 300310 Timisoara, Romania; (O.R.); (S.M.); (S.F.)
| | - Bianca Oprescu
- “Victor Babes” Infectious Diseases and Pulmonology Clinical Hospital Timisoara, 300310 Timisoara, Romania; (O.R.); (S.M.); (S.F.)
| | - Stefan Mihaicuta
- “Victor Babes” Infectious Diseases and Pulmonology Clinical Hospital Timisoara, 300310 Timisoara, Romania; (O.R.); (S.M.); (S.F.)
- Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Stefan Frent
- “Victor Babes” Infectious Diseases and Pulmonology Clinical Hospital Timisoara, 300310 Timisoara, Romania; (O.R.); (S.M.); (S.F.)
- Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Geissler KH, Shieh MS, Krishnan JA, Lindenauer PK, Ash AS, Goff SL. Health Insurance Type and Outpatient Specialist Care Among Children With Asthma. JAMA Netw Open 2024; 7:e2417319. [PMID: 38884996 PMCID: PMC11184461 DOI: 10.1001/jamanetworkopen.2024.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/17/2024] [Indexed: 06/18/2024] Open
Abstract
Importance Although children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance. Objective To examine differences among children with asthma regarding receipt of asthma specialist care by insurance type. Design, Setting, and Participants In this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children's Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024. Exposure Medicaid vs private insurance. Main Outcomes and Measures The primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time. Results Among 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, -10.4 percentage points to -9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma. Conclusions and Relevance In this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.
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Affiliation(s)
- Kimberley H. Geissler
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield
| | - Jerry A. Krishnan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago
- Office of Population Health Sciences, University of Illinois Chicago
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst
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Panettieri Jr R, Lugogo N, Corren J, Ambrose CS. Tezepelumab for Severe Asthma: One Drug Targeting Multiple Disease Pathways and Patient Types. J Asthma Allergy 2024; 17:219-236. [PMID: 38524099 PMCID: PMC10960583 DOI: 10.2147/jaa.s342391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Asthma is a heterogeneous inflammatory disease of the airways, affecting many children, adolescents, and adults worldwide. Up to 10% of people with asthma have severe disease, associated with a higher risk of hospitalizations, greater healthcare costs, and poorer outcomes. Patients with severe asthma generally require high-dose inhaled corticosteroids and additional controller medications to achieve disease control; however, many patients remain uncontrolled despite this intensive treatment. The treatment of severe uncontrolled asthma has improved with greater understanding of asthma pathways and phenotypes as well as the advent of targeted biologic therapies. Tezepelumab, a monoclonal antibody, blocks thymic stromal lymphopoietin, an epithelial cytokine that has multifaceted effects on the initiation and persistence of asthma inflammation and pathophysiology. Unlike other biologic treatments, tezepelumab has demonstrated efficacy across severe asthma phenotypes, with the magnitude of effects varying by phenotype. Here we describe the anti-inflammatory effects and efficacy of tezepelumab across the most relevant phenotypes of severe asthma. Across clinical studies, tezepelumab reduced annualized asthma exacerbation rates versus placebo by 63-71% in eosinophilic severe asthma, by 58-68% in allergic severe asthma, by 67-71% in allergic and eosinophilic severe asthma, by 34-49% in type 2-low asthma, and by 31-41% in oral corticosteroid-dependent asthma. Furthermore, in all these asthma phenotypes, tezepelumab demonstrated higher efficacy in reducing exacerbations requiring hospitalizations or emergency department visits versus placebo. In patients with severe uncontrolled asthma, who commonly have multiple drivers of inflammation and disease, tezepelumab may modulate airway inflammation more extensively, as other available biologics block only specific downstream components of the inflammatory cascade.
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Affiliation(s)
- Reynold Panettieri Jr
- Rutgers Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, USA
| | - Njira Lugogo
- Michigan Medicine Asthma Program, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Corren
- Departments of Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Joshi PR. Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges. Geriatrics (Basel) 2024; 9:34. [PMID: 38525751 PMCID: PMC10961796 DOI: 10.3390/geriatrics9020034] [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: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
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Affiliation(s)
- Pushpa Raj Joshi
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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Luedders J, Poole JA, Rorie AC. Extreme Weather Events and Asthma. Immunol Allergy Clin North Am 2024; 44:35-44. [PMID: 37973258 DOI: 10.1016/j.iac.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The objective of this article is to review recent literature on the implications of extreme weather events such as thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes in relationship to asthma symptoms. Several studies have shown worsening of asthma symptoms with thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes. In particular, thunderstorm asthma can be exacerbated by certain factors such as temperature, precipitation, and allergen sensitization. Therefore, it is imperative that the allergy and immunology community be aware of the health effects associated with these extreme weather events in order to educate patients and engage in mitigation strategies.
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Affiliation(s)
- Jennilee Luedders
- Division of Allergy & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, 985990 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Jill A Poole
- Division of Allergy & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, 985990 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Andrew C Rorie
- Division of Allergy & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, 985990 Nebraska Medical Center, Omaha, NE 68198, USA
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Sasano H, Harada N, Harada S, Takeshige T, Sandhu Y, Tanabe Y, Ishimori A, Matsuno K, Nagaoka T, Ito J, Chiba A, Akiba H, Atsuta R, Izuhara K, Miyake S, Takahashi K. Pretreatment circulating MAIT cells, neutrophils, and periostin predicted the real-world response after 1-year mepolizumab treatment in asthmatics. Allergol Int 2024; 73:94-106. [PMID: 37336695 DOI: 10.1016/j.alit.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Mepolizumab treatment improves symptom control and quality of life and reduces exacerbations in patients with severe eosinophilic asthma. However, biomarkers that predict therapeutic effectiveness must be determined for use in precision medicine. Herein, we elucidated the dynamics of various parameters before and after treatment as well as patient characteristics predictive of clinical responsiveness to mepolizumab after 1-year treatment. METHODS Twenty-seven patients with severe asthma were treated with mepolizumab for one year. Asthma control test scores, pulmonary function tests, fractional exhaled nitric oxide levels, and blood samples were evaluated. Additionally, we explored the role of CD69-positive mucosal-associated invariant T (MAIT) cells as a candidate biomarker for predicting treatment effectiveness by evaluating an OVA-induced asthma murine model using MR1 knockout mice, where MAIT cells were absent. RESULTS The frequencies of CD69-positive group 1 innate lymphoid cells, group 3 innate lymphoid cells, natural killer cells, and MAIT cells decreased after mepolizumab treatment. The frequency of CD69-positive MAIT cells and neutrophils was lower and serum periostin levels were higher in responders than in non-responders. In the OVA-induced asthma murine model, CD69-positive MAIT cell count in the whole mouse lung was significantly higher than that in the control mice. Moreover, OVA-induced eosinophilic airway inflammation was exacerbated in the MAIT cell-deficient MR1 knockout mice. CONCLUSIONS This study shows that circulating CD69-positive MAIT cells, neutrophils, and serum periostin might predict the real-world response after 1-year mepolizumab treatment. Furthermore, MAIT cells potentially have a protective role against type 2 airway inflammation.
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Affiliation(s)
- Hitoshi Sasano
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan; Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan; Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Sonoko Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan; Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yuuki Sandhu
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yuki Tanabe
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ayako Ishimori
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tetsutaro Nagaoka
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Jun Ito
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Asako Chiba
- Department of Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisaya Akiba
- Department of Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Atsuta
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Sachiko Miyake
- Department of Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan; Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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11
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Nieto A, El-Sayed ZA, Gómez RM, Hossny E, Jiu-Yao W, Kalayci Ö, Morais-Almeida M, Phipatanakul W, Pitrez PM, Pozo Beltrán CF, Xepapadaki P, Papadopoulos NG. Unanswered questions on the use of biologics in pediatric asthma. World Allergy Organ J 2023; 16:100837. [PMID: 38020283 PMCID: PMC10656246 DOI: 10.1016/j.waojou.2023.100837] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
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Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit. Health Research Institute. Children's Hospital La Fe, Valencia, Spain
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Wang Jiu-Yao
- Research Center of Allergy, Immunology, and Microbiome (A.I.M.). China Medical University Children's Hospital, Taichung, Taiwan
| | - Ömer Kalayci
- Pediatric Allergy and Asthma, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo Marcio Pitrez
- School of Medicine, Pediatric Pulmonary Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK
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Talwar D, Yadav M, Maturu N, Sharma R, Meshram P, Das S. An early Indian experience with benralizumab - A compendium on severe asthma cases: a case series. F1000Res 2023; 12:1225. [PMID: 38434642 PMCID: PMC10904938 DOI: 10.12688/f1000research.132704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Severe eosinophilic asthma (SEA), one of the phenotypes of asthma that is characterized by elevated blood eosinophil counts, is a common cause of uncontrolled asthma. Patients with SEA often experience severe persistent symptoms and have frequent exacerbations despite optimal inhaler therapy. They also have poor lung function and quality of life (QoL). Benralizumab (Fasenra), a monoclonal antibody, has been approved for managing cases of SEA. This series of six cases, the first of its kind from India, aims to add to the real-world evidence of benralizumab in India. Methods: Benralizumab 30 mg (once in four weeks for the first three doses followed by a dose every eight weeks for two years) was administered in six patients with symptoms of cough, breathlessness on exertion, and wheezing, diagnosed with SEA. The following were the endpoints assessed: (i) overlap between high immunoglobulin E (IgE) and eosinophilic asthma; (ii) reduction of exacerbations; (iii) withdrawal of oral corticosteroids; and (iv) improvement in lung function and QoL. Results: In all cases, management with benralizumab resulted in optimal clinical and functional improvement, a decline in systemic steroid use, and improved QoL. Conclusions: The cases presented here are the first of their kind in the Indian asthmatic population with all SEA patients demonstrating significant improvement in symptoms with the use of benralizumab.
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Affiliation(s)
- Deepak Talwar
- Pulmonology and Sleep Medicine, Metro Hospitals and Heart Institute, Noida, Uttar Pradesh, 201301, India
| | - Manoj Yadav
- Pulmonology, Kailash Hospital, Centre for Respiratory Disease, Vadodara, Gujrat, 390007, India
| | - Nagarjuna Maturu
- Pulmonology, Yashodha Hospital, Hyderabad, Telangana, 500036, India
| | - Rahul Sharma
- Pulmonology, Yatharth Superspeciality Hospital, Noida, Uttar Pradesh, 201304, India
| | - Priti Meshram
- Pulmonology Medicine, GGMC and JJ Hospital, Mumbai, Maharashtra, 400008, India
| | - Soumya Das
- Pulmonology, B.P Poddar Hospital and Medical Research Centre, Kolkata, West Bengal, 700053, India
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Barnabas M, Awakan OJ, Rotimi DE, Akanji MA, Adeyemi OS. Exploring redox imbalance and inflammation for asthma therapy. Mol Biol Rep 2023; 50:7851-7865. [PMID: 37517067 DOI: 10.1007/s11033-023-08688-8] [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: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Asthma is a prolonged inflammatory disorder of the airways, that affects an estimated 300 million people worldwide. Asthma is triggered by numerous endogenous and exogenous stimuli with symptoms like wheezing, cough, short of breath, chest tightening, airway obstruction, and hyperreactivity observed in patients. OBJECTIVE The review seeks to identify targets of redox imbalance and inflammation that could be explored to create effective treatments for asthma. METHODS The methodology involved a search and review of literature relating to asthma pathogenesis, redox homeostasis, and inflammation. RESULTS Eosinophils and neutrophils are involved in asthma pathogenesis. These inflammatory cells generate high levels of endogenous oxidants such as hydrogen peroxide and superoxide, which could result in redox imbalance in the airways of asthmatics. Redox imbalance occurs when the antioxidant systems becomes overwhelmed resulting in oxidative stress. Oxidative stress and inflammation have been linked with asthma inflammation and severity. Reactive oxygen species (ROS)/reactive nitrogen species (RNS) cause lung inflammation by activating nuclear factor kappa-B (NF-κB), mitogen-activated protein kinase (MAPK), activator protein-1, as well as additional transcription factors. These factors stimulate cytokine production which ultimately activates inflammatory cells in the bronchi, causing lung cellular injury and destruction. ROS/RNS is also produced by these inflammatory cells to eradicate invading bacteria. Antioxidant treatments for asthma have not yet been fully explored. CONCLUSION Redox and inflammatory processes are viable targets that could be explored to create better therapy for asthma.
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Affiliation(s)
- Morayo Barnabas
- SDG 03 Group - Good Health & Well-being, Landmark University, Omu-Aran, 251101, Kwara State, Nigeria
- Department of Biochemistry, Medicinal Biochemistry, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran, 251101, Nigeria
| | - Oluwakemi J Awakan
- SDG 03 Group - Good Health & Well-being, Landmark University, Omu-Aran, 251101, Kwara State, Nigeria
- Department of Biochemistry, Medicinal Biochemistry, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran, 251101, Nigeria
| | - Damilare Emmanuel Rotimi
- SDG 03 Group - Good Health & Well-being, Landmark University, Omu-Aran, 251101, Kwara State, Nigeria
- Department of Biochemistry, Medicinal Biochemistry, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran, 251101, Nigeria
| | - Musbau A Akanji
- Department of Biochemistry, Kwara State University, Malete, Ilorin, Kwara State, Nigeria
| | - Oluyomi Stephen Adeyemi
- SDG 03 Group - Good Health & Well-being, Landmark University, Omu-Aran, 251101, Kwara State, Nigeria.
- Department of Biochemistry, Medicinal Biochemistry, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran, 251101, Nigeria.
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Casas-Maldonado F, Álvarez-Gutiérrez FJ, Blanco Aparicio M, Domingo Ribas C, Cisneros Serrano C, Soto Campos G, Román Bernal B, González-Barcala FJ. Treatment Patterns of Monoclonal Antibodies in Patients With Severe Uncontrolled Asthma Treated by Pulmonologists in Spain. OPEN RESPIRATORY ARCHIVES 2023; 5:100252. [PMID: 37810425 PMCID: PMC10556773 DOI: 10.1016/j.opresp.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/24/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and objectives The use of monoclonal antibody (mAb)-based therapies is becoming the new standard of care for severe uncontrolled asthma (SUA). Even though patients may qualify for one or more of these targeted treatments, based on different clinical criteria, a global vision of mAb prescription management in a large sample of hospitals is not well characterised in Spain.The objective was to give a global vision of mAb prescription management in a large sample of hospitals in Spain. Materials and methods We used an aggregate data survey method to interview pulmonology specialists in a large sample of Spanish centres (90). The following treatment-related information was obtained on patients treated with mAbs: specific mAbs prescribed, treatment interruption, switch and restart and the reasons for these treatment changes. Results mAb prescription was more frequent in females (13.3% females vs 7.4% males; p < 0.001). There were no differences in prevalence by hospital complexity level. In contrast, there were differences by geographical area. Omalizumab was the most prescribed mAb (6.2%), followed by mepolizumab (2.9%). Discontinuation of Omalizumab (due to a lack of effectivity) and switches from this mAb to mepolizumab were more frequent. Very few restarts to the first treatment were observed after a switch from ≥2 mAbs. Conclusions Omalizumab appeared as the most prescribed mAb in SUA but was also the most withdrawn; a specific and objective characterisation of patients with SUA, along with asthma phenotyping, and together with further evaluation of safety and effectiveness profiles, will lead to future progress in the management of SUA with mAbs.
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Affiliation(s)
- Francisco Casas-Maldonado
- Servicio de Neumología, Hospital Universitario Clínico San Cecilio, Avenida de la Investigación, s/n, Granada, Spain
| | | | | | - Christian Domingo Ribas
- Servei de Pneumologia, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Bellatera, Cerdanyola del Vallès, Spain
| | - Carolina Cisneros Serrano
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica La Princesa, Calle de Diego de León, 62, Madrid, Spain
| | - Gregorio Soto Campos
- Servicio de Neumología y Alergia, Hospital Universitario de Jerez, Ctra. Trebujena, s/n, Jerez de la Frontera, Cádiz, Spain
| | - Berta Román Bernal
- Servicio de Neumología, Hospital Dr. José Molina Orosa, Crta. Arrecife-San Bartolomé, Km 1, 3, Arrecife, Las Palmas, Spain
| | - Francisco-Javier González-Barcala
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana, s/n, Santiago de Compostela, A Coruña, Spain
- Departamento de Medicina-Universidad de Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias – CIBERES, Santiago de Compostela, Spain
- Grupo Traslational Research in Airway Diseases-FIDIS, Spain
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15
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Liaqat A, Mason M, Foster B, Gregory G, Patel A, Barlas A, Kulkarni S, Basso R, Patak P, Liaqat H, Qureshi M, Shehata A, Awad Y, Ghaly M, Gulzar Q, Doty W. Evidence-Based Approach of Biologic Therapy in Bronchial Asthma. J Clin Med 2023; 12:4321. [PMID: 37445357 DOI: 10.3390/jcm12134321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
The emergence of biologic agents in the treatment of bronchial asthma has a wide impact on improving quality of life, reducing morbidity, and overall health care utilization. These therapies usually work by targeting specific inflammatory pathways involving type 2 inflammation and are particularly effective in severe eosinophilic asthma. Various randomized controlled trials have shown their effectiveness by reducing exacerbation rates and decreasing required glucocorticoid dosages. One of the relatively newer agents, tezepelumab, targets thymic stromal lymphoprotein and has proven its efficacy in patients independent of asthma phenotype and serum biomarker levels. This article reviews the pathophysiologic mechanism behind biologic therapy and offers an evidence-based discussion related to the indication, benefits, and adverse effects of such therapies.
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Affiliation(s)
- Adnan Liaqat
- Pulmonary and Critical Care Medicine, McLaren Health/Michigan State University, Flint, MI 48532, USA
| | - Mathew Mason
- Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Brian Foster
- Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL 33321, USA
| | - Grant Gregory
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA
| | - Avani Patel
- Internal Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Aisha Barlas
- Internal Medicine, Mercy Health, Rockford, IL 61114, USA
| | - Sagar Kulkarni
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Rafaela Basso
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Pooja Patak
- Pulmonary and Critical Care Medicine, University of Missouri, Kansas City, MO 64110, USA
| | - Hamza Liaqat
- Internal Medicine, Wah Medical College, Wah Cantt 47040, Pakistan
| | - Muhammad Qureshi
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Abdelrahman Shehata
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Yousef Awad
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Mina Ghaly
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Qamar Gulzar
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
| | - Walter Doty
- Pulmonary and Critical Care Medicine, Southeast Health, Dothan, AL 36301, USA
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Bleecker ER, Meyers DA, Billheimer D, Li H, Newbold P, Kwiatek J, Hirsch I, Katial R, Li X. Clinical Implications of Longitudinal Blood Eosinophil Counts in Patients With Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1805-1813. [PMID: 36868471 DOI: 10.1016/j.jaip.2023.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The stability and variability of blood eosinophil counts (BECs) to phenotype patients with severe asthma is not fully understood. OBJECTIVE This post hoc, longitudinal, pooled analysis of placebo-arm patients from 2 phase 3 studies evaluated the clinical implications of BEC stability and variability in moderate-to-severe asthma. METHODS This analysis included patients from SIROCCO and CALIMA who received maintenance medium- to high-dosage inhaled corticosteroids plus long-acting β2-agonists; 2:1 patients with BECs of 300 cells/μL or higher and less than 300 cells/μL were enrolled. The BECs were measured 6 times over 1 year in a centralized laboratory. Exacerbations, lung function, and Asthma Control Questionnaire 6 scores were documented across patients grouped by BEC (<300 cells/μL or ≥300 cells/μL) and variability (<80% or ≥80% BECs less than or greater than 300 cells/μL). RESULTS Among 718 patients, 42.2% (n = 303) had predominantly high, 30.9% (n = 222) had predominantly low, and 26.9% (n = 193) had variable BECs. Prospective exacerbation rates (mean ± SD) were significantly greater in patients with predominantly high (1.39 ± 2.20) and variable (1.41 ± 2.09) BECs versus predominantly low (1.05 ± 1.66) BECs. Similar results were observed for the number of exacerbations while on placebo. CONCLUSIONS Although patients with variable BECs had intermittently high and low BECs, they experienced similar exacerbation rates to the predominantly high group, which were greater than those in the predominantly low group. A high BEC supports an eosinophilic phenotype in clinical settings without additional measurements, whereas a low BEC requires repeated measurements because it could reflect intermittently high or predominantly low BECs.
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Affiliation(s)
- Eugene R Bleecker
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz.
| | - Deborah A Meyers
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Dean Billheimer
- Arizona Statistical Consulting, University of Arizona College of Public Health, Tucson, Ariz
| | - Huashi Li
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Paul Newbold
- Late-stage Respiratory & Immunology, AstraZeneca, Gaithersburg, Md
| | - Justin Kwiatek
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Ian Hirsch
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Rohit Katial
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Xingnan Li
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
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Louis R, Harrison TW, Chanez P, Menzella F, Philteos G, Cosio BG, Lugogo NL, de Luiz G, Burden A, Adlington T, Keeling N, Kwiatek J, Garcia Gil E. Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1759-1770.e7. [PMID: 36948488 DOI: 10.1016/j.jaip.2023.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. OBJECTIVE Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. METHODS Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. RESULTS For non-OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. CONCLUSIONS These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction.
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Affiliation(s)
- Renaud Louis
- Department of Pneumology CHU Liége, GIGAI3, University of Liége, Liége, Belgium
| | - Tim W Harrison
- Respiratory Research Unit, Nottingham Respiratory NIHR BRC, University of Nottingham, Nottingham, UK; Global Medical Affairs, AstraZeneca, Cambridge, UK.
| | - Pascal Chanez
- Department of Respiratory CIC Nord INSERMINRAE C2VN, Aix Marseille University, Marseille, France
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, Local Health Authority, Montebelluna, Italy
| | - George Philteos
- Royal University Hospital, University of Saskatchewan, Saskatoon, Sask, Canada
| | - Borja G Cosio
- Hospital Son Espases-IdISBa and Ciberes, Palma de Mallorca, Spain
| | | | - Gustavo de Luiz
- Clinical Research and Respiratory Medicine Department, Vithas Xanit International Hospital, Benalmadena, Málaga, Spain
| | - Annie Burden
- Biometrics, Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Timothy Adlington
- Biometrics, Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Nanna Keeling
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Justin Kwiatek
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Del
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O'Byrne PM, Panettieri RA, Taube C, Brindicci C, Fleming M, Altman P. Development of an inhaled anti-TSLP therapy for asthma. Pulm Pharmacol Ther 2023; 78:102184. [PMID: 36535465 DOI: 10.1016/j.pupt.2022.102184] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Thymic stromal lymphopoietin (TSLP), an epithelial cell-derived cytokine, acts as a key mediator in airway inflammation and modulates the function of multiple cell types, including dendritic cells and group 2 innate lymphoid cells. TSLP plays a role in asthma pathogenesis as an upstream cytokine, and data suggest that TSLP blockade with the anti-TSLP monoclonal antibody, tezepelumab, could be efficacious in a broad asthma population. Currently approved asthma biologic therapies target allergic or eosinophilic disease and require phenotyping; therefore, an unmet need exists for a therapy that can address Type 2 (T2)-high and T2-low inflammation in asthma. All currently approved biologic treatments are delivered intravenously or subcutaneously; an inhaled therapy route that allows direct targeting of the lung with reduced systemic impact may offer advantages. Currently in development, ecleralimab (CSJ117) represents the first inhaled anti-TSLP antibody fragment that binds soluble TSLP and prevents TSLP receptor activation, thereby inhibiting further inflammatory signalling cascades. This anti-TSLP antibody fragment is being developed for patients with severe uncontrolled asthma despite standard of care inhaled therapy. A Phase IIa proof of concept study, using allergen bronchoprovocation as a model for asthma exacerbations, found that ecleralimab was well-tolerated and reduced allergen-induced bronchoconstriction in adult patients with mild asthma. These results suggest ecleralimab may be a promising, new therapeutic class for asthma treatment.
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Affiliation(s)
- Paul M O'Byrne
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada.
| | | | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen, Germany
| | | | | | - Pablo Altman
- Novartis Pharmaceuticals Corporation, New Jersey, USA.
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19
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Gil-Martínez M, Lorente-Sorolla C, Rodrigo-Muñoz JM, Lendínez MÁ, Núñez-Moreno G, de la Fuente L, Mínguez P, Mahíllo-Fernández I, Sastre J, Valverde-Monge M, Quirce S, Caballero ML, González-Barcala FJ, Arismendi E, Bobolea I, Valero A, Muñoz X, Cruz MJ, Martínez-Rivera C, Plaza V, Olaguibel JM, del Pozo V. Analysis of Differentially Expressed MicroRNAs in Serum and Lung Tissues from Individuals with Severe Asthma Treated with Oral Glucocorticoids. Int J Mol Sci 2023; 24:1611. [PMID: 36675122 PMCID: PMC9864670 DOI: 10.3390/ijms24021611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Nowadays, microRNAs (miRNAs) are increasingly used as biomarkers due to their potential contribution to the diagnosis and targeted treatment of a range of diseases. The aim of the study was to analyze the miRNA expression profiles in serum and lung tissue from patients with severe asthma treated with oral corticosteroids (OCS) and those without OCS treatment. For this purpose, serum and lung tissue miRNAs of OCS and non-OCS asthmatic individuals were evaluated by miRNAs-Seq, and subsequently miRNA validation was performed using RT-qPCR. Additionally, pathway enrichment analysis of deregulated miRNAs was conducted. We observed altered expression by the next-generation sequencing (NGS) of 11 miRNAs in serum, of which five (hsa-miR-148b-3p, hsa-miR-221-5p, hsa-miR-618, hsa-miR-941, and hsa-miR-769-5p) were validated by RT-qPCR, and three miRNAs in lung tissue (hsa-miR-144-3p, hsa-miR-144-5p, and hsa-miR-451a). The best multivariate logistic regression model to differentiate individuals with severe asthma, treated and untreated with OCS, was to combine the serum miRNAs hsa-miR-221-5p and hsa-miR-769-5p. Expression of hsa-miR-148b-3p and hsa-miR-221-5p correlated with FEV1/FVC (%) and these altered miRNAs act in key signaling pathways for asthma disease and the regulated expression of some genes (FOXO3, PTEN, and MAPK3) involved in these pathways. In conclusion, there are miRNA profiles differentially expressed in OCS-treated individuals with asthma and could be used as biomarkers of OCS treatment.
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Affiliation(s)
- Marta Gil-Martínez
- Immunoallergy Laboratory, Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Av. Reyes Católicos 2, 28040 Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Clara Lorente-Sorolla
- Immunoallergy Laboratory, Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - José M. Rodrigo-Muñoz
- Immunoallergy Laboratory, Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Av. Reyes Católicos 2, 28040 Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Miguel Ángel Lendínez
- Immunoallergy Laboratory, Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Gonzalo Núñez-Moreno
- Department of Genetics, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Bioinformatics Unit, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
| | - Lorena de la Fuente
- Department of Genetics, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
| | - Pablo Mínguez
- Department of Genetics, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Bioinformatics Unit, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
| | - Ignacio Mahíllo-Fernández
- Biostatistics and Epidemiology Unit, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Joaquín Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Marcela Valverde-Monge
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
| | - María L. Caballero
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
| | - Francisco J. González-Barcala
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Pulmonology Department, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Allergy Unit & Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Allergy Unit & Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Allergy Unit & Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Xavier Muñoz
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Pulmonology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - María Jesús Cruz
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Pulmonology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Pulmonology Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Vicente Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - José M. Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Severe Asthma Unit, Department of Allergy, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Victoria del Pozo
- Immunoallergy Laboratory, Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Av. Reyes Católicos 2, 28040 Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
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20
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Baseline FeNO Independently Predicts the Dupilumab Response in Patients With Moderate-to-Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 11:1213-1220.e2. [PMID: 36535524 DOI: 10.1016/j.jaip.2022.11.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND FeNO may have a role as both a prognostic and predictive biomarker in combination with eosinophils for assessing responsiveness to some biological therapies. OBJECTIVE We evaluated the value of baseline FeNO, adjusted for baseline blood eosinophil levels and other clinical characteristics, as an independent predictor of treatment response to dupilumab in patients with uncontrolled moderate-to-severe asthma. METHODS We performed a post hoc analysis of LIBERTY ASTHMA QUEST (NCT02414854), a phase 3, double-blind study in patients aged 12 years and older with uncontrolled moderate-to-severe asthma, who received dupilumab 200 or 300 mg, or placebo every 2 weeks up to 52 weeks. We assessed the annualized event rate of severe exacerbations and least-squares mean change from baseline in prebronchodilator FEV1 at weeks 12 and 52 in relationship to baseline FeNO, adjusted for eosinophils and other clinical characteristics. RESULTS The annualized event rate increased with increasing baseline FeNO in placebo and decreased in dupilumab groups. The relative risk of severe exacerbations was 22·7%, 58·3%, and 69·3% lower for dupilumab versus placebo for the FeNO less than 25, 25 to less than 50, and 50 and greater parts per billion subgroups. The magnitude of FEV1 improvement increased with higher baseline FeNO for dupilumab and was consistent across the continuum of FeNO levels in placebo. Both findings were independent of blood eosinophil levels. Significant differences were observed between FeNO subgroups. CONCLUSIONS Increased baseline FeNO was associated with greater clinical effects in dupilumab versus placebo independently of eosinophil levels and other clinical characteristics.
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21
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Qian Y, Sun Y, Chen Y, Mao Z, Shi Y, Wu D, Gu B, Liu Z, Zhang Q. Nrf2 regulates downstream genes by targeting miR-29b in severe asthma and the role of grape seed proanthocyanidin extract in a murine model of steroid-insensitive asthma. PHARMACEUTICAL BIOLOGY 2022; 60:347-358. [PMID: 35171066 PMCID: PMC8856085 DOI: 10.1080/13880209.2022.2032205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 11/14/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
CONTEXT Grape seed proanthocyanidin extract (GSPE) is effective in treating severe asthma (SA). OBJECTIVE To examine the relationship between Nrf2-miR-29b axis and SA, and to detect whether preventive use of GSPE relieves SA via it. MATERIALS AND METHODS We recruited 10 healthy controls, 10 patients with non-severe asthma (nSA), and 9 patients with SA from February 2017 to December 2017. Peripheral blood mononuclear cells from these volunteers were extracted. A murine model of steroid-insensitive asthma was established in six-week-old female BALB/c mice that were sensitised and challenged with OVA, Al(OH)3 and LPS for 31 days. Mice in the treated groups were injected with DXM (5 mg/kg/d), with or without GSPE (100 mg/kg/d). Control group received PBS. We performed quantitative real-time PCR, western blot and luciferase reporter assay in animal and cell models. RESULTS SA group demonstrated significantly lower concentrations of Nrf2 protein, Nrf2 mRNA, and miR-29b than nSA group and control group. Conversely, higher levels of platelet derived growth factor C (PDGFC), phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1), and collagen type III alpha 1 (COL3A1) were measured in SA than in the other two groups. PDGFC, PIK3R1, and COL3A1 were the target genes of miR-29b. GSPE + DXM significantly elevated the expression of Nrf2 (+188%), Nrf2 mRNA (+506%), and miR-29b (+201%), and significantly reduced the expression of PDGFC (-72%), PIK3R1 (-40%), and COL3A1 (-65%) compared with OVA + LPS. CONCLUSIONS Nrf2-miR-29b axis is involved in the pathogenesis of SA. GSPE, as an adjuvant drug, maybe a potential therapeutic agent for SA.
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Affiliation(s)
- Yan Qian
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yun Sun
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yi Chen
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Zhengdao Mao
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yujia Shi
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Di Wu
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Bin Gu
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Zhiguang Liu
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Qian Zhang
- The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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22
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Lim GN, Allen JC, Tiew PY, Chen W, Koh MS. Healthcare utilisation and health-related quality of life of severe asthma patients in Singapore. J Asthma 2022; 60:969-980. [PMID: 35972821 DOI: 10.1080/02770903.2022.2114086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BackgroundNotwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilisation, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised.ObjectivesTo determine the burden of disease and extent of quality of life impairment in SA patients in Singapore.MethodsA cross-sectional analysis of SA patients seen in Singapore General Hospital (2020-2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses.ResultsA total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation.ConclusionSA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.
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Affiliation(s)
| | | | - Pei Yee Tiew
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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23
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Marcos MC, Cisneros Serrano C. What is the added value of FeNO as T2 biomarker? FRONTIERS IN ALLERGY 2022; 3:957106. [PMID: 36032508 PMCID: PMC9403133 DOI: 10.3389/falgy.2022.957106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
There is increasing evidence about the role of nitric oxide in type 2 (T2) immune response. Fraction of exhaled nitric oxide (FeNO) is a product of airways inflammation and it is increased in patients with asthma. Since Gustaffson published the first article about this biomarker in the 1990s, interest has continued to grow. Compared with other T2 biomarkers such as blood eosinophil count, induced sputum, or serum periostin, FeNO has some remarkable advantages, including its not invasive nature, easy repeatability, and possibility to be performed even in patients with severe airway obstruction. It is considered as an indicator of T2 inflammation and, by the same token, a useful predictor for inhaled steroid response. It is difficult to determine the utility of nitric oxide (NO) for initial asthma diagnosis. In such a heterogenous disease, a single parameter would probably not be enough to provide a complete picture. There is also an important variability among authors concerning FeNO cutoff values and the percentage of sensibility and specificity for diagnosis. Its high specificity indicates a potential role to “rule in” asthma; however, its lower sensibility could suggest a lower capacity to “rule out” this pathology. For this reason, if a diagnosis of asthma is being considered, FeNO should be considered along with other tests. FeNO has also shown its utility to detect response to steroids, adherence to treatment, and risk of exacerbation. Even though there is not enough quality of evidence to establish overall conclusions, FeNO could be an alternative procedure to diagnose or exclude asthma and also a predictive tool in asthma treated with corticosteroids.
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24
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Soremekun S, Heaney LG, Skinner D, Bulathsinhala L, Carter V, Chaudhry I, Hosseini N, Eleangovan N, Murray R, Tran TN, Emmanuel B, Garcia Gil E, Menzies-Gow A, Peters M, Lugogo N, Jones R, Price DB. Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study. Thorax 2022:thorax-2021-217032. [PMID: 35922128 DOI: 10.1136/thorax-2021-217032] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
RATIONALE Progressive lung function (LF) decline in patients with asthma contributes to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however, evidence is limited with mixed results. METHODS This historical cohort study of a broad asthma patient population in the Optimum Patient Care Research Database, examined asthma patients with 3+eligible post-18th birthday peak expiratory flow rate (PEF) records (primary analysis) or records of forced expiratory flow in 1 s (FEV1) (sensitivity analysis). Adjusted linear growth models tested the association between mean annual exacerbation rate (AER) and LF trajectory. RESULTS We studied 1 09 182 patients with follow-up ranging from 5 to 50 years, of which 75 280 had data for all variables included in the adjusted analyses. For each additional exacerbation, an estimated additional -1.34 L/min PEF per year (95% CI -1.23 to -1.50) were lost. Patients with AERs >2/year and aged 18-24 years at baseline lost an additional -5.95 L/min PEF/year (95% CI -8.63 to -3.28) compared with those with AER 0. These differences in the rate of LF decline between AER groups became progressively smaller as age at baseline increased. The results using FEV1 were consistent with the above. CONCLUSION To our knowledge, this study is the largest nationwide cohort of its kind and demonstrates that asthma exacerbations are associated with faster LF decline. This was more prominent in younger patients but was evident in older patients when it was related to lower starting LF, suggesting a persistent deteriorating phenotype that develops in adulthood over time. Earlier intervention with appropriate management in younger patients with asthma could be of value to prevent excessive LF decline.
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Affiliation(s)
- Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London, UK, UK
| | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, UK
| | - Derek Skinner
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Isha Chaudhry
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Naeimeh Hosseini
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Neva Eleangovan
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Ruth Murray
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore
| | | | | | | | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rupert Jones
- Observational and Pragmatic Research Institute, Singapore.,Faculty of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore .,Optimum Patient Care UK, Cambridge, England, UK.,Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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25
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Development of a Novel Targeted Metabolomic LC-QqQ-MS Method in Allergic Inflammation. Metabolites 2022; 12:metabo12070592. [PMID: 35888716 PMCID: PMC9319984 DOI: 10.3390/metabo12070592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
The transition from mild to severe allergic phenotypes is still poorly understood and there is an urgent need of incorporating new therapies, accompanied by personalized diagnosis approaches. This work presents the development of a novel targeted metabolomic methodology for the analysis of 36 metabolites related to allergic inflammation, including mostly sphingolipids, lysophospholipids, amino acids, and those of energy metabolism previously identified in non-targeted studies. The methodology consisted of two complementary chromatography methods, HILIC and reversed-phase. These were developed using liquid chromatography, coupled to triple quadrupole mass spectrometry (LC-QqQ-MS) in dynamic multiple reaction monitoring (dMRM) acquisition mode and were validated using ICH guidelines. Serum samples from two clinical models of allergic asthma patients were used for method application, which were as follows: (1) corticosteroid-controlled (ICS, n = 6) versus uncontrolled (UC, n = 4) patients, and immunotherapy-controlled (IT, n = 23) versus biologicals-controlled (BIO, n = 12) patients. The results showed significant differences mainly in lysophospholipids using univariate analyses in both models. Multivariate analysis for model 1 was able to distinguish both groups, while for model 2, the results showed the correct classification of all BIO samples within their group. Thus, this methodology can be of great importance for further understanding the role of these metabolites in allergic diseases as potential biomarkers for disease severity and for predicting patient treatment response.
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26
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Meteran H, Tønnesen LL, Sivapalan P, Ingebrigtsen TS, Jensen JUS. Recent developments in the management of severe asthma. Breathe (Sheff) 2022; 18:210178. [PMID: 36338257 PMCID: PMC9584584 DOI: 10.1183/20734735.0178-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/07/2022] [Indexed: 12/03/2022] Open
Abstract
Fevipiprant is unlikely to be implemented as a future treatment for severe asthma, while tezepelumab may be a future treatment option for patients with severe asthma with and without eosinophilic inflammationhttps://bit.ly/3KE1BH4
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27
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Understanding the Cellular Sources of the Fractional Exhaled Nitric Oxide (FeNO) and Its Role as a Biomarker of Type 2 Inflammation in Asthma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5753524. [PMID: 35547356 PMCID: PMC9085317 DOI: 10.1155/2022/5753524] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) has gained great clinical importance as a biomarker of type 2 inflammation in chronic airway diseases such as asthma. FeNO originates primarily in the bronchial epithelium and is produced in large quantities by the enzyme inducible nitric oxide synthase (iNOS). It should be noted that nitric oxide (NO) produced at femtomolar to picomolar levels is fundamental for respiratory physiology. This basal production is induced in the bronchial epithelium by interferon gamma (IFNγ) via Janus kinases (JAK)/STAT-1 signaling. However, when there is an increase in the expression of type 2 inflammatory cytokines such as IL-4 and IL-13, the STAT-6 pathway is activated, leading to overexpression of iNOS and consequently to an overproduction of airway NO. Increased NO levels contributes to bronchial hyperreactivity and mucus hypersecretion, increases vascular permeability, reduces ciliary heartbeat, and promotes free radical production, airway inflammation, and tissue damage. In asthmatic patients, FeNO levels usually rise above 25 parts per billion (ppb) and its follow-up helps to define asthma phenotype and to monitor the effectiveness of corticosteroid treatment and adherence to treatment. FeNO is also very useful to identify those severe asthma patients that might benefit of personalized therapies with monoclonal antibodies. In this review, we revised the cellular and molecular mechanisms of NO production in the airway and its relevance as a biomarker of type 2 inflammation in asthma.
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Li L, Holloway JW, Ewart S, Arshad SH, Relton CL, Karmaus W, Zhang H. Newborn DNA methylation and asthma acquisition across adolescence and early adulthood. Clin Exp Allergy 2022; 52:658-669. [PMID: 34995380 PMCID: PMC9050758 DOI: 10.1111/cea.14091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Little is known about the association of newborn DNA methylation (DNAm) with asthma acquisition across adolescence and early adult life. OBJECTIVE We aim to identify epigenetic biomarkers in newborns for asthma acquisition during adolescence or young adulthood. METHODS The Isle of Wight Birth Cohort (IOWBC) (n = 1456) data at ages 10, 18 and 26 years were assessed. To screen cytosine-phosphate-guanine site (CpGs) potentially associated with asthma acquisition, at the genome scale, we examined differentially methylated regions (DMR) using dmrff R package and individual CpG sites using linear regression on such associations. For CpGs that passed screening, we examined their enrichment in biological pathways using their mapping genes and tested their associations with asthma acquisitions using logistic regressions. Findings in IOWBC were tested in an independent cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. RESULTS In total, 2636 unique CpGs passed screening, based on which we identified one biological pathway linked to asthma acquisition during adolescence in females (FDR adjusted p-value = .003 in IOWBC). Via logistic regressions, for females, four CpGs were shown to be associated with asthma acquisition during adolescence, and another four CpGs with asthma acquisition in young adulthood (FDR adjusted p-value < .05 in IOWBC) and these eight CpGs were replicated in ALSPAC (all p-values < .05). DNAm at all the identified CpGs was shown to be temporally consistent, and at six of the CpGs was associated with expressions of adjacent or mapping genes in females (all p-values < .05). For males, 622 CpGs were identified in IOWBC (FDR = 0.01), but these were not tested in ALSPAC due to small sample sizes. CONCLUSION AND CLINICAL RELEVANCE Eight CpGs on LHX5, IL22RA2, SOX11, CBX4, ACPT, CFAP46, MUC4, and ATP1B2 genes have the potential to serve as candidate epigenetic biomarkers in newborns for asthma acquisition in females during adolescence or young adulthood.
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Affiliation(s)
- Liang Li
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - John W. Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Ewart
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - S. Hasan Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- The David Hide Asthma and Allergy Research Centre, St Mary’s, Hospital, Parkhurst Road, Newport, Isle of Wight PO30 5TG, UK
| | - Caroline L. Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Porsbjerg CM, Menzies-Gow AN, Tran TN, Murray RB, Unni B, Audrey Ang SL, Alacqua M, Al-Ahmad M, Al-Lehebi R, Altraja A, Belevskiy AS, Björnsdóttir US, Bourdin A, Busby J, Canonica GW, Christoff GC, Cosio BG, Costello RW, FitzGerald JM, Fonseca JA, Hansen S, Heaney LG, Heffler E, Hew M, Iwanaga T, Jackson DJ, Kocks JWH, Kallieri M, Bruce Ko HK, Koh MS, Larenas-Linnemann D, Lehtimäki LA, Loukides S, Lugogo N, Maspero J, Papaioannou AI, Perez-de-Llano L, Pitrez PM, Popov TA, Rasmussen LM, Rhee CK, Sadatsafavi M, Schmid J, Siddiqui S, Taillé C, Taube C, Torres-Duque CA, Ulrik C, Upham JW, Wang E, Wechsler ME, Bulathsinhala L, Carter V, Chaudhry I, Eleangovan N, Hosseini N, Rowlands MA, Price DB, van Boven JFM. Global Variability in Administrative Approval Prescription Criteria for Biologic Therapy in Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1202-1216.e23. [PMID: 34990866 DOI: 10.1016/j.jaip.2021.12.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/08/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Regulatory bodies have approved five biologics for severe asthma. However, regional differences in accessibility may limit the global potential for personalized medicine. OBJECTIVE To compare global differences in ease of access to biologics. METHODS In April 2021, national prescription criteria for omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab were reviewed by severe asthma experts collaborating in the International Severe Asthma Registry. Outcomes (per country, per biologic) were (1) country-specific prescription criteria and (2) development of the Biologic Accessibility Score (BACS). The BACS composite score incorporates 10 prescription criteria, each with a maximum score of 10 points. Referenced to European Medicines Agency marketing authorization specifications, a higher score reflects easier access. RESULTS Biologic prescription criteria differed substantially across 28 countries from five continents. Blood eosinophil count thresholds (usually ≥300 cells/μL) and exacerbations were key requirements for anti-IgE/anti-IL-5/5R prescriptions in around 80% of licensed countries. Most countries (40% for dupilumab to 54% for mepolizumab) require two or more moderate or severe exacerbations, whereas numbers ranged from none to four. Moreover, 0% (for reslizumab) to 21% (for omalizumab) of countries required long-term oral corticosteroid use. The BACS highlighted marked between-country differences in ease of access. For omalizumab, mepolizumab, benralizumab, and dupilumab, only two, one, four, and seven countries, respectively, scored equal or higher than the European Medicines Agency reference BACS. For reslizumab, all countries scored lower. CONCLUSIONS Although some differences were expected in country-specific biologic prescription criteria and ease of access, the substantial differences found in the current study present a challenge to implementing precision medicine across the world.
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Affiliation(s)
- Celeste M Porsbjerg
- Respiratory Research Unit, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | | | - Ruth B Murray
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Bindhu Unni
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Shi Ling Audrey Ang
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andrey S Belevskiy
- Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Moscow, Russian Federation
| | - Unnur S Björnsdóttir
- Department of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | | | - João A Fonseca
- Health Information and Decision Sciences Department (MEDCIDS) and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Susanne Hansen
- Respiratory Research Unit, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - Daniel J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Janwillem W H Kocks
- Observational and Pragmatic Research Institute, Singapore, Singapore; General Practitioners Research Institute, Groningen, The Netherlands; Groningen Research Institute Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Kallieri
- Second Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Mariko Siyue Koh
- Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; SingHealth Duke-NUS Lung Centre, Duke-NUS Medical School, Singapore
| | - Désirée Larenas-Linnemann
- Directora Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico City, Mexico
| | - Lauri A Lehtimäki
- Allergy Centre, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stelios Loukides
- Second Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Andriana I Papaioannou
- Second Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Perez-de-Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Paulo Márcio Pitrez
- Hospital Moinhos de Vento, Porto Alegre, Brazil and Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Linda M Rasmussen
- Allergy Clinic, Copenhagen University Hospital-Gentofte, Hellerup, Denmark
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salman Siddiqui
- University of Leicester, Department of Respiratory Sciences and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | | | - Charlotte Ulrik
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - John W Upham
- Diamantina Institute and PA-Southside Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo; Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colo
| | - Lakmini Bulathsinhala
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Victoria Carter
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Isha Chaudhry
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Neva Eleangovan
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Naeimeh Hosseini
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Mari-Anne Rowlands
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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García-Moguel I, Rosado A, Gómez-Cardeñosa A, Gandolfo-Cano M, Robledo Echarren T, Moro Moro MDM, Reaño Martos MDM, Pineda-Pineda R, Valverde-Monge M, Martin-Arriscado Arroba C, Domínguez-Ortega J. Reliability, Satisfaction and Effectiveness of Benralizumab Home Self-Administration in Patients with Severe Eosinophilic Asthma in Real-World Practice: The Auto-Benra Study. J Asthma Allergy 2022; 15:623-632. [PMID: 35592384 PMCID: PMC9113658 DOI: 10.2147/jaa.s358738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The increase in drugs available for severe uncontrolled asthma and the lifestyle of these patients make it necessary to implement self-administration programs of these therapies at home. Benralizumab, a monoclonal antibody targeting IL5R, was authorized in Spain for poorly controlled severe eosinophilic asthma. The possibility of administration at home was approved in March 2020 in Spain. The aim of the Auto-Benra study was to evaluate the usability and satisfaction of the benralizumab prefilled syringe and autoinjector and assessing the effectivity of these devices in uncontrolled severe eosinophilic asthma (SEA) in home-self administration. Methods This is a retrospective, observational multicenter study uncontrolled SEA patients treated with benralizumab at least with 3 doses self-administered at home before April 30, 2021. Reliability and satisfaction with benralizumab at home were evaluated with subcutaneous administration assessment questionnaire (SQAAQ) and visual analogic scales (VAS). Effectiveness was evaluated in all patients with asthma control test (ACT), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), annual exacerbation rate, oral corticosteroid treatment (OCS) and asthma-related hospitalizations and emergency visits. Results Fifty-four patients across 9 hospitals in Spain were included. The mean SQAAQ score was 6.89 (±0.16) points. Patients and their caregivers and doctors report excellent satisfaction by VAS, with no differences between benralizumab devices used (prefilled syringe and autoinjector). Severe exacerbation rate decreased by 65% (p = 0.0007) after benralizumab treatment. ACT score improved on average 6.27 ± 5.35 points (p < 0.0001) and the mean MiniAQLQ increased up to 1.58 ± 1.47 points (p < 0.0001). Twenty-four patients were OCS-dependent and at the end of study 14 patients get complete OCS withdrawal. Conclusion AUTO-BENRA study supports the use of benralizumab at home given the excellent results of satisfaction and usability by patients and their caregivers.
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Affiliation(s)
- Ismael García-Moguel
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Correspondence: Ismael García-Moguel, Tel +34 645852229, Email
| | - Ana Rosado
- Department of Allergy, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aída Gómez-Cardeñosa
- Department of Allergy, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- Centro de investigación biomédica en enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
| | - Mar Gandolfo-Cano
- Department of Allergy, Hospital Universitario de Fuenlabrada, Madrid, Spain
- RETIC ARADyAL, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Robledo Echarren
- Department of Allergy, Hospital Clinico San Carlos (HCSC), Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | | | | | | | - Marcela Valverde-Monge
- Department of Allergy, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- Centro de investigación biomédica en enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
| | - Cristina Martin-Arriscado Arroba
- Research and Science Support Unit, Instituto de investigación Biomédica del Hospital Universitario 12 de Octubre I+12, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain
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Diver S, Sridhar S, Khalfaoui LC, Russell RJ, Emson C, Griffiths JM, de los Reyes M, Yin D, Colice G, Brightling CE. FeNO differentiates epithelial gene expression clusters: exploratory analysis from the MESOS randomised controlled trial. J Allergy Clin Immunol 2022; 150:830-840. [DOI: 10.1016/j.jaci.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/03/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022]
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Cohn L. Can asthma biologics change the course of disease and induce drug-free remission? J Allergy Clin Immunol 2022; 150:59-61. [PMID: 35447228 DOI: 10.1016/j.jaci.2022.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Lauren Cohn
- Yale School of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, 333 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057 and VA Connecticut Healthcare System, West Haven, CT 06516.
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Alsaffar RM, Alkholifi FK. Exploring the efficacy and contribution of Dupilumab in asthma management. Mol Immunol 2022; 146:9-17. [PMID: 35397375 DOI: 10.1016/j.molimm.2022.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/15/2023]
Abstract
IgG4 monoclonal antibody Dupilumab binds to the alpha chain (IL4R) of both types of the ligand-binding domains (IL4R/ IL13R1; equally IL4 and IL13 specific) of the IL-4 receptor. The current focus on precision medicine techniques to blocking pathways implicated in allergy disorders is crucial to the development of Dupilumab and broadening its therapeutic uses. Our review describes how the IL-4R complexes signaling pathway works, explores the probable mechanisms of Dupilumab activity and addresses its clinical usefulness and safety in asthma. The FDA (Food and Drug Administration) already licences it to treat Alzheimer's disease and moderate-to-severe asthma, and it has shown highly significant results in the management of chronic rhinosinusitis and Eosinophilic esophagitis (EoE). Previous investigations and clinical trials undertaken by various pharmaceutical firms are examined in this review article to assess the existing literature fully. The discovery of Dupilumab and the expanding range of therapeutic uses are pertinent to the current focus on precision medicine methods to blocking asthma-related pathways.
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Affiliation(s)
- Rana M Alsaffar
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia.
| | - Faisal K Alkholifi
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia
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MicroRNA-629-3p Promotes Interleukin-13-Induced Bronchial Epithelial Cell Injury and Inflammation by Targeting FOXA2. Cell Biochem Biophys 2022; 80:457-466. [DOI: 10.1007/s12013-022-01072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
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Loewenthal L, Menzies-Gow A. FeNO in Asthma. Semin Respir Crit Care Med 2022; 43:635-645. [DOI: 10.1055/s-0042-1743290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractAsthma is a common disease affecting 350 million people worldwide, which is characterized by airways inflammation and hyperreactivity. Historically diagnosis and treatment have been mainly based on symptoms, which have the potential to result in misdiagnosis and inappropriate treatment. Nitric oxide (NO) is exhaled in human breath and is a marker of airways inflammation. Levels of NO are increased in the exhaled breath of patients with type 2 asthma and fractional exhaled nitric oxide (FeNO) provides an objective biomarker of airway inflammation. FeNO testing is an accessible, noninvasive, and easy-to-use test. Cut-off values have been established by the American Thoracic Society (ATS), the Global Initiative for Asthma (GINA), and the National Institute for Health and Care Excellence (NICE) but vary between guidance. FeNO levels have been shown to be predictive of blood and sputum eosinophil levels but should not be used in isolation and current guidance emphasizes the importance of incorporating clinical symptoms and testing when utilizing FeNO results. The inclusion of FeNO testing can increase diagnostic accuracy of asthma, while high levels in asthmatic patients can help predict response to inhaled corticosteroids (ICS) and suppression of levels with ICS to monitor adherence. FeNO levels are also a predictor of asthma risk with increased exacerbation rates and accelerated decline in lung function associated with high levels as well as having an emerging role in predicting response to some biologic therapies in severe asthma. FeNO testing is cost-effective and has been shown, when combined with clinical assessment, to improve asthma management.
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Affiliation(s)
- Lola Loewenthal
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Andrew Menzies-Gow
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
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Abstract
INTRODUCTION New targets are needed to enable more accurate diagnosis, monitoring and effective therapy in uncontrolled asthma and chronic obstructive pulmonary disease (COPD), two disorders characterized by pathogenic alterations in the innate immune response. Interestingly, the IL-10-related cytokine IL-26 has been found to be abundantly expressed in human airways and alterations in its expression have been linked to reduced lung function and markers of neutrophilic inflammation in patients with uncontrolled asthma or COPD. AREAS COVERED Literature search was conducted on PubMed to identify articles in the field of IL-26 immunology, as well as clinical studies on IL-26 in asthma and COPD, published between 2000 and 2021. We outline the main sources of IL-26 in human airways, as well as the effect of this cytokine on relevant immune and structural cells. Finally, we discuss the potential involvement of IL-26 in the pathophysiology of uncontrolled asthma and COPD. EXPERT OPINION IL-26 constitutes a potential target for diagnostic purposes and therapeutic modulation of the innate immune response in the airways of patients with asthma and COPD. It seems reasonable to expect more conclusive evidence of its clinical utility for personalized medicine within the coming 5-year period.
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Affiliation(s)
- Eduardo I Cardenas
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Karlhans Fru Che
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jon R Konradsen
- Division of Clinical Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Center for Allergy Research, Karolinska Institute, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Aihua Bao
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Anders Lindén
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
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Carpagnano GE, Scioscia G, Buonamico E, Lacedonia D, Diaferia F, Capozza E, Lepore G, Resta O, Foschino Barbaro MP. Early effectiveness of type-2 severe asthma treatment with dupilumab in a real-life setting; a FeNO-driven choice that leads to winning management. Multidiscip Respir Med 2022; 17:797. [PMID: 35280851 PMCID: PMC8848342 DOI: 10.4081/mrm.2022.797] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Dupilumab is a humanized monoclonal antibody targeting the IL4/IL13 signaling pathway, already used for atopic dermatitis and chronic rhinitis with nasal polyps, recently approved for severe type-2 asthma. Its efficacy has been demonstrated in randomized control trials. The aim of our study is to evaluate possible early clinical improvement and type 2 biomarkers modifications in severe asthmatic patients treated with dupilumab in a real-life setting. Methods We included 12 patients with severe, uncontrolled asthma and dupilumab was chosen if there was at least one evidence of blood eosinophils> 150 cells/ml and/or FeNO>25 ppb during last year. Recent blood eosinophil count report, assessment through ACT, FeNO test and spirometry were performed at baseline and after 3 months of treatment. We calculated also the number of patients achieving a minimal, yet clinically relevant difference in FEV1 and ACT. Results After three months of treatment with dupilumab, ACT had a significant improvement (mean ACT pre 13.25±4.65 vs mean ACT post 19.17±4.45; p<0.01), so as FEV1% (mean FEV1% pre 62.58±15.73 vs mean FEV1% post 71.00±13.11; p<0.01). FeNO had a significant reduction (median FeNO 32 pre, IQR 19-48.5 vs median FeNO19 post, IQR 16.5-26), differently from eosinophils blood count (median eosinophils pre 280, IQR 193.8-647.3 vs median eosinophils post 349.5, IQR 103-836.8; p=0.52). Four patients (33%) had a positive MCID for FEV1, and eight patients (67%) had a positive MCID for ACT. Conclusions In RCTs performed during clinical development program dupilumab showed an early efficacy in increasing FEV1, reducing FeNO and improving asthma control. Our study demonstrates early improvement in asthmatic symptoms, lung function and FeNO in severe type-2 asthma patients after only 3 months of dupilumab biologic therapy. The introduction of FeNO levels evaluation in the selection criteria for dupilumab, further helps the identification of eligible patients among type-2 severe asthma patients and allows a complete outpatient assessment. Further real-life studies with a longer follow up time will be useful to confirm dupilumab efficacy and to promote its use in clinical practice.
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Chiner E, Hernández C, Blanco‐Aparicio M, Funenga‐Fitas E, Jiménez‐Ruiz C. Patient perspectives of the influence of severe and non‐severe asthma on their quality of life: A national survey of asthma patients in Spain. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:130-141. [PMID: 34766442 PMCID: PMC9060022 DOI: 10.1111/crj.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022]
Abstract
Introduction Little is known about adult asthma patients' perspective of their disease burden. This study aimed to obtain a comprehensive picture of patient needs, evaluate their knowledge, source of information, and perception of the severity of their asthma, and compare these variables between severe (SA) and non‐severe (NSA) asthma patients. Methods We conducted an online cross‐sectional survey in Spain among asthma patients aged ≥18 years. A bespoke questionnaire was used to collect sociodemographic data, asthma characteristics, treatments, disease burden, patient's perception of disease severity, and asthma information sources. Patients were classified as SA and NSA according to GINA 2020 treatment steps recommendations. To compare populations, 600 participants (200 SA and 400 NSA) were randomly selected to complete the survey. Results Participants were mostly women, mean age >38 years. SA patients underestimated the severity of their asthma; 52% judged it as mild, and only 2% considered their asthma severe. Overall, 50% of NSA and 96% of SA patients had experienced ≥1 exacerbation the previous year (p < 0.001). Fewer asthma exacerbations (SA) and improved quality of life (QoL) (NSA) were the most frequently expected therapy outcomes. NSA patients believe that asthma impacts their daily life (37%) and worsens QoL (34%) to a lesser degree than SA (67% and 59%, respectively; p < 0.001). Patient‐preferred sources of information were specialists (NSA:42%; SA: 38%) and primary care physicians (NSA: 41%; SA: 33%). Conclusions Despite the effective therapies currently available, the results of this study still show a significant emotional burden and QoL impairment in patients with severe asthma.
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Affiliation(s)
- Eusebi Chiner
- Pneumology Service Hospital Universitari Sant Joan d'Alacant Alicante Spain
| | - Carme Hernández
- Home Hospitalization Unit, Medical and Nursing Direction, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
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Koistinen V, Kauppi P, Idänpään-Heikkilä J, Veijalainen L, Iso-Mustajärvi I, Ylisaukko-oja T, Mehtälä J, Viinanen A, Kilpeläinen M. Effectiveness of mepolizumab in patients with severe eosinophilic asthma: results from real-world clinical practice in Finland. J Asthma 2022; 59:2375-2385. [DOI: 10.1080/02770903.2021.2020813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ville Koistinen
- Allergy Center, Tampere University Hospital, Tampere, Finland
| | - Paula Kauppi
- Department of Pulmonary Diseases and Allergology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | | | | | - Tero Ylisaukko-oja
- MedEngine Oy, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - Arja Viinanen
- Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Maritta Kilpeläinen
- Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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Wang CJ, Cheng SL, Kuo SH. Asthma and COVID-19 Associations: Focus on IgE-Related Immune Pathology. Life (Basel) 2022; 12:life12020153. [PMID: 35207441 PMCID: PMC8874771 DOI: 10.3390/life12020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
Management of patients with asthma during the coronavirus disease 2019 (COVID-19) pandemic is a concern, especially since asthma predisposes patients to respiratory problems. Interestingly, asthma characterized by type 2 inflammation, also known as T-helper type 2-high endotype, displays a cellular and molecular profile that may confer protective effects against COVID-19. The results of experimental and clinical studies have established the actions of immunoglobulin E (IgE) in inducing airway hyperreactivity and weakening an interferon-mediated antiviral response following respiratory viral infection. Robust evidence supports the beneficial effect of the anti-IgE biologic treatment omalizumab on reducing respiratory virus-induced asthma exacerbations and reducing the frequency, duration, and severity of respiratory viral illness in patients with asthma. Indeed, accumulating reports of patients with severe asthma treated with omalizumab during the pandemic have reassuringly shown that continuing omalizumab treatment during COVID-19 is safe, and in fact may help prevent the severe course of COVID-19. Accordingly, guidance issued by the Global Initiative for Asthma recommends that all patients with asthma continue taking their prescribed asthma medications, including biologic therapy, during the COVID-19 pandemic. The impact of biologic treatments on patients with asthma and COVID-19 will be better understood as more evidence emerges.
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Affiliation(s)
- Chung-Jen Wang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22056, Taiwan; (C.-J.W.); (S.-L.C.)
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22056, Taiwan; (C.-J.W.); (S.-L.C.)
- Department of Chemical Engineering and Materials Science, Yuab Ze University, Taoyuan City 32003, Taiwan
| | - Sow-Hsong Kuo
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22056, Taiwan; (C.-J.W.); (S.-L.C.)
- Correspondence:
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Goncharova IA, Bragina EY, Zhalsanova IZ, Freidin MB, Nazarenko MS. Putative regulatory functions of SNPs associated with bronchial asthma, arterial hypertension and their comorbid phenotype. Vavilovskii Zhurnal Genet Selektsii 2022; 25:855-863. [PMID: 35088020 PMCID: PMC8761574 DOI: 10.18699/vj21.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
Linkage disequilibrium (LD) of single nucleotide polymorphisms (SNPs) of TLR4/AL160272.2 (rs1927914, rs1928298, rs7038716, rs7026297, rs7025144) was estimated in the Slavs of West Siberia. We further investigated an association of SNPs in TLR4/AL160272.2 (rs1927914, rs7038716, rs7025144), SERPINA1 (rs1980616), ATXN2/BRAP (rs11065987), IL2RB (rs2284033), NT5C2 (rs11191582), CARD8 (rs11669386), ANG/RNASE4 (rs1010461), and ABTB2/ САТ (rs2022318) genes with bronchial asthma (BA), arterial hypertension (AH) and their comorbidity. Then, the disease-associated SNPs were annotated in silico in relation to their potential regulatory functions. Strong LD was detected between rs1928298 and rs1927914, as well as rs7026297 and rs7038716 in the Slavs of West Siberia. It was found that the rs1927914 G allele of the TLR4 gene and the rs1980616 C allele of the SERPINA1 gene are associated with the predisposition to BA. These SNPs can affect binding affinity of transcription factors of the Pou and Klf4 families, as well as the expression levels of the TLR4 and SERPINA1 genes. The rs11065987 allele A of the ATXN2/BRAP genes, the rs11669386 A allele of the CARD8 gene, the rs2284033 allele G of the IL2RB gene, and the rs11191582 allele G of the NT5C2 gene were associated with the risk of AH. These variants can alter binding affinity of the Hoxa9, Irf, RORalpha1 and HMG-IY transcription factors, as well as the expression levels of the ALDH2, CARD8, NT5C2, ARL3, and SFXN2 genes in blood cells/vessels/heart, respectively. The risk of developing a comorbid phenotype of AD and AH is associated with the A allele of rs7038716 and the T allele of rs7025144 of the TLR4/AL160272.2 genes, the A allele of rs1010461 of the ANG gene and the C allele of rs2022318 of the ABTB2/CAT genes. Variants rs7038716 and rs7025144 can change the expression levels of the TLR4 gene in blood cells, while rs1010461 and rs2022318 influence the expression levels of the ANG and RNASE4 genes as well as the CAT and ABTB2 genes in blood cells, lungs/vessels/heart.
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Affiliation(s)
- I. A. Goncharova
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - E. Yu. Bragina
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - I. Zh. Zhalsanova
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - M. B. Freidin
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - M. S. Nazarenko
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences
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Runnstrom M, Pitner H, Xu J, Lee FEH, Kuruvilla M. Utilizing Predictive Inflammatory Markers for Guiding the Use of Biologicals in Severe Asthma. J Inflamm Res 2022; 15:241-249. [PMID: 35068937 PMCID: PMC8769207 DOI: 10.2147/jir.s269297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma is a chronic respiratory disease characterized by chronic airway inflammation and airflow obstruction. Up to ten percent of asthmatics have severe asthma, and many remain uncontrolled despite optimal medical management. With our increased understanding of the heterogeneity of asthma and its complex pathophysiology, several biomarkers have been developed and in the recent past, several biologic therapies for severe asthma have been developed and are now in widespread use. Although these biological agents have shown great benefit in treating severe asthma, not all patients respond equally well, and some do not derive any benefit. As much of the current literature of these medications have not assessed biomarkers or have used different cutoffs, it is often challenging to decide the best medication for an individual patient. Here, we review common asthma subtypes, current available biologic therapies for asthma, the clinical application of currently available type 2 biomarkers, as well as summarizing the evidence on how patient characteristics and biomarkers can help with choosing the optimal biologic for a patient that has the highest likelihood of success.
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Affiliation(s)
- Martin Runnstrom
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Hilary Pitner
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jennifer Xu
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - F Eun-Hyung Lee
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Merin Kuruvilla
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
- Correspondence: Merin Kuruvilla Email
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Israel E, Canonica GW, Brusselle G, Yang S, Howarth PH, Martin AL, Koufopoulou M, Smith SG, Alfonso-Cristancho R. Real-life effectiveness of mepolizumab in severe asthma: a systematic literature review. J Asthma 2021; 59:2201-2217. [PMID: 34951336 DOI: 10.1080/02770903.2021.2008431] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The efficacy and safety of mepolizumab in patients with severe eosinophilic asthma in randomized controlled trials is well established. Following approval of mepolizumab as add-on therapy for severe eosinophilic asthma in multiple regions worldwide, it is now important to determine its impact in real-world settings in which patients are not subject to stringent eligibility criteria. This systematic literature review assessed published evidence of clinical outcomes, safety, and healthcare resource use among patients with severe asthma receiving mepolizumab in real-world settings. DATA SOURCES Searches were conducted in Embase, MEDLINE, and MEDLINE In-Process via Ovid. STUDY SELECTIONS Eligible studies were observational, and enrolled ≥10 patients with asthma who received mepolizumab 100 mg subcutaneously. Data extracted included annualized exacerbation rate, mean daily oral corticosteroid (OCS) dose, proportion of patients using OCS, several measures of lung function, patient-reported asthma control and health-related quality of life (HRQoL), safety, and economic burden. RESULTS Twenty-three articles (22 unique studies; 2,040 patients with severe asthma on mepolizumab) were identified. Mepolizumab use was associated with a reduction in annualized exacerbation rates (requiring OCS) of 54-97% (p < 0.05 in all studies), reduced mean/median daily OCS doses, and OCS discontinuation during follow-up (27-84% of patients). Improvements in lung function, asthma control, and HRQoL were also observed. The most commonly reported adverse events included headache and arthralgia; discontinuation of mepolizumab due to adverse events occurred in 0-10.6% of patients. CONCLUSION Findings show that patients with severe asthma consistently demonstrate clinically relevant benefits with mepolizumab treatment in a real-world setting. Supplemental data for this article is available online at at www.tandfonline.com/ijas .
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Affiliation(s)
- Elliot Israel
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy Clinic, Department of Biomedical Sciences, Humanitas University and Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | - Amber L Martin
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | | | - Steven G Smith
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
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Massey O, Suphioglu C. Recent Advances in the Inhibition of the IL-4 Cytokine Pathway for the Treatment of Allergen-Induced Asthma. Int J Mol Sci 2021; 22:ijms222413655. [PMID: 34948449 PMCID: PMC8706302 DOI: 10.3390/ijms222413655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022] Open
Abstract
The IL-4 and IL-13 cytokine pathways play integral roles in stimulating IgE inflammation, with the IL-4 cytokine being a major cytokine in the etiology of thunderstorm asthma, atopic dermatitis, and allergic rhinitis. The increasing prevalence of thunderstorm asthma in the younger population and the lessening efficacy of corticosteroids and other anti-inflammatories has created a need for more effective pharmaceuticals. This review summarizes the IL-4 and IL-13 pathways while highlighting and discussing the current pathway inhibitors aimed at treating thunderstorm asthma and atopic dermatitis, as well as the potential efficacy of peptide therapeutics in this field.
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Affiliation(s)
- Oliver Massey
- NeuroAllergy Research Laboratory, School of Life and Environmental Sciences, Deakin University, Geelong, VIC 3216, Australia;
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3216, Australia
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory, School of Life and Environmental Sciences, Deakin University, Geelong, VIC 3216, Australia;
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3216, Australia
- Correspondence:
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Mir-Ihara P, Narváez-Fernández E, Domínguez-Ortega J, Entrala A, Barranco P, Luna-Porta JA, Romero D, Villamañán E, Losantos-García I, Quirce S. Safety of biological therapy in elderly patients with severe asthma. J Asthma 2021; 59:2218-2222. [PMID: 34889165 DOI: 10.1080/02770903.2021.2010747] [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: 10/19/2022]
Abstract
OBJECTIVE To assess the safety of biological therapy for severe T2 asthma (omalizumab, mepolizumab, benralizumab and reslizumab) under real-life conditions in elderly patients older than 70 years. METHODS Retrospective data collection including clinical characteristics, comorbidities, treatment, disease control and adverse events (AE) of all patients with severe asthma on biological therapy older than 70 years seen in the Severe Asthma Unit of our hospital. RESULTS Of 147 patients with severe asthma being treated with biologics, 21 patients older than 70 years were included. The median age of these patients was 76.3 years (range 71-86) and the majority were women (n = 18, 85.7%). There were 9 patients (42.9%) who experienced an AE related to biological treatment. Four (44.4%) were in treatment with omalizumab, two (22.2%) with mepolizumab, two patients (22.2%) with reslizumab and one (11.1%) with benralizumab. The median FEV1 (%) was 66%. These patients had a considerably higher body mass index (BMI). No significant differences were found for any other variable. Most of the AE reported were considered mild with the exception of one case of systemic AE (anaphylaxis) associated with omalizumab. CONCLUSION This study indicates that the prescription of biological therapy in elderly patients with severe asthma seems to be safe. More evidence is needed in this particular population.
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Affiliation(s)
| | | | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - Ana Entrala
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - Pilar Barranco
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - Juan-Alberto Luna-Porta
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - David Romero
- Department of Pulmonology, La Paz University Hospital, Madrid, Spain
| | - Elena Villamañán
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain
| | | | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
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Menzella F, Ghidoni G, Fontana M, Capobelli S, Livrieri F, Castagnetti C, Facciolongo N. The role of systemic corticosteroids in severe asthma and new evidence in their management and tapering. Expert Rev Clin Immunol 2021; 17:1283-1299. [PMID: 34761712 DOI: 10.1080/1744666x.2021.2004123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Based on the latest literature evidence, between 30% and 60% of adults with severe refractory asthma (SRA) are systemic corticosteroid (SCS) dependent. There are numerous therapeutic options in asthma, which are often not effective in severe forms. In these cases, SCS should be considered, but it is increasingly recognized that their regular use is often associated with significant and potentially serious adverse events. AREAS COVERED The aim of this article is to provide an update about the recent and significant literature on SCS and to establish their role in the management of SRA. We summarized the most important and recent evidence and we provided useful indications for clinicians. EXPERT OPINION There is now strong evidence supporting the increased risk of comorbidities and complications with long-term SCS therapies, regardless of the dose. New evidence on SCS tapering and withdrawal will allow to define protocols to address SCS management with greater safety and effectiveness, after starting efficient steroid-sparing strategies. In the next 5years, it will be necessary to implement corrective actions to address these unmet needs, to reduce the inappropriate use of SCS by maximizing the application of more innovative and effective therapies.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Giulia Ghidoni
- University Hospital of Modena, 208968,Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Matteo Fontana
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Silvia Capobelli
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Francesco Livrieri
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Claudia Castagnetti
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL Di Reggio Emilia - IRCCS, Reggio Emilia, Italy
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Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:422-432. [PMID: 34763123 DOI: 10.1016/j.jaip.2021.10.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an important factor in biologic selection, especially given the documented ability of some biologics to reduce OCS dependence. Comorbid diseases and relevant safety considerations to each biologic should also be considered. More data are needed to determine whether biomarker profiles identify patients suited to one biologic versus another as limited data support differential predictors of response. Further prospective head-to-head trials and post hoc analyses of clinical trial data are warranted. The authors believe that these recommendations have value as they offer expert opinion to assist health care providers in making difficult decisions regarding the quality of care in severe, type 2 asthma with biologic medications. They remain conditional and are based on limited data owing to a lack of head-to-head comparisons.
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Fildan AP, Rajnoveanu RM, Cirjaliu R, Pohrib I, Tudorache E, Ilie AC, Oancea C, Tofolean D. Biological therapies targeting the type 2 inflammatory pathway in severe asthma (Review). Exp Ther Med 2021; 22:1263. [PMID: 34603531 PMCID: PMC8453334 DOI: 10.3892/etm.2021.10698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/03/2021] [Indexed: 12/21/2022] Open
Abstract
Asthma is a variable chronic respiratory disease characterized by airway inflammation and hyperresponsiveness, bronchoconstriction, and mucus hypersecretion. While most patients with asthma achieve good control of the disease, 5-10% experience severe symptoms and recurrent exacerbation despite the maximal offered therapy with inhaled corticosteroids and long acting bronchodilators. In previous years, novel biological therapies have become available, and various asthma phenotypes that are characterized by specific biomarkers have been identified. Currently approved biological agents target inflammatory molecules of the type 2 inflammatory pathway, and are effective at decreasing the frequency of asthma attacks, controlling symptoms and decreasing use of systemic steroids. The present study reviewed the effectiveness and safety profile of the currently approved biological drugs and provided an overview of the assessment of patients with severe asthma who are potentially suitable for biological therapy, in order to help clinicians to select the most appropriate biological agent.
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Affiliation(s)
| | - Ruxandra-Mioara Rajnoveanu
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400371, Romania
| | - Roxana Cirjaliu
- Faculty of Medicine, Ovidius University, Constanța 900527, Romania
| | - Ionela Pohrib
- Faculty of Medicine, Ovidius University, Constanța 900527, Romania
| | - Emanuela Tudorache
- Department of Pneumology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Adrian Cosmin Ilie
- Department of Pneumology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Cristian Oancea
- Department of Pneumology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Doina Tofolean
- Faculty of Medicine, Ovidius University, Constanța 900527, Romania
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Ricciardolo FLM, Bertolini F, Carriero V. The Role of Dupilumab in Severe Asthma. Biomedicines 2021; 9:biomedicines9091096. [PMID: 34572281 PMCID: PMC8468984 DOI: 10.3390/biomedicines9091096] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/16/2022] Open
Abstract
Dupilumab is a fully humanized monoclonal antibody, capable of inhibiting intracellular signaling of both interleukin (IL)-4 and IL-13. These are two molecules that, together with other proinflammatory cytokines such as IL-5 and eotaxins, play a pivotal role in orchestrating the airway inflammatory response defined as Type 2 (T2) inflammation, driven by Th2 or Type 2 innate lymphoid cells, which is the major feature of the T2 high asthma phenotype. The dual inhibition of IL-4 and IL-13 activities is due to the blockade of type II IL-4 receptor through the binding of dupilumab with the subunit IL-4Rα. This results in the repression of STAT6 and in the suppression of subsequent de novo formation of several molecules involved in the T2 inflammatory signature. Several clinical trials tested the efficacy and safety of dupilumab in large populations of uncontrolled severe asthmatics, revealing significant improvements in lung function, asthma control, and exacerbation rate. Similar results were reported when dupilumab was employed in patients harboring pathogenetic processes related to T2 immune response, such as atopic dermatitis and chronic rhinosinusitis. In this review, we provide an overview of the recent research in the field of respiratory medicine about dupilumab mechanism of action and its effects.
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50
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Katsoulis K, Kipourou M, Loukides S. Reduction/elimination of blood eosinophils in severe asthma: should there be a safety consideration? Expert Opin Biol Ther 2021; 22:377-384. [PMID: 34328380 DOI: 10.1080/14712598.2021.1960977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Eosinophils play a central role in the inflammation of asthma and are the target of new biologic treatments for patients with severe asthma. Biologics targeting the IL-5 pathway have been shown to reduce asthma exacerbations, improve lung function, reduce oral corticosteroid use, and improve quality of life, accompanied by reduced or even eliminated blood eosinophils. Eosinophils have been associated with host protection and tumor growth, raising potential concerns about the consequences of these long-term therapies that reduce or eliminate them. AREAS COVERED In this review, we explore the current safety profile of biologics regarding the impact they may have on blood eosinophils, trying to answer the question about any safety consideration. EXPERT OPINION Eosinophils have been associated with host protection and tumor growth, raising potential concerns about the consequences of long-term therapies that reduce or eliminate these blood cells.
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Affiliation(s)
| | - Maria Kipourou
- Respiratory Department, 424 Army General Hospital, Thessaloniki, Greece
| | - Stelios Loukides
- 2nd Respiratory Department, Attiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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