1
|
Lee TY, Price D, Yadav CP, Roy R, Lim LHM, Wang E, Wechsler ME, Jackson DJ, Busby J, Heaney LG, Pfeffer PE, Mahboub B, Perng Steve DW, Cosio BG, Perez-de-Llano L, Al-Lehebi R, Larenas-Linnemann D, Al-Ahmad M, Rhee CK, Iwanaga T, Heffler E, Canonica GW, Costello R, Papadopoulos NG, Papaioannou AI, Porsbjerg CM, Torres-Duque CA, Christoff GC, Popov TA, Hew M, Peters M, Gibson PG, Maspero J, Bergeron C, Cerda S, Contreras-Contreras EA, Chen W, Sadatsafavi M. International Variation in Severe Exacerbation Rates in Patients With Severe Asthma. Chest 2024; 166:28-38. [PMID: 38395297 DOI: 10.1016/j.chest.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Exacerbation frequency strongly influences treatment choices in patients with severe asthma. RESEARCH QUESTION What is the extent of the variability of exacerbation rate across countries and its implications in disease management? STUDY DESIGN AND METHODS We retrieved data from the International Severe Asthma Registry, an international observational cohort of patients with a clinical diagnosis of severe asthma. We identified patients aged ≥ 18 years who did not initiate any biologics prior to baseline visit. A severe exacerbation was defined as the use of oral corticosteroids for ≥ 3 days or asthma-related hospitalization/ED visit. A series of negative binomial models were applied to estimate country-specific severe exacerbation rates during 365 days of follow-up, starting from a naive model with country as the only variable to an adjusted model with country as a random-effect term and patient and disease characteristics as independent variables. RESULTS The final sample included 7,510 patients from 17 countries (56% from the United States), contributing to 1,939 severe exacerbations (0.27/person-year). There was large between-country variation in observed severe exacerbation rate (minimum, 0.04 [Argentina]; maximum, 0.88 [Saudi Arabia]; interquartile range, 0.13-0.54), which remained substantial after adjusting for patient characteristics and sampling variability (interquartile range, 0.16-0.39). INTERPRETATION Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies.
Collapse
Affiliation(s)
- Tae Yoon Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - David Price
- Optimum Patient Care Global, Cambridge, England; Observational and Pragmatic Research Institute, Singapore, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | | | - Rupsa Roy
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Laura Huey Mien Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO; Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, England; School of Immunology & Microbial Sciences, King's College London, London, England
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, England; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Diahn-Warng Perng Steve
- Division of Clinical Respiratory, Physiology Chest Department, Taipei Veterans General Hospital, Taipei City, Taiwan; COPD Assembly of the Asian Pacific Society of Respirology, Tokyo, Japan
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain; Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Spain
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait
| | - 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
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - 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
| | - Giorgio 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
| | - Richard Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, England; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | | | - Todor A Popov
- Clinic of Occupational Diseases, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Celine Bergeron
- Centre for Lung Health, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Saraid Cerda
- Medical Specialties Unit, Secretary of National Defense, Mexico City, Mexico
| | - Elvia Angelica Contreras-Contreras
- Mexican Council of Clinical Immunology and Allergy, Mexico City Office, Mexico City, Mexico; Department of Allergy and Clinical Immunology, Lic. Adolfo López Mateos Regional Hospital of the Institute of Security and Social Services for State Workers (ISSSTE), Mexico City, Mexico
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| |
Collapse
|
2
|
Scelo G, Tran TN, Le TT, Fagerås M, Dorscheid D, Busby J, Al-Ahmad M, Al-Lehebi R, Altraja A, Beastall A, Bergeron C, Bjermer L, Bjerrum AS, Cano-Rosales DJ, Canonica GW, Carter V, Charriot J, Christoff GC, Cosio BG, Denton E, Fernandez-Sanchez MJ, Fonseca JA, Gibson PG, Goh C, Heaney LG, Heffler E, Hew M, Iwanaga T, Katial R, Koh MS, Kuna P, Larenas-Linnemann D, Lehtimäki L, Mahboub B, Martin N, Matsumoto H, Menzies-Gow AN, Papadopoulos NG, Patel P, Perez-De-Llano L, Peters M, Pfeffer PE, Popov TA, Porsbjerg CM, Rhee CK, Sadatsafavi M, Taillé C, Torres-Duque CA, Tsai MJ, Ulrik CS, Upham JW, von Bülow A, Wang E, Wechsler ME, Price DB. Exploring Definitions and Predictors of Response to Biologics for Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00530-0. [PMID: 38768896 DOI: 10.1016/j.jaip.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Biologic effectiveness is often assessed as response, a term that eludes consistent definition. Identifying those most likely to respond in real-life has proven challenging. OBJECTIVE To explore definitions of biologic responders in adults with severe asthma and investigate patient characteristics associated with biologic response. METHODS This was a longitudinal cohort study using data from 21 countries, which shared data with the International Severe Asthma Registry. Changes in four asthma outcome domains were assessed in the 1-year period before and after biologic initiation in patients with a predefined level of prebiologic impairment. Responder cutoffs were 50% or greater reduction in exacerbation rate, 50% or greater reduction in long-term oral corticosteroid daily dose, improvement in one or more category in asthma control, and 100 mL or greater improvement in FEV1. Responders were defined using single and multiple domains. The association between prebiologic characteristics and postbiologic initiation response was examined by multivariable analysis. RESULTS A total of 2,210 patients were included. Responder rate ranged from 80.7% (n = 566 of 701) for exacerbation response to 10.6% (n = 9 of 85) for a four-domain response. Many responders still exhibited significant impairment after biologic initiation: 46.7% (n = 206 of 441) of asthma control responders with uncontrolled asthma before the biologic still had incompletely controlled disease postbiologic initiation. Predictors of response were outcome-dependent. Lung function responders were more likely to have higher prebiologic FeNO (odds ratio = 1.20 for every 25-parts per billion increase), and shorter asthma duration (odds ratio = 0.81 for every 10-year increase in duration). Higher blood eosinophil count and the presence of type 2-related comorbidities were positively associated with higher odds of meeting long-term oral corticosteroid, control, and lung function responder criteria. CONCLUSIONS Our findings underscore the multimodal nature of response, showing that many responders experience residual symptoms after biologic initiation and that predictors of response vary according to the outcome assessed.
Collapse
Affiliation(s)
- Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Tham T Le
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Malin Fagerås
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md; BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Delbert Dorscheid
- Center for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University Al-Rashed Allergy Center, Ministry of Health, Kuwait
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City Alfaisal University, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Celine Bergeron
- Centre for Lung Health, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anne S Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | - Borja G Cosio
- Son Espases University Hospital, IdISBa-Ciberes, Mallorca, Spain
| | - Eve Denton
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogotá, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Celine Goh
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, United Kingdom
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, 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
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Hisako Matsumoto
- Department of Respiratory Medicine, and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | | | - Nikolaos G Papadopoulos
- Centre for Respiratory Medicine and Allergy, Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Pujan Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luis Perez-De-Llano
- Pneumology Service. Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Todor A Popov
- Clinic of Allergy and Asthma, University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, Department of Respiratory Medicine and Infectious Diseases, Research Unit, Copenhagen, Denmark
| | - Chin K Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, 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
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université Paris Cité, Paris, France
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - John W Upham
- Frazer Institute & PA-Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Anna von Bülow
- Respiratory Research Unit-Hvidovre, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Eileen Wang
- National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, Colo
| | - Michael E Wechsler
- National Jewish Health Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colo
| | - 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
|
3
|
Perez-de-Llano L, Scelo G, Canonica GW, Chen W, Henley W, Larenas-Linnemann D, Peters MJ, Pfeffer PE, Tran TN, Ulrik CS, Popov TA, Sadatsafavi M, Hew M, Máspero J, Gibson PG, Christoff GC, Fitzgerald JM, Torres-Duque CA, Porsbjerg CM, Papadopoulos NG, Papaioannou AI, Heffler E, Iwanaga T, Al-Ahmad M, Kuna P, Fonseca JA, Al-Lehebi R, Rhee CK, Koh MS, Cosio BG, Perng Steve DW, Mahboub B, Menzies-Gow AN, Jackson DJ, Busby J, Heaney LG, Patel PH, Wang E, Wechsler ME, Altraja A, Lehtimäki L, Bourdin A, Bjermer L, Bulathsinhala L, Carter V, Murray R, Beastall A, Denton E, Price DB. Impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in patients with severe asthma. Ann Allergy Asthma Immunol 2024; 132:610-622.e7. [PMID: 38151100 DOI: 10.1016/j.anai.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There is little agreement on clinically useful criteria for identifying real-world responders to biologic treatments for asthma. OBJECTIVE To investigate the impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in adults with severe asthma. METHODS This was a longitudinal, cohort study across 22 countries participating in the International Severe Asthma Registry (https://isaregistries.org/) between May 2017 and January 2023. Change in 4 asthma domains (exacerbation rate, asthma control, long-term oral corticosteroid [LTOCS] dose, and lung function) was assessed from biologic initiation to 1 year post-treatment (minimum 24 weeks). Pre- to post-biologic changes for responders and nonresponders were described along a categorical gradient for each domain derived from pre-biologic distributions (exacerbation rate: 0 to 6+/y; asthma control: well controlled to uncontrolled; LTOCS: 0 to >30 mg/d; percent-predicted forced expiratory volume in 1 second [ppFEV1]: <50% to ≥80%). RESULTS Percentage of biologic responders (ie, those with a category improvement pre- to post-biologic) varied by domain and increased with greater pre-biologic impairment, increasing from 70.2% to 90.0% for exacerbation rate, 46.3% to 52.3% for asthma control, 31.1% to 58.5% for LTOCS daily dose, and 35.8% to 50.6% for ppFEV1. The proportion of patients having improvement post-biologic tended to be greater for anti-IL-5/5R compared with for anti-IgE for exacerbation, asthma control, and ppFEV1 domains, irrespective of pre-biologic impairment. CONCLUSION Our results provide realistic outcome-specific post-biologic expectations for both physicians and patients, will be foundational to inform future work on a multidimensional approach to define and assess biologic responders and response, and may enhance appropriate patient selection for biologic therapies. TRIAL REGISTRATION The ISAR database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization studies (ENCEPP/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EUPAS38288) and with all applicable local and international laws and regulation, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=38289). Governance was provided by ADEPT (registration number: ADEPT1220).
Collapse
Affiliation(s)
- Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - William Henley
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Health Statistics Group, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jorge Máspero
- 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, Argentina
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - J Mark Fitzgerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - 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
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - 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
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Lung Division, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - 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, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
| |
Collapse
|
4
|
Porsbjerg CM, Townend J, Bergeron C, Christoff GC, Katsoulotos GP, Larenas-Linnemann D, Tran TN, Al-Lehebi R, Bosnic-Anticevich SZ, Busby J, Hew M, Kostikas K, Papadopoulos NG, Pfeffer PE, Popov TA, Rhee CK, Sadatsafavi M, Tsai MJ, Ulrik CS, Al-Ahmad M, Altraja A, Beastall A, Bulathsinhala L, Carter V, Cosio BG, Fletton K, Hansen S, Heaney LG, Hubbard RB, Kuna P, Murray RB, Nagano T, Pini L, Cano Rosales DJ, Schleich F, Wechsler ME, Amaral R, Bourdin A, Brusselle GG, Chen W, Chung LP, Denton E, Fonseca JA, Hoyte F, Jackson DJ, Katial R, Kirenga BJ, Koh MS, Ławkiedraj A, Lehtimäki L, Liew MF, Mahboub B, Martin N, Menzies-Gow AN, Pang PH, Papaioannou AI, Patel PH, Perez-De-Llano L, Peters MJ, Ricciardi L, Rodríguez-Cáceres B, Solarte I, Tay TR, Torres-Duque CA, Wang E, Zappa M, Abisheganaden J, Assing KD, Costello RW, Gibson PG, Heffler E, Máspero J, Nicola S, Perng (Steve) DW, Puggioni F, Salvi S, Sheu CC, Sirena C, Taillé C, Tan TL, Bjermer L, Canonica GW, Iwanaga T, Jiménez-Maldonado L, Taube C, Brussino L, Price DB. Association between pre-biologic T2-biomarker combinations and response to biologics in patients with severe asthma. Front Immunol 2024; 15:1361891. [PMID: 38711495 PMCID: PMC11070939 DOI: 10.3389/fimmu.2024.1361891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Background To date, studies investigating the association between pre-biologic biomarker levels and post-biologic outcomes have been limited to single biomarkers and assessment of biologic efficacy from structured clinical trials. Aim To elucidate the associations of pre-biologic individual biomarker levels or their combinations with pre-to-post biologic changes in asthma outcomes in real-life. Methods This was a registry-based, cohort study using data from 23 countries, which shared data with the International Severe Asthma Registry (May 2017-February 2023). The investigated biomarkers (highest pre-biologic levels) were immunoglobulin E (IgE), blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO). Pre- to approximately 12-month post-biologic change for each of three asthma outcome domains (i.e. exacerbation rate, symptom control and lung function), and the association of this change with pre-biologic biomarkers was investigated for individual and combined biomarkers. Results Overall, 3751 patients initiated biologics and were included in the analysis. No association was found between pre-biologic BEC and pre-to-post biologic change in exacerbation rate for any biologic class. However, higher pre-biologic BEC and FeNO were both associated with greater post-biologic improvement in FEV1 for both anti-IgE and anti-IL5/5R, with a trend for anti-IL4Rα. Mean FEV1 improved by 27-178 mL post-anti-IgE as pre-biologic BEC increased (250 to 1000 cells/µL), and by 43-216 mL and 129-250 mL post-anti-IL5/5R and -anti-IL4Rα, respectively along the same BEC gradient. Corresponding improvements along a FeNO gradient (25-100 ppb) were 41-274 mL, 69-207 mL and 148-224 mL for anti-IgE, anti-IL5/5R, and anti-IL4Rα, respectively. Higher baseline BEC was also associated with lower probability of uncontrolled asthma (OR 0.392; p=0.001) post-biologic for anti-IL5/5R. Pre-biologic IgE was a poor predictor of subsequent pre-to-post-biologic change for all outcomes assessed for all biologics. The combination of BEC + FeNO marginally improved the prediction of post-biologic FEV1 increase (adjusted R2: 0.751), compared to BEC (adjusted R2: 0.747) or FeNO alone (adjusted R2: 0.743) (p=0.005 and <0.001, respectively); however, this prediction was not improved by the addition of IgE. Conclusions The ability of higher baseline BEC, FeNO and their combination to predict biologic-associated lung function improvement may encourage earlier intervention in patients with impaired lung function or at risk of accelerated lung function decline.
Collapse
Affiliation(s)
- Celeste M. Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - John Townend
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Celine Bergeron
- Department of Medicine, Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Gregory P. Katsoulotos
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame, Sydney, NSW, Australia
| | | | - Trung N. Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sinthia Z. Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health National Health Services (NHS) Trust, London, United Kingdom
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - 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, Republic of Korea
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen ;University Hospital - Hvidovre, Copenhagen, Denmark
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Borja G. Cosio
- Son Espases University Hospital-Institut d’Investigació Sanitària Illes Balears (IdISBa)-Ciberes, Mallorca, Spain
| | - Kirsty Fletton
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Richard B. Hubbard
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Respiratory Medicine at the School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Laura Pini
- Department of Clinical and Experimental Sciences – University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | | | - Florence Schleich
- Centre Hospitalier Universitaire (CHU) Sart-Tilman, GIGA I3, University of Liege, Liège, Belgium
| | - Michael E. Wechsler
- Department of Medicine, National Jewish Health (NJH) Cohen Family Asthma Institute, National Jewish Health, Denver, CO, United States
| | - Rita Amaral
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, National Center for Scientific Research (CNRS), The National Institute of Health and Medical Research (INSERM), Centre Hospitalier Universitaire (CHU) Montpellier, Montpellier, France
| | - Guy G. Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Eve Denton
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joao A. Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Flavia Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - David J. Jackson
- Guy’s Severe Asthma Centre, Guy’s Hospital, King’s College London, London, United Kingdom
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Bruce J. Kirenga
- Department of Medicine, Lung Institute, Makerere University Lung Institute, Kampala, Uganda
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mei Fong Liew
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Dubai Academic and Health Corporation, Dubai, United Arab Emirates
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
- Department of Respiratory Medicine, University of Leicester, Leicester, United Kingdom
| | - Andrew N. Menzies-Gow
- BioPharmaceutical Medical, AstraZeneca, Cambridge, United Kingdom
- Lung Division, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Pee Hwee Pang
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Andriana I. Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Pujan H. Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luis Perez-De-Llano
- Pneumology Service, Lucus Augusti University Hospital, Sergas (Galician Healthcare Service) Integrated Management Structure (EOXI) Lugo, Cervo, Spain
| | - Matthew J. Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Luisa Ricciardi
- Allergy and Clinical Immunology, G. Martino Hospital, University of Messina, Messina, Italy
| | | | - Ivan Solarte
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Carlos A. Torres-Duque
- Centro Internacional de Investigación en Neumología (CINEUMO), Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Richard W. Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, Royal College of Surgeons Ireland (RCSI), Dublin, Ireland
| | - Peter G. Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jorge Máspero
- 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
| | - Stefania Nicola
- Allergy and Immunology Unit, L'Azienda Ospedaliera (AO) Ordine Mauriziano di Torino, Turin, Italy
| | - Diahn-Warng Perng (Steve)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, l'Assistance publique – Hôpitaux de Paris (AP-HP) Nord-Université Paris Cité, Paris, France
| | - Tze Lee Tan
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Libardo Jiménez-Maldonado
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
- Fundación Neumológica Colombiana, ASMAIRE REXPIRA (Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma) Program, Bogotá, Colombia
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Luisa Brussino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore, 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
|
5
|
Hansen S, Baastrup Søndergaard M, von Bülow A, Bjerrum AS, Schmid J, Rasmussen LM, Johnsen CR, Ingebrigtsen T, Håkansson KEJ, Johansson SL, Bisgaard M, Assing KD, Hilberg O, Ulrik C, Porsbjerg C. Clinical Response and Remission in Patients With Severe Asthma Treated With Biologic Therapies. Chest 2024; 165:253-266. [PMID: 37925144 DOI: 10.1016/j.chest.2023.10.046] [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: 07/11/2023] [Revised: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The development of novel targeted biologic therapies for severe asthma has provided an opportunity to consider remission as a new treatment goal. RESEARCH QUESTION How many patients with severe asthma treated with biologic therapy achieve clinical remission, and what predicts response to treatment? STUDY DESIGN AND METHODS The Danish Severe Asthma Register is a nationwide cohort including all adult patients receiving biologic therapy for severe asthma in Denmark. This observational cohort study defined "clinical response" to treatment following 12 months as a ≥ 50% reduction in exacerbations and/or a ≥ 50% reduction in maintenance oral corticosteroid dose, if required. "Clinical remission" was defined by cessation of exacerbations and maintenance oral corticosteroids, as well as a normalization of lung function (FEV1 > 80%) and a six-question Asthma Control Questionnaire score ≤ 1.5 following 12 months of treatment. RESULTS Following 12 months of treatment, 104 (21%) of 501 biologic-naive patients had no response to treatment, and 397 (79%) had a clinical response. Among the latter, 97 (24%) fulfilled the study criteria of clinical remission, corresponding to 19% of the entire population. Remission was predicted by shorter duration of disease and lower BMI in the entire population of patients treated with biologic therapy. INTERPRETATION Clinical response was achieved in most adult patients initiating biologic therapy, and clinical remission was observed in 19% of the patients following 12 months of treatment. Further studies are required to assess the long-term outcome of achieving clinical remission with biologic therapy.
Collapse
Affiliation(s)
- Susanne Hansen
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Marianne Baastrup Søndergaard
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Anne-Sofie Bjerrum
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Johannes Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Linda M Rasmussen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Hellerup, Denmark
| | - Claus R Johnsen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Hellerup, Denmark
| | - Truls Ingebrigtsen
- Department of Respiratory Medicine, Gentofte Hospital, Hellerup, Denmark
| | | | | | - Maria Bisgaard
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Charlotte Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark.
| |
Collapse
|
6
|
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
|
7
|
Pelaia C, Pelaia G, Busse W. Do Comorbidities Influence the Response to Biologics in Severe Asthma? Am J Respir Crit Care Med 2024; 209:233-235. [PMID: 38064716 PMCID: PMC10840761 DOI: 10.1164/rccm.202311-2103ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Affiliation(s)
- Corrado Pelaia
- Department of Medical and Surgical Sciences University "Magna Graecia" of Catanzaro Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Health Sciences University "Magna Graecia" of Catanzaro Catanzaro, Italy
| | - William Busse
- Allergy, Pulmonary and Critical Care Medicine University of Wisconsin School of Medicine and Public Health Madison, Wisconsin
| |
Collapse
|
8
|
Canonica GW, Agache I, Schünemann HJ, Roche N, Price D, Del Giacco S. Next generation health guidelines: The role of real-life data in evidence-based medicine. Allergy 2024; 79:12-14. [PMID: 37680074 DOI: 10.1111/all.15887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Affiliation(s)
- G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Holger J Schünemann
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Guidelines International Network, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- GRADE Working Group, Hamilton, Ontario, Canada
| | - Nicolas Roche
- Département Médico-Universitaire THOROS (Thorax ORL Sommeil), AP-HP.Centre, Paris, France
- Université Paris Cité, UMR 1016, Institut Cochin, Paris, France
| | - David Price
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| |
Collapse
|
9
|
Scelo G, Torres-Duque CA, Maspero J, Tran TN, Murray R, 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, Linnemann DL, Garcia U, Kuna P, Fonseca JA, Al-Lehebi R, Koh MS, Rhee CK, Cosio BG, de Llano LP, Perng Steve DW, Huang EWC, Wang HC, Tsai MJ, Mahboub B, Salameh LIJ, Jackson D, Busby J, Heaney LG, Pfeffer P, Goddard AG, Wang E, Hoyte F, Wechsler ME, Chapman N, Katial R, Carter V, Bulathsinhala L, Eleangovan N, Ariti C, Lyu J, Price DB, Porsbjerg C. Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry. Ann Allergy Asthma Immunol 2024; 132:42-53. [PMID: 37640263 DOI: 10.1016/j.anai.2023.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. OBJECTIVE To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. METHODS This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2-related comorbidities, (2) potentially oral corticosteroid (OCS)-related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). RESULTS Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2-related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. CONCLUSION In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. CLINICAL TRIAL REGISTRATION The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).
Collapse
Affiliation(s)
- Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Carlos A Torres-Duque
- CINEUMO, 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 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 and Harefield Hospitals, London, United Kingdom
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Andréanne Côté
- Department of Medicine, Laval University, Quebec, Canada
| | - Celine Bergeron
- Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Delbert Dorscheid
- Center for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Libardo Jiménez-Maldonado
- Universidad de La Sabana, Chia, Colombia; Fundación Neumológica Colombiana, ASMAIRE Program, Bogotá, Colombia
| | | | | | - Carlos Andres Celis-Preciado
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | | | - Ivan Solarte
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Patricia Parada-Tovar
- CINEUMO, 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, Denmark
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University 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, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Camille Taille
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université Paris Cité, Paris, France
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Nicolas Roche
- Department of Respiratory Medicine, APHP-Centre University Paris Cité, Cochin Hospital and Institute (UMR1016), Paris, France
| | - Andriana I Papaioannou
- Second Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Deirdre Long
- Department of Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Richard Costello
- Clinical Research Centre, Department of Respiratory Medicine, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | | | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | | | - Ulises Garcia
- Department of Allergy and Immunology, National Medical Center of Bajio, Professor of Allergy and Immunology in the University of Guanajuato, Guanajuato, Mexico
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Mariko Siyue 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, St. Mary's Hospital, Seoul, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Luis Perez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 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, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Laila Ibraheem Jaber Salameh
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - David 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, Queen's University Belfast, Belfast, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Paul Pfeffer
- Department of Respiratory Medicine, Barts Health National Health Service (NHS) 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, National Jewish Health, Denver, Colorado
| | - Flavia Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Nicholas Chapman
- Saint Joseph Hospital, Denver Colorado National Jewish Health, Denver, Colorado
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Con Ariti
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Juntao Lyu
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| | - Celeste Porsbjerg
- Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
10
|
Urdova V, Rogers L, Jesenak M, Seys SF. Real-life studies and registries of severe asthma: The advent of digital technology. Respir Med 2023; 220:107429. [PMID: 37926182 DOI: 10.1016/j.rmed.2023.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
Severe asthma is a chronic and heterogeneous disease that negatively affects the quality of life of our patients and health care utilization. Given the remaining burden of uncontrolled disease in many of these patients, better understanding of its epidemiology, disease mechanisms, effectiveness of novel therapies such as biologics are still highly needed. Asthma treatment guidelines are largely informed by randomized controlled trials (RCTs) and meta analyses of RCTs, however inclusion criteria of many efficacy RCTs of asthma treatments often exclude a high number of patients with asthma in the community. Data from real-life studies and registries of severe asthma can complement efficacy studies by not only providing evidence on how a treatment performs in everyday clinical practice, post marketing safety information, data to support subsequent clinical trial design, but also helping to delineate the natural history of a disease and supporting important translational research endeavors. In the current review, we summarise available national and international collaborative studies and registries, the variables studies and the novel data and insights they provide. The key source of information for most asthma registries are real-life data from patient's electronic health records. Advent of digital technology in collecting data and their analysis is obvious and we draw attention to generation of new knowledge from registries of severe asthma to improve current diagnostic and therapeutic guidelines and asthma control.
Collapse
Affiliation(s)
- V Urdova
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia.
| | - L Rogers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Jesenak
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - S F Seys
- Research Unit, Galenus Health, Hasselt, Belgium
| |
Collapse
|
11
|
Celik GE, Aydin O, Gokmen D, Koycu Buhari G, Celebi Sozener Z, Gemicioglu B, Bulut I, Beyaz S, Orcen C, Ozdemir SK, Keren M, Damadoglu E, Yakut T, Kalpaklioglu AF, Baccioglu A, Yalim SA, Yilmaz I, Koca Kalkan I, Uysal MA, Ozgun Niksarlioglu EY, Kalyoncu AF, Karakaya G, Erbay M, Nayci S, Tepetam FM, Gelincik AA, Dirol H, Goksel O, Karaoglanoglu S, Oner Erkekol F, Isik SR, Yildiz F, Yavuz Y, Karadogan D, Bozkurt N, Seker U, Oguzulgen IK, Basyigit I, Baris SA, Yilmazel Ucar E, Erdogan T, Polatli M, Ediger D, Gunaydin FE, Turk M, Pur L, Katran ZY, Sekibag Y, Aykac EF, Mungan D, Gul O, Cengiz A, Akkurt B, Ozden S, Demir S, Unal D, Aslan AF, Can A, Gumusburun R, Bogatekin G, Akten HS, Inan S, Erdinc M, Ogus AC, Kavas M, Polat Yulug D, Cakmak ME, Kaya SB, Alpagat G, Ozgur ES, Uzun O, Tas Gulen S, Pekbak G, Kizilirmak D, Havlucu Y, Donmez H, Arslan B, Cetin GP, Soyyigit S, Kara BY, Pasaoglu Karakis G, Dursun AB, Kendirlinan R, Ozturk AB, Sevinc C, Omeroglu Simsek G, Abadoglu O, Cerci P, Yucel T, Yorulmaz I, Tezcaner ZC, Tatar EC, Suslu AE, Ozer S, Dursun E, Yorgancioglu A. Picturing asthma in Turkey: results from the Turkish adult asthma registry. J Asthma 2023; 60:1973-1986. [PMID: 37096963 DOI: 10.1080/02770903.2023.2206902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.
Collapse
Affiliation(s)
- Gulfem Elif Celik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Omur Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
| | - Bilun Gemicioglu
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ismet Bulut
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sengul Beyaz
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Cihan Orcen
- Clinic of Allergy and Immunology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Secil Kepil Ozdemir
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Metin Keren
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Tugce Yakut
- Clinic of Immunology and Allergic Diseases, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ayse Fusun Kalpaklioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Ayse Baccioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Sumeyra Alan Yalim
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Insu Yilmaz
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ilkay Koca Kalkan
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Atilla Uysal
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elif Yelda Ozgun Niksarlioglu
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Muge Erbay
- Clinic of Immunology and Allergy Diseases, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Sibel Nayci
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Asli Akkor Gelincik
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Hulya Dirol
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ozlem Goksel
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Selen Karaoglanoglu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Ferda Oner Erkekol
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Allergy and Immunology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Sacide Rana Isik
- Adult Allergy and Immunology Department, American Hospital, Istanbul, Turkey
| | - Fusun Yildiz
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
- School of Medicine, Department of Pulmonary Diseases, Cyprus Internatıonal Unıversıty, Cyprus
| | - Yasemin Yavuz
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilek Karadogan
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgul Bozkurt
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ummuhan Seker
- Clinic of Immunology and Allergic Diseases, Bursa City Hospital, Bursa, Turkey
| | | | - Ilknur Basyigit
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Serap Argun Baris
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Elif Yilmazel Ucar
- Faculty of Medicine, Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
| | - Tuba Erdogan
- Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy, Baskent University, Ankara, Turkey
| | - Mehmet Polatli
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Dane Ediger
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Fatma Esra Gunaydin
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Murat Turk
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
- Clinic of Immunologic and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Pur
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Zeynep Yegin Katran
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yonca Sekibag
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Enes Furkan Aykac
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Dilsad Mungan
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ozcan Gul
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Cengiz
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bulent Akkurt
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyma Ozden
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semra Demir
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ayse Feyza Aslan
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Reyhan Gumusburun
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Hatice Serpil Akten
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Sinem Inan
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Munevver Erdinc
- Faculty of Medicine, Department of Pulmonology, Ege University, Izmir, Turkey
| | - Aliye Candan Ogus
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Demet Polat Yulug
- Clinic of Chest Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gulistan Alpagat
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Eylem Sercan Ozgur
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Oguz Uzun
- Department of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Tas Gulen
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulseren Pekbak
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Deniz Kizilirmak
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Halil Donmez
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bahar Arslan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Gulden Pacaci Cetin
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Sadan Soyyigit
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Yilmaz Kara
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Gulden Pasaoglu Karakis
- School of Medicine, Department of Chest Diseases, Adult Allergy-Immunology Unit, Biruni University, Istanbul, Turkey
| | - Adile Berna Dursun
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
- Medical School, Department of Respiratory Medicine, Lokman Hekim University, Ankara, Turkey
| | - Resat Kendirlinan
- Clinic of Immunology and Allergic Diseases, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ayse Bilge Ozturk
- Faculty of Medicine, Department of Allergy and Immunology, Medeniyet University, Istanbul, Turkey
| | - Can Sevinc
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | - Gokcen Omeroglu Simsek
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | | | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Taskin Yucel
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Irfan Yorulmaz
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Zahide Ciler Tezcaner
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Emel Cadalli Tatar
- Department of Otolaryngology, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Ahmet Emre Suslu
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
- Ahmet Emre Suslu Private Ear Nose and Throat Clinic, Ankara, Turkey
| | - Serdar Ozer
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Engin Dursun
- Faculty of Medicine, Department of Otorhinolaryngology, Lokman Hekim University, Ankara, Turkey
| | - Arzu Yorgancioglu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
12
|
Cushen B, Koh MS, Tran TN, Martin N, Murray R, Uthaman T, Goh CYY, Vella R, Eleangovan N, Bulathsinhala L, Maspero JF, Peters MJ, Schleich F, Pitrez P, Christoff G, Sadatsafavi M, Torres-Duque CA, Porsbjerg C, Altraja A, Lehtimäki L, Bourdin A, Taube C, Papadopoulos NG, Zsuzsanna C, Björnsdóttir U, Salvi S, Heffler E, Iwanaga T, al-Ahmad M, Larenas-Linnemann D, van Boven JFM, Aarli BB, Kuna P, Loureiro CC, Al-lehebi R, Lee JH, Marina N, Bjermer L, Sheu CC, Mahboub B, Busby J, Menzies-Gow A, Wang E, Price DB. Adult Severe Asthma Registries: A Global and Growing Inventory. Pragmat Obs Res 2023; 14:127-147. [PMID: 37881411 PMCID: PMC10595155 DOI: 10.2147/por.s399879] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Aim The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests. Methods Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR's Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised. Results Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting >90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases. Conclusion Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.
Collapse
Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Neil Martin
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | | | - Thendral Uthaman
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Celine Yun Yi Goh
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Rebecca Vella
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Neva Eleangovan
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Jorge F 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
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Florence Schleich
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
| | - Paulo Pitrez
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | | | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Celeste Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Csoma Zsuzsanna
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Unnur Björnsdóttir
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Mona al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | | | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
| | - Bernt Bøgvald Aarli
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Cláudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Riyad Al-lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Nuria Marina
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - On behalf of ISAR Inventory Study Group
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
- 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
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
- Faculty of Public Health, Medical University, Sofia, Bulgaria
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
- Pulmocare Research and Education Foundation, Pune, India
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Kindai University Hospital, Osakasayama, Japan
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Lung Division, Royal Brompton & Harefield Hospital, London, UK
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| |
Collapse
|
13
|
Lajoie C, Ghanemi A, Bourbeau K, Sidibé A, Wang YP, Desmeules S, Mac-Way F. Multimodality approach to treat calciphylaxis in end-stage kidney disease patients. Ren Fail 2023; 45:2256413. [PMID: 37724534 PMCID: PMC10512890 DOI: 10.1080/0886022x.2023.2256413] [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: 06/26/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023] Open
Abstract
A multimodality approach has been proposed as an effective treatment for calciphylaxis in patients with end-stage kidney disease. In this retrospective study, we report the cases of 12 end-stage kidney disease patients from l'Hôtel-Dieu de Québec hospital (Canada) who were diagnosed with calciphylaxis between 2004 and 2012 and treated with a multimodality clinical approach including sodium thiosulfate (STS). Statistical analyses were performed to evaluate the impacts of patients characteristics, the different interventions as well as therapy regimen on the therapeutic response. The majority of patients (n = 9) were hemodialyzed. The patients-associated comorbidities were consistent with previously reported risk factors for calciphylaxis: Diabetes (n = 11), calcium-based phosphate binders use (n = 10), warfarin use (n = 9), obesity (n = 7), female gender (n = 8) and intravenous iron use (n = 8). STS was given for a median duration of 81 days. 75% of the patients had a response (total or partial) including a complete response in 42% of patients. One-year mortality rate was low (25%). STS was used during a mean duration of 83.33 ± 41.52 days and with a total cumulating dose of 1129.00 ± 490.58 g. The recorded mean time before a complete response was 102.20 days (51-143). Pain improvement occurred after a mean time of 8.67 ± 10.06 days. None of the studied factors was statistically associated with a complete or a partial response to the multimodality approach. Although our data have a limited statistical power, they support treating calciphylaxis with a multimodality approach including STS as its effects are independent from important clinical variables.
Collapse
Affiliation(s)
- Chloé Lajoie
- CHU de Québec, L’Hôtel-Dieu de Québec Hospital, Faculty and Department of Pharmacy, Université Laval, Québec, Canada
- Department of Pharmacy, CSSS de la Minganie, Québec, Canada
| | - Abdelaziz Ghanemi
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Kateri Bourbeau
- CHU de Québec, L’Hôtel-Dieu de Québec Hospital, Faculty and Department of Pharmacy, Université Laval, Québec, Canada
| | - Aboubacar Sidibé
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Yue-Pei Wang
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Simon Desmeules
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| |
Collapse
|
14
|
Fan M, Song W, Hao Z, Zhang J, Li Y, Fu J. Construction of lncRNA-miRNA-mRNA regulatory network in severe asthmatic bronchial epithelial cells: A bioinformatics study. Medicine (Baltimore) 2023; 102:e34749. [PMID: 37657025 PMCID: PMC10476739 DOI: 10.1097/md.0000000000034749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 09/03/2023] Open
Abstract
Asthma is a chronic respiratory disease caused by environment-host interactions. Bronchial epithelial cells (BECs) are the first line of defense against environmental toxins. However, the mechanisms underlying the role of BECs in severe asthma (SA) are not yet fully understood. Long noncoding RNAs (lncRNAs) and microRNAs (miRNAs) have been shown to play important roles in the regulation of gene expression in the pathogenesis of SA. In this study, bioinformatics was used for the first time to reveal the lncRNA-miRNA-mRNA regulatory network of BECs in SA. Five mRNA datasets of bronchial brushing samples from patients with SA and healthy controls (HC) were downloaded from the Gene Expression Omnibus (GEO) database. A combination of the Venn diagram and robust rank aggregation (RRA) method was used to identify core differentially expressed genes (DEGs). Protein-protein interaction (PPI) analysis of core DEGs was performed to screen hub genes. The miRDB, miRWalk, and ENCORI databases were used to predict the miRNA-mRNA relationships, and the ENCORI and starBase v2.0 databases were used to predict the upstream lncRNAs of the miRNA-mRNA relationships. Four core DEGs were identified: carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5), interleukin-1 receptor type 2 (IL1R2), trefoil factor 3 (TFF3), and vascular endothelial growth factor A (VEGFA). These 4 core DEGs indicated that SA was not significantly associated with sex. Enrichment analysis showed that the MAPK, Rap1, Ras, PI3K-Akt and Calcium signaling pathways may serve as the principal pathways of BECs in SA. A lncRNA-miRNA-mRNA regulatory network of the severe asthmatic bronchial epithelium was constructed. The top 10 competing endogenous RNAs (ceRNAs) were FGD5 antisense RNA 1 (FGD5-AS1), metastasis associated lung adenocarcinoma transcript 1 (MALAT1), X inactive specific transcript (XIST), HLA complex group 18 (HCG18), small nucleolar RNA host gene 16 (SNHG16), has-miR-20b-5p, has-miR-106a-5p, hsa-miR-106b-5p, has-miR-519d-3p and Fms related receptor tyrosine kinase 1 (FLT1). Our study revealed a potential mechanism for the lncRNA-miRNA-mRNA regulatory network in BECs in SA.
Collapse
Affiliation(s)
- Mengzhen Fan
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenjie Song
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin Key Laboratory of Modern Chinese Medicine Theory Innovation and Transformation, Tianjin, China
| | - Zheng Hao
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin Key Laboratory of Modern Chinese Medicine Theory Innovation and Transformation, Tianjin, China
- Medical History Documentation Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Zhang
- Department of General Surgery, Henan University of Science and Technology Affiliated First Hospital, Luoyang, China
| | - Yang Li
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinjie Fu
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
15
|
Hale EM, Greene G, Mulvey C, Mokoka MC, van Boven JFM, Cushen B, Sulaiman I, Brennan V, Lombard L, Walsh J, Plunkett S, McCartan TA, Kerr PJ, Reilly RB, Hughes C, Kent BD, Jackson DJ, Butler M, Counihan I, Hayes J, Faul J, Kelly M, Convery R, Nanzer AM, Fitzgerald JM, Murphy DM, Heaney LG, Costello RW. Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial. THE LANCET. RESPIRATORY MEDICINE 2023; 11:591-601. [PMID: 36963417 DOI: 10.1016/s2213-2600(22)00534-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 03/26/2023]
Abstract
BACKGROUND The clinical value of using digital tools to assess adherence and lung function in uncontrolled asthma is not known. We aimed to compare treatment decisions guided by digitally acquired data on adherence, inhaler technique, and peak flow with existing methods. METHODS A 32-week prospective, multicentre, single-blinded, parallel, randomly controlled trial was done in ten severe asthma clinics across Ireland, Northern Ireland, and England. Participants were 18 years or older, had uncontrolled asthma, asthma control test (ACT) score of 19 or less, despite treatment with high-dose inhaled corticosteroids, and had at least one severe exacerbation in the past year despite high-dose inhaled corticosteroids. Patients were randomly assigned in a 1:1 ratio to the active group or the control group, by means of a computer-generated randomisation sequence of permuted blocks of varying sizes (2, 4, and 6) stratified by fractional exhaled nitric oxide (FeNO) concentration and recruitment site. In the control group, participants were masked to their adherence and errors in inhaler technique data. A statistician masked to study allocation did the statistical analysis. After a 1-week run-in period, both groups attended three nurse-led education visits over 8 weeks (day 7, week 4, and week 8) and three physician-led treatment adjustment visits at weeks 8, 20, and 32. In the active group, treatment adjustments during the physician visits were informed by digital data on inhaler adherence, twice daily digital peak expiratory flow (ePEF), patient-reported asthma control, and exacerbation history. Treatment was adjusted in the control group on the basis of pharmacy refill rates (a measure of adherence), asthma control by ACT questionnaire, and history of exacerbations and visual management of inhaler technique. Both groups used a digitally enabled Inhaler Compliance Assessment (INCA) and PEF. The primary outcomes were asthma medication burden measured as proportion of patients who required a net increase in treatment at the end of 32 weeks and adherence rate measured in the last 12 weeks by area under the curve in the intention-to-treat population. The safety analyses included all patients who consented for the trial. The trial is registered with ClinicalTrials.gov, NCT02307669 and is complete. FINDINGS Between Oct 25, 2015, and Jan 26, 2020, of 425 patients assessed for eligibility, 220 consented to participate in the study, 213 were randomly assigned (n=108 in the active group; n=105 in the control group) and 200 completed the study (n=102 in the active group; n=98 in the control group). In the intention-to-treat analysis at week 32, 14 (14%) active and 31 (32%) control patients had a net increase in treatment compared with baseline (odds ratio [OR] 0·31 [95% CI 0·15-0·64], p=0·0015) and 11 (11%) active and 21 (21%) controls required add-on biological therapy (0·42 [0·19-0·95], p=0·038) adjusted for study site, age, sex, and baseline FeNO. Three (16%) of 19 active and 11 (44%) of 25 control patients increased their medication from fluticasone propionate 500 μg daily to 1000 μg daily (500 μg twice a day; adjusted OR 0·23 [0·06-0·87], p=0·026). 26 (31%) of 83 active and 13 (18%) of 73 controls reduced their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily (adjusted OR 2·43 [1·13-5·20], p=0·022. Week 20-32 actual mean adherence was 64·9% (SD 23·5) in the active group and 55·5% (26·8) in the control group (between-group difference 11·1% [95% CI 4·4-17·9], p=0·0012). A total of 29 serious adverse events were recorded (16 [55%] in the active group, and 13 [45%] in the control group), 11 of which were confirmed as respiratory. None of the adverse events reported were causally linked to the study intervention, to the use of salmeterol-fluticasone inhalers, or the use of the digital PEF or INCA. INTERPRETATION Evidence-based care informed by digital data led to a modest improvement in medication adherence and a significantly lower treatment burden. FUNDING Health Research Board of Ireland, Medical Research Council, INTEREG Europe, and an investigator-initiated project grant from GlaxoSmithKline.
Collapse
Affiliation(s)
- Elaine Mac Hale
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Garrett Greene
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland; Department of Statistics, University College Dublin, Dublin
| | - Christopher Mulvey
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Matshediso C Mokoka
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Breda Cushen
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Imran Sulaiman
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Vincent Brennan
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Lorna Lombard
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Joanne Walsh
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Sinead Plunkett
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Thomas A McCartan
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Patrick J Kerr
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Cian Hughes
- Trinity Centre for Biomedical Engineering, School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's Hospital, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Marcus Butler
- Respiratory Medicine Division, St Vincent's Hospital, Dublin, Ireland
| | - Ian Counihan
- Respiratory Medicine Division, OLUH, Drogheda, Ireland
| | - James Hayes
- Respiratory Medicine Division, Cavan Hospital, Cavan, Ireland
| | - John Faul
- Respiratory Medicine, James Connolly Hospital, Dublin
| | - Martin Kelly
- Respiratory Medcine, Altnagelvin Area Hospital, Northern Ireland, UK
| | - Rory Convery
- Consultant Respiratory Physician at Southern Health and Social Care Trust, Northern Ireland, UK
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - J Mark Fitzgerald
- Respiratory Medicine Division, University of British Colombia, Vancouver, Canada
| | - Desmond M Murphy
- Department of Respiratory Medicine, University Hospital Cork and Clinical Research Facility, University College Cork, Cork, Ireland
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, UK
| | - Richard W Costello
- INCA Research Team, RCSI University of Medicine and Health Science, Clinical Research Centre, Dublin, Ireland; Department of Respiratory Medicine, Beaumont Hospital and RCSI University of Medicine and Health Science, Dublin, Ireland.
| |
Collapse
|
16
|
Håkansson KEJ, Løkke A, Ibsen R, Hilberg O, Backer V, Ulrik CS. Beyond direct costs: individual and societal financial burden of asthma in young adults in a Danish nationwide study. BMJ Open Respir Res 2023; 10:10/1/e001437. [PMID: 37156597 PMCID: PMC10174025 DOI: 10.1136/bmjresp-2022-001437] [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: 09/01/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION As a common chronic disease seen across all ages, asthma has the potential to incur high societal and individual costs from both direct healthcare costs and loss of productivity. Most previous studies use smaller, selected populations to assess the cost of asthma, possibly reducing generalisability. We, therefore, aimed to assess the total, nationwide economic burden of asthma by severity from both an individual and a societal perspective. METHODS The annual cost of asthma was assessed in a Danish nationwide cohort of patients aged 18-45 during 2014-2016 as excess healthcare costs, loss of income and welfare expenditure compared with controls (matched 1:4) using national registries. Asthma severity was defined as mild-to-moderate (steps 1-3 or step 4 without exacerbations) or severe (step 4 with exacerbations or step 5). RESULTS Across 63 130 patients (mean age 33, 55% female), the annual excess cost of asthma compared with controls was predicted to €4095 (95% CI €3856 to €4334) per patient. Beyond direct costs related to treatment and hospitalisations (€1555 (95% CI €1517 to €1593)), excess indirect costs related to loss of income (€1060 (95% CI €946 to €1171)) and welfare expenditure (eg, sick pay and disability pensions) (€1480 (95% CI €1392 to €1570)) were seen. Crude pooling of excess costs resulted in an annual societal cost of €263 million for all included patients.Severe asthma (4.5%) incurred 4.4 times higher net costs (€15 749 (95% CI 13 928 to €17 638)) compared with mild-to-moderate disease (€3586 (95% CI €3349 to €3824)). Furthermore, patients with severe asthma experienced an annual loss of income of €3695 (95% CI €4106 to €3225) compared with controls. CONCLUSION In young adults with asthma, a significant societal and individual financial burden of disease was seen across severities. Expenditure was mainly driven by loss of income and welfare utilisation, rather than direct healthcare costs.
Collapse
Affiliation(s)
| | - Anders Løkke
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
17
|
Lee TY, Sadatsafavi M, Yadav CP, Price DB, Beasley R, Janson C, Koh MS, Roy R, Chen W. Individualised risk prediction model for exacerbations in patients with severe asthma: protocol for a multicentre real-world risk modelling study. BMJ Open 2023; 13:e070459. [PMID: 36894199 PMCID: PMC10008482 DOI: 10.1136/bmjopen-2022-070459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Severe asthma is associated with a disproportionally high disease burden, including the risk of severe exacerbations. Accurate prediction of the risk of severe exacerbations may enable clinicians to tailor treatment plans to an individual patient. This study aims to develop and validate a novel risk prediction model for severe exacerbations in patients with severe asthma, and to examine the potential clinical utility of this tool. METHODS AND ANALYSIS The target population is patients aged 18 years or older with severe asthma. Based on the data from the International Severe Asthma Registry (n=8925), a prediction model will be developed using a penalised, zero-inflated count model that predicts the rate or risk of exacerbation in the next 12 months. The risk prediction tool will be externally validated among patients with physician-assessed severe asthma in an international observational cohort, the NOVEL observational longiTudinal studY (n=1652). Validation will include examining model calibration (ie, the agreement between observed and predicted rates), model discrimination (ie, the extent to which the model can distinguish between high-risk and low-risk individuals) and the clinical utility at a range of risk thresholds. ETHICS AND DISSEMINATION This study has obtained ethics approval from the Institutional Review Board of National University of Singapore (NUS-IRB-2021-877), the Anonymised Data Ethics and Protocol Transparency Committee (ADEPT1924) and the University of British Columbia (H22-01737). Results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER European Union electronic Register of Post-Authorisation Studies, EU PAS Register (EUPAS46088).
Collapse
Affiliation(s)
- Tae Yoon Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Optimum Patient Care Global, Cambridge, UK
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Rupsa Roy
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| |
Collapse
|
18
|
Zhou Y, Qiu Y, Bao W, Han L, Xue Y, Zhang Y, Tian X, Fu Q, Lv C, Yin D, Zhang M. Evaluating the effects of vitamin D Level on airway obstruction in two asthma endotypes in humans and in two mouse models with different intake of vitamin D during early-life. Front Immunol 2023; 14:1107031. [PMID: 36793727 PMCID: PMC9922677 DOI: 10.3389/fimmu.2023.1107031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/06/2023] [Indexed: 02/03/2023] Open
Abstract
Introduction Asthma is primarily divided into two categories: type 2 (T2-high) and non-type 2 (T2-low). A relationship between asthma severity and vitamin D deficiency has been identified, but its impact on each asthma endotype remains unknown. Methods We clinically examined the influence of vitamin D on patients with T2-high (n = 60) or T2-low asthma (n = 36) compared with controls (n = 40). Serum 25(OH)D levels, inflammatory cytokines and spirometry were measured. Mouse models were then used to further analyze the effects of vitamin D on both asthmatic endotypes. BALB/c mice were fed with vitamin D-deficient (LVD), -sufficient (NVD), or -supplemented diets (HVD) throughout lactation and offspring followed the same diet after weaning. Offspring were sensitized/challenged with ovalbumin (OVA) to establish "T2-high" asthma or OVA combined with ozone exposure (OVA + ozone) to induce "T2-low" asthma. Spirometry and serum, bronchoalveolar lavage fluid (BALF), and lung tissues were analyzed. Results Serum 25(OH)D levels were decreased in asthmatic patients compared with controls. Patients with vitamin D deficiency (Lo) had varying degrees of elevation of the pro-inflammatory cytokines IL-5, IL-6, and IL-17A, decreased expression of the anti-inflammatory cytokine IL-10, and altered forced expiratory volume in the first second as a percentage of predicted value (FEV1%pred) in both asthmatic endotypes. Vitamin D status had a stronger correlation with FEV1%pred in T2-low asthma than T2-high asthma, and 25(OH)D level was only positively linked to maximal mid-expiratory flow as a percentage of predicted value (MMEF%pred) in the T2-low group. Inflammation, hyperresponsiveness, and airway resistance (RL) was increased in both asthma models compared with controls while vitamin D deficiency further increased airway inflammation and airway obstruction. These findings were particularly prominent in T2-low asthma. Discussion The potential function and mechanisms of vitamin D and both asthma endotypes should be studied individually, and further analysis of the potential signaling pathways involved with vitamin D on T2-low asthma is warranted.
Collapse
Affiliation(s)
- Yan Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yali Qiu
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Wuping Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue Tian
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Fu
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjian Lv
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongning Yin
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai, China,*Correspondence: Min Zhang,
| |
Collapse
|
19
|
Maio S, Murgia N, Tagliaferro S, Angino A, Sarno G, Carrozzi L, Pistelli F, Bacci E, Paggiaro PL, Latorre M, Baldacci S, Viegi G. The Italian severe/uncontrolled asthma registry (RItA): A 12-month clinical follow-up. Respir Med 2022; 205:107030. [PMID: 36370538 DOI: 10.1016/j.rmed.2022.107030] [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: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND follow-up studies on registries of severe/uncontrolled asthma (SUA) patients are scanty. OBJECTIVE to analyze baseline and follow-up characteristics of SUA patients and their longitudinal patterns. METHODS 180 adult patients (age ≥15 yrs) were investigated at baseline and 12-month follow-up through the Italian SUA registry (RItA). Latent transition analysis (LTA) was performed to detect cross-sectional SUA phenotypes and longitudinal patterns. Risk factors for longitudinal patterns were assessed through logistic regression. RESULTS a significant/borderline improvement of asthma control outcomes in the last 2-4 weeks emerged at follow-up with respect to baseline for: daily activities limitations (Δ -16%), frequent diurnal symptoms (Δ -25%), uncontrolled asthma symptoms according to ACT (Δ -26%). Last 12-month use of oral corticosteroids was less frequent at follow-up than at baseline (Δ -25%). Health status improvement was confirmed by lung function test results. Through LTA, two longitudinal patterns were detected considering last 12-month control outcomes: "persistence/worsening" (53.9%), "under control/improvement" (46.1%). A lower likelihood of having "persistence/worsening" SUA was exhibited by patients under anti-IgE (OR 0.38, 95% CI 0.17-0.84) and inhaled corticosteroids-bronchodilator association treatment (OR 0.13, 95% CI 0.01-1.26, borderline value), while a higher likelihood was shown by older age at first asthma diagnosis (OR 1.04, 95% CI 1.01-1.07). CONCLUSION the implementation of a SUA registry, the availability of patient-level data and the application of an innovative longitudinal analysis allowed to observe a general improvement in asthma control, one year after baseline, and a lower risk of SUA "persistence/worsening" in patients under anti-IgE and regular ICS-bronchodilator association use.
Collapse
Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy.
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Medicine, Dept., Perugia University, Italy
| | - Sofia Tagliaferro
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Giuseppe Sarno
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Elena Bacci
- Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Pier Luigi Paggiaro
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Manuela Latorre
- Pulmonary Unit, Department of Medical Specialties, Nuovo Ospedale Apuano, Massa, Italy
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| |
Collapse
|
20
|
Chen W, Sadatsafavi M, Tran TN, Murray RB, Wong CBN, Ali N, Ariti C, Garcia Gil E, Newell A, Alacqua M, Al-Ahmad M, Altraja A, Al-Lehebi R, Bhutani M, Bjermer L, Bjerrum AS, Bourdin A, Bulathsinhala L, von Bülow A, Busby J, Canonica GW, Carter V, Christoff GC, Cosio BG, Costello RW, FitzGerald JM, Fonseca JA, Yoo KH, Heaney LG, Heffler E, Hew M, Hilberg O, Hoyte F, Iwanaga T, Jackson DJ, Jones RC, Koh MS, Kuna P, Larenas-Linnemann D, Lehmann S, Lehtimäki LA, Lyu J, Mahboub B, Maspero J, Menzies-Gow AN, Sirena C, Papadopoulos N, Papaioannou AI, Pérez de Llano L, Perng DW, Peters M, Pfeffer PE, Porsbjerg CM, Popov TA, Rhee CK, Salvi S, Taillé C, Taube C, Torres-Duque CA, Ulrik CS, Ra SW, Wang E, Wechsler ME, Price DB. Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy. J Asthma Allergy 2022; 15:1491-1510. [PMID: 36303891 PMCID: PMC9595059 DOI: 10.2147/jaa.s377174] [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: 06/24/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR; https://isaregistries.org/), who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson’s chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.
Collapse
Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Chong Boon Nigel Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nasloon Ali
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Cono Ariti
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | - Anthony Newell
- Observational and Pragmatic Research Institute, Singapore, Singapore,Optimum Patient Care, Queensland, VIC, Australia
| | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohit Bhutani
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Western Canada, AB, Canada
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anne Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Jutland, Aarhus, Denmark
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Lakmini Bulathsinhala
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - J Mark FitzGerald
- Department of Medicine, the University of British Columbia, Vancouver, BC, Canada
| | - João A Fonseca
- Comunity Health, Information and Decision Sciences Department (MEDCIDS) & Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kwang Ha Yoo
- KonKuk University School of Medicine in Seoul, Seoul, Korea
| | - 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, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia,Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ole Hilberg
- Medical Department, Vejle University Hospital, Jutland, Vejle, Denmark
| | - Flavia Hoyte
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA,Department of Internal Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy’s and St Thomas’ NHS Trust, London, UK,School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Rupert C Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK
| | - Mariko Siyue Koh
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Lung Centre, Singapore, Singapore
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Łódź, Poland
| | | | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lauri A Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juntao Lyu
- Observational and Pragmatic Research Institute, Singapore, Singapore,Optimum Patient Care, Queensland, VIC, Australia
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - 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
| | | | | | - Nikolaos Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK,Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Pérez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Lugo, Spain,Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Diahn-Warng Perng
- Division of Clinical Respiratory Physiology Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan,COPD Assembly of the Asian Pacific Society of RespirologyHongo, Bunkyo-ku, Tokyo, Japan
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Todor A Popov
- University Hospital ”sv. Ivan Rilski”, Sofia, Bulgaria
| | - Chin Kook Rhee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - 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
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Seung Won Ra
- Department of Internal Medicine, Division of Pulmonology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eileen Wang
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA,Department of Internal Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, CO, USA
| | - David B Price
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Correspondence: David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore, Singapore, 573969, Tel +65 3105 1489, Email
| |
Collapse
|
21
|
Fouka E, Domvri K, Gkakou F, Alevizaki M, Steiropoulos P, Papakosta D, Porpodis K. Recent insights in the role of biomarkers in severe asthma management. Front Med (Lausanne) 2022; 9:992565. [PMID: 36226150 PMCID: PMC9548530 DOI: 10.3389/fmed.2022.992565] [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: 07/12/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022] Open
Abstract
Contemporary asthma management requires a proactive and individualized approach, combining precision diagnosis and personalized treatment. The introduction of biologic therapies for severe asthma to everyday clinical practice, increases the need for specific patient selection, prediction of outcomes and monitoring of these costly and long-lasting therapies. Several biomarkers have been used in asthma in disease identification, prediction of asthma severity and prognosis, and response to treatment. Novel advances in the area of personalized medicine regarding disease phenotyping and endotyping, encompass the development and application of reliable biomarkers, accurately quantified using robust and reproducible methods. The availability of powerful omics technologies, together with integrated and network-based genome data analysis, and microbiota changes quantified in serum, body fluids and exhaled air, will lead to a better classification of distinct phenotypes or endotypes. Herein, in this review we discuss on currently used and novel biomarkers for the diagnosis and treatment of asthma.
Collapse
Affiliation(s)
- Evangelia Fouka
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: Evangelia Fouka
| | - Kalliopi Domvri
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foteini Gkakou
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Alevizaki
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Despoina Papakosta
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Porpodis
- G. Papanikolaou General Hospital, Thessaloniki, Greece
- Pulmonary Department of Aristotle University of Thessaloniki, Thessaloniki, Greece
- Konstantinos Porpodis
| |
Collapse
|
22
|
Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:31/164/210278. [PMID: 35675922 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
Collapse
Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy .,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
23
|
Håkansson KEJ, Backer V, Ulrik CS. Disease Control, Not Severity, Drives Job Absenteeism in Young Adults with Asthma - A Nationwide Cohort Study. J Asthma Allergy 2022; 15:827-837. [PMID: 35755419 PMCID: PMC9231418 DOI: 10.2147/jaa.s360776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The impact of asthma and disease control on job absenteeism in young adults is sparsely investigated and conflicting evidence exist. Based on a nationwide cohort, the present study aims to describe the overall job absenteeism across asthma severities and describe the possible influence of asthma control. Methods REASSESS is a nationwide cohort of Danish asthma patients aged 18–45 using controller medication between 2014 and 2018, followed retrospectively for up to 15 years using national databases. Impact of asthma was investigated using negative binomial regression adjusted for age, sex, Charlson score and level of education and presented as adjusted incidence rate ratios with 95% confidence intervals. Results A total of 60,534 patients with asthma (median age 33 (25, 39), 55% female, 19% uncontrolled disease and 5.7% possible severe asthma) were followed for 12.7 (6.5–14.8) years. The prevalence of any absenteeism was more common in both mild-to-moderate and possible severe asthma compared to the background population (67%, 80% and 62%, respectively; p < 0.0001). Compared to the background population, mild-to-moderate and possible severe asthma were more likely to have temporary sick leave (1.37 (1.33–1.42); 1.78 (1.62–1.96)), unemployment (1.11 (1.07–1.14); 1.26 (1.15–1.38)) and obtain disability benefits (1.67 (1.66–1.67); 2.64 (2.63–2.65)). Uncontrolled asthma had increased temporary sick leave (1.42 (1.34–1.50)), unemployment (1.40 (1.32–1.48)) and disability (1.26 (1.26–1.27)) when compared to controlled disease. Significant increases in absenteeism could be measured already at ≥100 annual doses of rescue medication (1.09 (1.04–0.1.14)), patients’ first moderate or severe exacerbation (1.31 (1.15–1.49) and 1.31 (1.24–1.39), respectively). Further increases in absenteeism were observed with increasing rescue medication use and severe exacerbations. Conclusion Across severities, job absenteeism is increased among patients with asthma compared to the background population. Increases in absenteeism was seen already at ≥100 annual doses of rescue medication, representing a substantial, and probably preventable, reduction in productivity among young adults.
Collapse
Affiliation(s)
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Korn S, Milger K, Skowasch D, Timmermann H, Taube C, Idzko M, Voß HW, Holtdirk A, Hamelmann E, Buhl R. The German severe asthma patient: Baseline characteristics of patients in the German Severe Asthma Registry, and relationship with exacerbations and control. Respir Med 2022; 195:106793. [PMID: 35248804 DOI: 10.1016/j.rmed.2022.106793] [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: 11/03/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The German Asthma Net Severe Asthma Registry is collecting long-term data from a large cohort of patients aged ≥6 years with severe asthma. This manuscript presents their baseline characteristics, and identifies relationships with exacerbations and/or poor asthma control. METHODS The registry is collecting routine clinical parameters including: demographics and medical history; disease characteristics (Asthma Control Questionnaire [ACQ]-5, forced expiratory volume in 1 s [FEV1]); exacerbations; and biomarkers (eosinophils, immunoglobulin E [IgE], fractional exhaled nitric oxide [FeNO]). RESULTS These analyses include data from 2011 patients at 72 sites (91.9% adult). Children (6-17 years) were more likely to be male, whereas more adults were female (males: children/adults 62%/41%). Most were receiving inhaled corticosteroid/long-acting β2-agonist combinations (78%/81%); 38.0% of adults were receiving systemic steroids. Asthma control was suboptimal in both groups: 21.5%/13.3% were controlled; 10.4%/49.1% were symptomatic; 33.1%/37.2% received emergency asthma treatment in the previous year. Median blood eosinophil (400/238 cells/μL) and IgE levels (494/186 IU/mL) were higher in children; FeNO was lower (19/35 ppb). Patients with ≥2 exacerbations in the previous year had lower FEV1 (absolute and % predicted) and IgE, and higher ACQ-5, FeNO and blood eosinophil levels (all p < 0.05). There was a weak, negative correlation between ACQ-5 and FEV1% predicted in adults (p < 0.001). CONCLUSIONS These analyses characterise the typical German patient with severe asthma, and provide information on their overall care. Their planned long-term follow-up will assess whether asthma control can be optimised, how best to do so, and most importantly how such optimisation can benefit patients.
Collapse
Affiliation(s)
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center Munich, and Member of the German Center for Lung Research, Germany
| | - Dirk Skowasch
- Department of Internal Med. II - Pneumology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Timmermann
- Hamburger Institut für Therapieforschung und Schwerpunktpraxis Colonnaden, Hamburg, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Essen, Germany
| | - Marco Idzko
- Department of Pneumology, University Hospital Vienna, Austria
| | | | | | - Eckard Hamelmann
- Department of Pediatrics. University Hospital OWL, University Bielefeld, Bielefeld, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, 55131, Mainz, Germany
| |
Collapse
|
26
|
Håkansson KEJ, Renzi-Lomholt M, Backer V, Ulrik CS. High Use of Antidepressant Medication in Both Mild-to-Modelate and Possible Severe Asthma - A Nationwide Cohort Study. J Asthma Allergy 2022; 15:13-23. [PMID: 35027831 PMCID: PMC8749230 DOI: 10.2147/jaa.s340522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In asthma, increased severity has been linked to depression assessed as assessed by patient-reported outcomes. However, little is known about predictors of antidepressant use in asthma compared to the background population. METHODS The study consists of 60,534 asthma patients aged 18-45 and a 1:1 age- and sex-matched control group. Using national registries and prescription data, the prevalence of and risk factors for antidepressant use were investigated by logistic regression adjusted for age, sex, workforce and civil status, income- and education-level and comorbidity. Results presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 16% and 22%, respectively, among patients with mild-to-moderate and possible severe asthma redeemed antidepressant drugs, compared to 10% of controls. Antidepressant use was more prevalent amongst patients with high rescue medication use (>600 annual doses) and those with a history of moderate or severe exacerbation(s). Both mild-to-moderate and possible severe asthma were independent risk factors for antidepressant use (OR 1.40 (95% CI 1.35, 1.46) and OR 1.55 (95% CI 1.41, 1.70), respectively). Female sex, age, being divorced or never married, having only primary education or currently being under education, as well as being on welfare/transfer income increased odds of antidepressant use. Completing higher education and having high income were associated with lower odds. CONCLUSION In asthma, antidepressant use is significantly higher than in the background population. Even after adjusting for known risk factors, asthma remains a predictor of antidepressant use, signalling a psychologic burden related to living with asthma.
Collapse
Affiliation(s)
| | - Martino Renzi-Lomholt
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
Menzies-Gow AN, McBrien C, Unni B, Porsbjerg CM, Al-Ahmad M, Ambrose CS, Dahl Assing K, von Bülow A, Busby J, Cosio BG, FitzGerald JM, Garcia Gil E, Hansen S, aHeaney LG, Hew M, Jackson DJ, Kallieri M, Loukides S, Lugogo NL, Papaioannou AI, Larenas-Linnemann D, Moore WC, Perez-de-Llano LA, Rasmussen LM, Schmid JM, Siddiqui S, Alacqua M, Tran TN, Suppli Ulrik C, Upham JW, Wang E, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Murray RB, Price CA, Price DB. Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study. J Asthma Allergy 2022; 15:63-78. [PMID: 35046670 PMCID: PMC8763264 DOI: 10.2147/jaa.s328653] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/23/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction International registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors. Methods This was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR; http://isaregistries.org, 2015–2020) or the CHRONICLE Study (2018–2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups. Results A total of 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti–IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti–IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization. Conclusion The description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.
Collapse
Affiliation(s)
- Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals, London, UK
| | | | - Bindhu Unni
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | | | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen’s University Belfast, Belfast, Northern Ireland
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - J Mark FitzGerald
- The Centre for Lung Health, Vancouver Coastal Health Research Institute, UBC, Vancouver, Canada
| | | | - Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G aHeaney
- UK Severe Asthma Network and National Registry, Queen’s University Belfast, Belfast, Northern Ireland
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David J Jackson
- UK Severe Asthma Network andNational Registry, Guy’s and St Thomas’ NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Maria Kallieri
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Njira L Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Wendy C Moore
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Luis A Perez-de-Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Linda M Rasmussen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Copenhagen, Denmark
| | | | - Salman Siddiqui
- University of Leicester, Department of Respiratory Sciences & NIHR Leicester Biomedical Research Centre (Respiratory Theme), Leicester, UK
| | | | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - John W Upham
- Diamantina Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA
- Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Victoria A Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Ruth B Murray
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Chris A Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Correspondence: David B Price Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore, 573969Tel +65 3105 1489 Email
| |
Collapse
|
28
|
Håkansson KEJ, Backer V, Ulrik CS. Socioeconomic status is associated with healthcare seeking behaviour and disease burden in young adults with asthma - A nationwide cohort study. Chron Respir Dis 2022; 19:14799731221117297. [PMID: 35938497 PMCID: PMC9364195 DOI: 10.1177/14799731221117297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Specialist management of asthma has been shown to associate with
socioeconomic status (SES). However, little is known about the influence of
SES on care burden in universal healthcare settings. Methods Patients aged 18–45 years using inhaled corticosteroids (ICS) were followed
in national databases. Impact of asthma was investigated using negative
binomial regression adjusted for age, sex, comorbidity, and GINA 2020 Step.
Uncontrolled asthma was defined as >600 annual SABA puffs, ≥2
prednisolone courses and/or ≥1 hospitalization. Results A total of 60,534 (55% female, median age 33 (IQR 25–39)) patients were
followed for 10.1 years (IQR 5.2–14.3)). Uncontrolled asthma resulted in 6.5
and 0.51 additional annual contacts to primary care and pulmonologists,
respectively. Unscheduled and primary care burden was dependent on SES, increasing with
rural residence, lower education, income and receiving welfare. Differences
in planned respiratory care were slight, only seen among divorced, low
income- or welfare recipients. Lower SES was consistently associated with an
increased utilization of SABA and prednisolone. No dose–response
relationship between ICS use and SES could be identified. Conclusion Lower SES in asthma is a risk factor for a predominance of unscheduled care
and adverse outcomes, warranting further attention to patients’ background
when assessing asthma care.
Collapse
Affiliation(s)
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Denmark.,Institute of Clinical Medicine, 4321University of Copenhagen, Denmark
| |
Collapse
|
29
|
Antoniou KM, Bolaki M, Karagiannis K, Trachalaki A, Ierodiakonou D, Stamatopoulou V, Chatzinikolaou C, Mastrodimou S, Stamataki E, Pitsidianakis G, Lambiri I, Mitrouska I, Spandidos DA, Tzanakis N. Real-life Cretan asthma registry focused on severe asthma: On behalf of 'The Cretan registry of the use of Biologics in Severe Asthma'. Exp Ther Med 2021; 22:1239. [PMID: 34539835 DOI: 10.3892/etm.2021.10674] [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: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
Asthma diagnosis and management remains a challenging task for the medical community. The aim of the present study was to present the functional and inflammatory profiles of patients with difficult-to-treat asthma in a real-life clinical setting referred to the specialized asthma clinic at the University Hospital of Heraklion. The registry included a cohort of 267 patients who were referred to the severe asthma clinic. Patients were assessed with emphasis on the history of allergies, nasal polyposis or other comorbidities. Blood testing for eosinophils counts and total and specific IgE, and pulmonary function tests were performed at baseline. The median age of patients with asthma was 55 years old, 68.5% were women and 58.3% were never smokers. The vast majority presented with late onset asthma (75.7%), whereas eight (3%) patients were on oral corticosteroids. The median number of exacerbations during the last 12 months was 1 (0-3). Furthermore, 50.7% of patients had a positive serum allergy test, the median eosinophil count was 300 (188-508.5) cells/µl of blood and median total IgE level was 117.5 (29.4-360.5) IU/ml. Patients were retrospectively grouped in the following categories: Group 1, mild-moderate asthma; group 2, patients prescribed a step 4 or 5 asthma therapy according to Global Initiative for Asthma; and group 3, patients on biologic agents. Group 1 had significantly higher FEV1% than groups 2 and 3 (93.4 vs. 79.9 and 79.4%, respectively; P<0.001). Finally, the median Asthma Control Questionnaire 7 (ACQ7) score was 1.14, with patients from groups 2 and 3 presenting higher ACQ7 scores compared with group 1 patients as expected (1.1 and 2.1 vs. 0.7, respectively; P<0.001). To the best of our knowledge, this was the first real-life asthma study in Crete that demonstrated that severe asthmatics predominantly have late-onset asthma with airflow obstruction and uncontrolled symptoms.
Collapse
Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Konstantinos Karagiannis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Athina Trachalaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Despo Ierodiakonou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece.,Department of Primary Care and Population Health, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vagia Stamatopoulou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Charito Chatzinikolaou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Semeli Mastrodimou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Evangelia Stamataki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - George Pitsidianakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Irini Lambiri
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Ioanna Mitrouska
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| |
Collapse
|
30
|
Paoletti G, Di Bona D, Chu DK, Firinu D, Heffler E, Agache I, Jutel M, Klimek L, Pfaar O, Mösges R, DunnGalvin A, Genuneit J, Hoffmann HJ, Canonica GW. Allergen immunotherapy: The growing role of observational and randomized trial "Real-World Evidence". Allergy 2021; 76:2663-2672. [PMID: 33583050 DOI: 10.1111/all.14773] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is a considerable body of knowledge about allergen immunotherapy (AIT), there is a lack of data on the reliability of real-world evidence (RWE) in AIT, and consequently, a lack of information on how AIT effectively works in real life. METHODS To address the current unmet need for an appraisal of the quality of RWE in AIT, the European Academy of Allergy and Clinical Immunology Methodology Committee recently initiated a systematic review of observational studies of AIT, which will use the RELEVANT tool and the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE) to rate the quality of the evidence base as a whole. The next step will be to develop a broadly applicable, pragmatic "real-world" database using systematic data collection. Based on the current RWE base, and perspectives and recommendations of authorities and scientific societies, a hierarchy of RWE in AIT is proposed, which places pragmatic trials and registry data at the positions of highest level of evidence. KEY RESULTS There is a need to establish more AIT registries that collect data in a cohesive way, using standardized protocols. CONCLUSIONS This will provide an essential source of real-world data that can be easily shared, promoting evidence-based research and quality improvement in study design and clinical decision-making.
Collapse
Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari – Aldo Moro Bari Italy
| | - Derek K. Chu
- Division of Immunology and Allergy Department of Health Research Methods, Evidence and Impact Department of Medicine McMaster University Hamilton ON Canada
- The Research Institute of St. Joe's Hamilton Hamilton ON Canada
| | - Davide Firinu
- Department of Clinical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University and “ALLMED”Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Ralph Mösges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology (IMSB) University of Cologne and CRI – Clinical Research International Limited Cologne Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry Ulm University Ulm Germany
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty Leipzig University Leipzig Germany
| | - Hans Jürgen Hoffmann
- Department of Clinical Medicine Aarhus University and Department of Respiratory Diseases and AllergyAarhus University Hospital Aarhus Denmark
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| |
Collapse
|
31
|
Håkansson KEJ, Backer V, Suppli Ulrik C. Socioeconomic biases in asthma control and specialist referral of possible severe asthma. Eur Respir J 2021; 58:13993003.00741-2021. [PMID: 33986027 DOI: 10.1183/13993003.00741-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS). METHODS Asthma patients fulfilling the following: aged 18-45 and redeeming ≥2 prescriptions of ICS during 2014-18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals). RESULTS Of 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51-0.85)), 36-45 versus 18-25 years), male sex (OR 0.75 (0.64-0.87)), residence outside the Capital Region (OR 0.70 (0.59-0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59-0.95)).Having completed higher education increased odds of specialist referral (OR 1.28 (1.03-1.59)), when compared to patients with basic education. CONCLUSION Even in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.
Collapse
Affiliation(s)
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
32
|
Bousquet J, Bedbrook A, Czarlewski W, De Carlo G, Fonseca JA, González Ballester MA, Illario M, Koskinen S, Laatikainen T, Onorato GL, Palkonen S, Patella V, Pham-Thi N, Puggioni F, Ventura MT, Joos G, Kuna P, Louis R, Makris M, Zalud P, Zuberbier T, Bachert C, Brussino L, Carreiro-Martins P, Carrion Y Ribas C, Chalubinski M, Costa EM, de Vries G, Gemicioglu B, Gennimata D, Micheli Y, Niedoszytko M, Regateiro FS, Romantowski J, Taborda-Barata L, Toppila-Salmi S, Tsiligianni I, Viart F, Laune D. Digital Health Europe (DHE) Twinning on severe asthma-kick-off meeting report. J Thorac Dis 2021; 13:3215-3225. [PMID: 34164213 PMCID: PMC8182538 DOI: 10.21037/jtd-21-792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jean Bousquet
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France
| | - Anna Bedbrook
- Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France.,Allergic Rhinitis and its Impact on Asthma (ARIA), Montpellier, France.,Mobile Airways Sentinel nekworK (MASK-air), Montpellier, France
| | - Wienczyslawa Czarlewski
- Allergic Rhinitis and its Impact on Asthma (ARIA), Montpellier, France.,Mobile Airways Sentinel nekworK (MASK-air), Montpellier, France.,Medical Consulting Czarlewski, Levallois, France
| | - Giuseppe De Carlo
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Joao A Fonseca
- Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Medida, Lda Porto, Portugal
| | - Miguel A González Ballester
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain, ICREA, Barcelona, Spain
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D Unit and Department of Public Health), Naples, Italy
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Gabrielle L Onorato
- Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France
| | - Susanna Palkonen
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | - Torsten Zuberbier
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium.,International Airway Research Center, First Affiliated Hospital, Sun Yat-sen University, Guangzou, China.,Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - Pedro Carreiro-Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carme Carrion Y Ribas
- School of Health Sciences and UOC eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maciej Chalubinski
- Department of Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Elisio M Costa
- Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | | | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Dimitra Gennimata
- Department of Pharmacy, Athens General Hospital "Korgialenio-Benakio" Hellenic Red Cross, Athens, Greece
| | | | - Marek Niedoszytko
- Medical University of Gdańsk, Department of Allergology, Gdańsk, Poland
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jan Romantowski
- Medical University of Gdańsk, Department of Allergology, Gdańsk, Poland
| | - Luis Taborda-Barata
- Health Sciences, University of Beira Interior, Covilhã, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece.,International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | | | | |
Collapse
|
33
|
Heaney LG, Perez de Llano L, Al-Ahmad M, Backer V, Busby J, Canonica GW, Christoff GC, Cosio BG, FitzGerald JM, Heffler E, Iwanaga T, Jackson DJ, Menzies-Gow AN, Papadopoulos NG, Papaioannou AI, Pfeffer PE, Popov TA, Porsbjerg CM, Rhee CK, Sadatsafavi M, Tohda Y, Wang E, Wechsler ME, Alacqua M, Altraja A, Bjermer L, Björnsdóttir US, Bourdin A, Brusselle GG, Buhl R, Costello RW, Hew M, Siyue MK, Lehmann S, Lehtimäki L, Peters M, Taillé C, Taube C, Tran TN, Zangrilli J, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Hosseini N, Kerkhof M, Murray RB, Price CA, Price DB. Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort. Chest 2021; 160:814-830. [PMID: 33887242 DOI: 10.1016/j.chest.2021.04.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts. RESEARCH QUESTION What is the prevalence of eosinophilic and noneosinophilic phenotypes in the population with severe asthma, and can these phenotypes be differentiated by clinical and biomarker variables? STUDY DESIGN AND METHODS This was an historical registry study. Adult patients with severe asthma and available blood eosinophil count (BEC) from 11 countries enrolled in the International Severe Asthma Registry (January 1, 2015-September 30, 2019) were categorized according to likelihood of eosinophilic phenotype using a predefined gradient eosinophilic algorithm based on highest BEC, long-term oral corticosteroid use, elevated fractional exhaled nitric oxide, nasal polyps, and adult-onset asthma. Demographic and clinical characteristics were defined at baseline (ie, 1 year before or closest to date of BEC). RESULTS One thousand seven hundred sixteen patients with prospective data were included; 83.8% were identified as most likely (grade 3), 8.3% were identified as likely (grade 2), and 6.3% identified as least likely (grade 1) to have an eosinophilic phenotype, and 1.6% of patients showed a noneosinophilic phenotype (grade 0). Eosinophilic phenotype patients (ie, grades 2 or 3) showed later asthma onset (29.1 years vs 6.7 years; P < .001) and worse lung function (postbronchodilator % predicted FEV1, 76.1% vs 89.3%; P = .027) than those with a noneosinophilic phenotype. Patients with noneosinophilic phenotypes were more likely to be women (81.5% vs 62.9%; P = .047), to have eczema (20.8% vs 8.5%; P = .003), and to use anti-IgE (32.1% vs 13.4%; P = .004) and leukotriene receptor antagonists (50.0% vs 28.0%; P = .011) add-on therapy. INTERPRETATION According to this multicomponent, consensus-driven, and evidence-based eosinophil gradient algorithm (using variables readily accessible in real life), the severe asthma eosinophilic phenotype was more prevalent than previously identified and was phenotypically distinct. This pragmatic gradient algorithm uses variables readily accessible in primary and specialist care, addressing inherent issues of phenotype heterogeneity and phenotype instability. Identification of treatable traits across phenotypes should improve therapeutic precision.
Collapse
Affiliation(s)
- Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, United Kingdom
| | - Luis Perez de Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, United Kingdom
| | - Giorgio 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
| | | | - 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
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - 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
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Paul E Pfeffer
- Queen Mary University of London, London, United Kingdom; UK Severe Asthma Network, Barts Health NHS Trust, London, United Kingdom
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy 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
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO; Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO
| | | | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Unnur S Björnsdóttir
- Department of Respiratory Medicine and Allergy, Landspitali The University Hospital of Iceland, Reykjavik, Iceland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital and Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mariko Koh Siyue
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Republic of Singapore; SingHealth Duke-NUS Lung Centre, Singapore, Republic of Singapore
| | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - 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, Germany
| | | | | | | | | | | | | | | | | | | | | | - David B Price
- Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Republic of Singapore.
| |
Collapse
|
34
|
Ryan D, Heatley H, Heaney LG, Jackson DJ, Pfeffer PE, Busby J, Menzies-Gow AN, Jones R, Tran TN, Al-Ahmad M, Backer V, Belhassen M, Bosnic-Anticevich S, Bourdin A, Bulathsinhala L, Carter V, Chaudhry I, Eleangovan N, FitzGerald JM, Gibson PG, Hosseini N, Kaplan A, Murray RB, Rhee CK, Van Ganse E, Price DB. Potential Severe Asthma Hidden in UK Primary Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1612-1623.e9. [PMID: 33309935 DOI: 10.1016/j.jaip.2020.11.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe asthma may be underrecognized in primary care. OBJECTIVE Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care. METHODS This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared. RESULTS Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA. CONCLUSIONS Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
Collapse
Affiliation(s)
- Dermot Ryan
- Usher Institute, University of Edinburgh, United Kingdom
| | - Heath Heatley
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom
| | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Department of ENT & Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Manon Belhassen
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | | | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eric Van Ganse
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| |
Collapse
|