1
|
Carr TF, Moore WC, Kraft M, Brusselle G, Castro M, Chupp GL, Wechsler ME, Hunter G, Lindsley AW, Llanos JP, Burke LK, Chandarana S, Ambrose CS. Efficacy of Tezepelumab in Patients with Severe, Uncontrolled Asthma Across Multiple Clinically Relevant Subgroups in the NAVIGATOR Study. Adv Ther 2024; 41:2978-2990. [PMID: 38802635 PMCID: PMC11213736 DOI: 10.1007/s12325-024-02889-8] [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: 03/08/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Many patients with severe asthma continue to experience symptoms and exacerbations despite treatment with standard-of-care therapy. In the phase 3 NAVIGATOR study, tezepelumab significantly reduced exacerbations over 52 weeks compared with placebo in patients with severe, uncontrolled asthma. This analysis assessed the efficacy of tezepelumab in reducing asthma exacerbations in various clinically relevant subgroups of patients in NAVIGATOR. METHODS NAVIGATOR was a phase 3, multicentre, randomized, double-blind, placebo-controlled study. Participants (12-80 years old) with severe, uncontrolled asthma were randomized 1:1 to receive tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. Pre-specified and post hoc analyses were performed to evaluate the annualized asthma exacerbation rate (AAER) over 52 weeks in clinically relevant subgroups of patients defined by baseline patient characteristics, medical history, exacerbation triggers, medication eligibility and medication use before and during the study. RESULTS Tezepelumab reduced the AAER over 52 weeks compared with placebo across a wide range of patient subgroups assessed. Reductions in exacerbations were similar across subgroups defined by baseline patient characteristics, ranging from 48% (95% confidence interval [CI]: 21, 65) to 60% (95% CI: 44, 71) in subgroups analysed by sex, smoking history and body mass index. Among the asthma-related comorbidity subgroups investigated, patients with aspirin or NSAID sensitivity had the greatest reductions in AAER with tezepelumab compared with placebo (83%; 95% CI: 66, 91). In patients eligible to receive dupilumab, tezepelumab reduced exacerbations compared with placebo by 64% (95% CI: 54, 71). Reductions in the AAER with tezepelumab compared with placebo were also observed irrespective of exacerbation trigger category and the number of asthma controller medications patients were receiving at baseline. CONCLUSION These findings further support the benefits of tezepelumab in patients with severe, uncontrolled asthma and can help to inform healthcare providers' treatment decisions. CLINICAL TRIAL REGISTRATION NAVIGATOR (NCT03347279).
Collapse
Affiliation(s)
- Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Wendy C Moore
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Monica Kraft
- Department of Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Geoffrey L Chupp
- Yale Center for Asthma and Airway Disease, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Gillian Hunter
- Biometrics, Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | | | - Luke K Burke
- Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Shradha Chandarana
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD, 20878, USA
| | - Christopher S Ambrose
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD, 20878, USA.
| |
Collapse
|
5
|
Wechsler ME, Scelo G, Larenas-Linnemann DES, Torres-Duque CA, Maspero J, Tran TN, Murray RB, Martin N, Menzies-Gow AN, Hew M, Peters MJ, Gibson PG, Christoff GC, Popov TA, Côté A, Bergeron C, Dorscheid D, FitzGerald JM, Chapman KR, Boulet LP, Bhutani M, Sadatsafavi M, Jiménez-Maldonado L, Duran-Silva M, Rodriguez B, Celis-Preciado CA, Cano-Rosales DJ, Solarte I, Fernandez-Sanchez MJ, Parada-Tovar P, von Bülow A, Bjerrum AS, Ulrik CS, Assing KD, Rasmussen LM, Hansen S, Altraja A, Bourdin A, Taille C, Charriot J, Roche N, Papaioannou AI, Kostikas K, Papadopoulos NG, Salvi S, Long D, Mitchell PD, Costello R, Sirena C, Cardini C, Heffler E, Puggioni F, Canonica GW, Guida G, Iwanaga T, Al-Ahmad M, García U, Kuna P, Fonseca JA, Al-Lehebi R, Koh MS, Rhee CK, Cosio BG, Perez de Llano L, Perng DWS, Huang EWC, Wang HC, Tsai MJ, Mahboub B, Salameh LIJ, Jackson DJ, Busby J, Heaney LG, Pfeffer PE, Goddard AG, Wang E, Hoyte FCL, Chapman NM, Katial R, Carter V, Bulathsinhala L, Eleangovan N, Ariti C, Lyu J, Porsbjerg C, Price DB. Association Between T2-related Comorbidities and Effectiveness of Biologics in Severe Asthma. Am J Respir Crit Care Med 2024; 209:262-272. [PMID: 38016003 DOI: 10.1164/rccm.202305-0808oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
Rationale: Previous studies investigating the impact of comorbidities on the effectiveness of biologic agents have been relatively small and of short duration and have not compared classes of biologic agents. Objectives: To determine the association between type 2-related comorbidities and biologic agent effectiveness in adults with severe asthma (SA). Methods: This cohort study used International Severe Asthma Registry data from 21 countries (2017-2022) to quantify changes in four outcomes before and after biologic therapy-annual asthma exacerbation rate, FEV1% predicted, asthma control, and long-term oral corticosteroid daily dose-in patients with or without allergic rhinitis, chronic rhinosinusitis (CRS) with or without nasal polyps (NPs), NPs, or eczema/atopic dermatitis. Measurements and Main Results: Of 1,765 patients, 1,257, 421, and 87 initiated anti-IL-5/5 receptor, anti-IgE, and anti-IL-4/13 therapies, respectively. In general, pre- versus post-biologic therapy improvements were noted in all four asthma outcomes assessed, irrespective of comorbidity status. However, patients with comorbid CRS with or without NPs experienced 23% fewer exacerbations per year (95% CI, 10-35%; P < 0.001) and had 59% higher odds of better post-biologic therapy asthma control (95% CI, 26-102%; P < 0.001) than those without CRS with or without NPs. Similar estimates were noted for those with comorbid NPs: 22% fewer exacerbations and 56% higher odds of better post-biologic therapy control. Patients with SA and CRS with or without NPs had an additional FEV1% predicted improvement of 3.2% (95% CI, 1.0-5.3; P = 0.004), a trend that was also noted in those with comorbid NPs. The presence of allergic rhinitis or atopic dermatitis was not associated with post-biologic therapy effect for any outcome assessed. Conclusions: These findings highlight the importance of systematic comorbidity evaluation. The presence of CRS with or without NPs or NPs alone may be considered a predictor of the effectiveness of biologic agents in patients with SA.
Collapse
Affiliation(s)
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | | | - Carlos A Torres-Duque
- CINEUMO/Centro Internacional de Investigación en Neumología, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Ruth B Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
- University of Leicester, Leicester, United Kingdom
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom
- Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Andréanne Côté
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Celine Bergeron
- Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Libardo Jiménez-Maldonado
- Fundación Neumológica Colombiana, Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma (ASMAIRE) Programa, Bogotá, Colombia
| | - Mauricio Duran-Silva
- Fundación Neumológica Colombiana, Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma (ASMAIRE) Programa, Bogotá, Colombia
| | | | - Carlos Andres Celis-Preciado
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | | | - Ivan Solarte
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | - Patricia Parada-Tovar
- CINEUMO/Centro Internacional de Investigación en Neumología, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Anne Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus City, Denmark
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Arnaud Bourdin
- PhyMedExp, Université de Montpellier, Centre National de Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Camille Taille
- Department of Respiratory Diseases, Bichat Hospital, Public Assistance-Hospitals of Paris North, Paris City University, Paris, France
| | - Jeremy Charriot
- PhyMedExp, Université de Montpellier, Centre National de Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nicolas Roche
- Department of Respiratory Medicine, Public Assistance-Hospitals of Paris North, Paris City University, Cochin Hospital and Institute (Unité Mixte de Recherche 1016), Paris, France
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | | | | | - Richard Costello
- Clinical Research Centre, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giuseppe Guida
- Department of Clinical and Biological Sciences, Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Ulises García
- Department of Allergy and Immunology, National Medical Center of Bajio, University of Guanajuato, Guanajuato, Mexico
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Łódź, Łódź, Poland
| | - João A Fonseca
- Center for Health Technology and Services Research (CINTESIS)
- Health Research Network (RISE), and
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - 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
| | - Borja G Cosio
- Hospital Universitari Son Espases, Fundación Instituto de Investigación Sanitaria Islas Baleares-Ciberes, Mallorca, Spain
| | - Luis Perez de Llano
- Pneumology Service, Lucus Augusti University Hospital, Sergas (Galician Healthcare Service) Integrated Management Structure (EOXI) Lugo, Monforte e Cervo, Lugo, Spain
| | - Diahn-Warng Steve Perng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Erick Wan-Chun Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hao-Chien Wang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and
- School of Medicine, College of Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Laila Ibraheem Jaber Salameh
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences and
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health National Hospital Service Trust, London, United Kingdom
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | - Flavia C L Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | | | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Con Ariti
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Juntao Lyu
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
| | - Celeste Porsbjerg
- Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark; and
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|