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Whetstone CE, Cusack RP, Price E, Howie K, Stevens C, Al-Sajee D, Beaudin S, Wattie J, Alsaji N, Schlatman A, Luk V, Ju X, O'Byrne P, Inman M, Sehmi R, Lima H, Gauvreau GM. Effect of benralizumab on inflammation in skin after intradermal allergen challenge in patients with moderate-to-severe atopic dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100310. [PMID: 39234416 PMCID: PMC11372810 DOI: 10.1016/j.jacig.2024.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 09/06/2024]
Abstract
Background Atopic dermatitis (AD) is a skin barrier dysfunction characterized by tissue eosinophilia. Objective In patients with AD, we evaluated the effect of eosinophil depletion with benralizumab on markers of inflammation in skin after intradermal allergen challenge. Methods A total of 20 patients with moderate-to-severe AD completed a randomized, double-blind, placebo-controlled parallel-group study comparing 3 doses of benralizumab (30 mg each) administered subcutaneously every 4 weeks (n = 9) with placebo (n = 11). Allergen and saline control intradermal challenges were conducted before and after treatment, with skin biopsy samples collected 24 hours after challenge. Early and late cutaneous responses were measured by skin wheal size. Levels of eosinophils and IL-5 receptor-α-bearing cells, including eosinophil progenitor (EoP) cells, basophils, and mast cells, in papillary dermis were measured by immunofluorescence microscopy, and levels of EoP cells, hematopoietic progenitor cells, and type 2 innate lymphoid cells in the blood were measured by flow cytometry. Outcomes were compared between the placebo and benralizumab treatment groups by using the Mann-Whitney U test. Results Benralizumab reduced eosinophil counts in the blood (P < .0001) and allergen-challenged skin, as measured by hematoxylin and eosin staining and eosinophil cationic protein antibody concentration (P < .05). Benralizumab lowered the levels of EoP cells, mast cells, and basophils in the skin, as well as the levels of EoP cells, hematopoietic progenitor cells, and type 2 innate lymphoid cells in the blood (all P < .05). There was a trend toward improvement in the early cutaneous response (P = .095) but no effect on the late cutaneous response. Conclusion In patients with moderate-to-severe AD, benralizumab treatment significantly inhibited accumulation of eosinophils and other IL-5 receptor-α-expressing cells in the papillary dermis after intradermal allergen challenge. Targeting IL-5 receptor-α-positive cells did not modulate the size of the allergen-induced skin wheal (ClincialTrials.gov identifier NCT03563066).
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Affiliation(s)
- Christiane E Whetstone
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Ruth P Cusack
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Emma Price
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Karen Howie
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Catie Stevens
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Dhuha Al-Sajee
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Sue Beaudin
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Wattie
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Alsaji
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Abbey Schlatman
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Luk
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Xiaotian Ju
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Paul O'Byrne
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Mark Inman
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Roma Sehmi
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Hermenio Lima
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Gail M Gauvreau
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
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Lübke J, Metzgeroth G, Reiter A, Schwaab J. Approach to the patient with eosinophilia in the era of tyrosine kinase inhibitors and biologicals. Curr Hematol Malig Rep 2024; 19:208-222. [PMID: 39037514 PMCID: PMC11416429 DOI: 10.1007/s11899-024-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE OF REVIEW In this review, we aim to explore the optimal approach to patients presenting with eosinophilia, considering recent advances in diagnostic and therapeutic strategies. Specifically, we focus on the integration of novel therapies into clinical practice to improve patient outcomes. RECENT FINDINGS Advanced insights into the clinical and genetic features of eosinophilic disorders have prompted revisions in diagnostic criteria by the World Health Organization classification (WHO-HAEM5) and the International Consensus Classification (ICC). These changes reflect a growing understanding of disease pathogenesis and the development of targeted treatment options. The therapeutic landscape now encompasses a range of established and novel therapies. For reactive conditions, drugs targeting the eosinophilopoiesis, such as those aimed at interleukin-5 or its receptor, have demonstrated significant potential in decreasing blood eosinophil levels and minimizing disease flare-ups and relapse. These therapies have the potential to mitigate the side effects commonly associated with prolonged use of oral corticosteroids or immunosuppressants. Myeloid and lymphoid neoplasms with eosinophilia and tyrosine kinase (TK) gene fusions are managed by various TK inhibitors with variable efficacy. Diagnosis and treatment rely on a multidisciplinary approach. By incorporating novel treatment options into clinical practice, physicians across different disciplines involved in the management of eosinophilic disorders can offer more personalized and effective care to patients. However, challenges remain in accurately diagnosing and risk-stratifying patients, as well as in navigating the complexities of treatment selection.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Li X, Newbold P, Katial R, Hirsch I, Li H, Martin UJ, Meyers DA, Bleecker ER. Multivariate Cluster Analyses to Characterize Asthma Heterogeneity and Benralizumab Responsiveness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2732-2743. [PMID: 38663470 DOI: 10.1016/j.jaip.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND An improved understanding of how severe asthma heterogeneity affects response could inform treatment decisions. OBJECTIVES Characterize heterogeneity and benralizumab responsiveness in patients grouped by predefined Severe Asthma Research Program clusters using a multivariate approach. METHODS In post-hoc analyses of the randomized, double-blind, placebo-controlled phase III SIROCCO (NCT01928771) and CALIMA (NCT01914757) studies, patients with severe asthma who received benralizumab or placebo were assigned to clusters using an established discriminant function to analyze 11 clinical characteristics simultaneously. The annualized asthma exacerbation rate, exacerbation incidence, and lung function were analyzed across clusters. RESULTS Patients (n = 2,281) met criteria for four of five clusters: cluster 2 (early-onset moderate asthma, n = 393), cluster 4 (early-onset severe asthma, n = 386), cluster 3 (late-onset severe asthma, n = 641), and cluster 5 (late-onset severe, obstructed asthma, n = 861); no patients met cluster 1 criteria. Exacerbation rate reductions were significant in late-onset severe asthma (-48% [95% CI, -61% to -31%]; P < .0001) and late-onset severe, obstructed asthma (-50% [95% CI, -59% to -38%]; P < .0001), with nonsignificant reductions in early-onset clusters. These differences could not be fully explained by blood eosinophil count differences. Values for improvements in FEV1 were significant in late-onset severe asthma (+133 mL [95% CI, 66-200]; P = .0001) and late-onset severe, obstructed asthma (+160 mL [95% CI, 85-235]; P < .0001) while maintaining acute bronchodilator responsiveness. CONCLUSIONS Benralizumab reduced exacerbations and improved lung function, primarily in late-onset asthma clusters. This multivariate approach to identify subphenotypes, potentially reflecting pathobiological mechanisms, can guide therapy beyond univariate approaches.
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Affiliation(s)
- Xingnan Li
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Paul Newbold
- Late Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Md
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, National Jewish Health, Denver, Colo
| | - Ian Hirsch
- Late Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Md
| | - Huashi Li
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Ubaldo J Martin
- Late Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Md
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Tang M, Charbit AR, Johansson MW, Jarjour NN, Denlinger LC, Raymond WW, Peters MC, Dunican EM, Castro M, Sumino K, Erzurum SC, Comhair SA, Moore WC, Levy BD, Israel E, Phipatanakul W, Phillips BR, Mauger DT, Bleecker ER, Wenzel SE, Fajt ML, Woodruff PG, Hastie AT, Fahy JV. Utility of eosinophil peroxidase as a biomarker of eosinophilic inflammation in asthma. J Allergy Clin Immunol 2024; 154:580-591.e6. [PMID: 38663815 DOI: 10.1016/j.jaci.2024.03.023] [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: 07/12/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The relative utility of eosinophil peroxidase (EPX) and blood and sputum eosinophil counts as disease biomarkers in asthma is uncertain. OBJECTIVE We sought to determine the utility of EPX as a biomarker of systemic and airway eosinophilic inflammation in asthma. METHODS EPX protein was measured by immunoassay in serum and sputum in 110 healthy controls to establish a normal reference range and in repeated samples of serum and sputum collected during 3 years of observation in 480 participants in the Severe Asthma Research Program 3. RESULTS Over 3 years, EPX levels in patients with asthma were higher than normal in 27% to 31% of serum samples and 36% to 53% of sputum samples. Eosinophils and EPX correlated better in blood than in sputum (rs values of 0.74 and 0.43, respectively), and high sputum EPX levels occurred in 27% of participants with blood eosinophil counts less than 150 cells/μL and 42% of participants with blood eosinophil counts between 150 and 299 cells/μL. Patients with persistently high sputum EPX values for 3 years were characterized by severe airflow obstruction, frequent exacerbations, and high mucus plug scores. In 59 patients with asthma who started mepolizumab during observation, serum EPX levels normalized in 96% but sputum EPX normalized in only 49%. Lung function remained abnormal even when sputum EPX normalized. CONCLUSIONS Serum EPX is a valid protein biomarker of systemic eosinophilic inflammation in asthma, and sputum EPX levels are a more sensitive biomarker of airway eosinophilic inflammation than sputum eosinophil counts. Eosinophil measures in blood frequently miss airway eosinophilic inflammation, and mepolizumab frequently fails to normalize airway eosinophilic inflammation even though it invariably normalizes systemic eosinophilic inflammation.
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Affiliation(s)
- Monica Tang
- University of California San Francisco, San Francisco, Calif
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David T Mauger
- Pennsylvania State University College of Medicine, Hershey, Pa
| | | | | | | | | | | | - John V Fahy
- University of California San Francisco, San Francisco, Calif.
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5
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Gauvreau GM, Sehmi R, FitzGerald JM, Leigh R, Cockcroft DW, Davis BE, Mayers I, Boulet LP, Al-Sajee D, Salter BM, Cusack RP, Ho T, Whetstone CE, Alsaji N, Satia I, Killian KJ, Mitchell PD, Magee IP, Bergeron C, Bhutani M, Werkström V, Durżyński T, Shoemaker K, Katial RK, Jison M, Newbold P, McCrae C, O'Byrne PM. Benralizumab for allergic asthma: a randomised, double-blind, placebo-controlled trial. Eur Respir J 2024; 64:2400512. [PMID: 39060015 PMCID: PMC11391094 DOI: 10.1183/13993003.00512-2024] [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: 03/20/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Benralizumab induces rapid and near-complete depletion of eosinophils from blood and lung tissue. We investigated whether benralizumab could attenuate the allergen-induced late asthmatic response (LAR) in participants with allergic asthma. METHODS Participants with allergic asthma who demonstrated increased sputum eosinophils and LAR at screening were randomised to benralizumab 30 mg or matched placebo given every 4 weeks for 8 weeks (3 doses). Allergen challenges were performed at weeks 9 and 12 when blood, sputum, bone marrow and bronchial tissue eosinophils and LAR were assessed. RESULTS 46 participants (mean age 30.9 years) were randomised to benralizumab (n=23) or placebo (n=23). Eosinophils were significantly reduced in the benralizumab group compared with placebo in blood at 4 weeks and sputum and bone marrow at 9 weeks after treatment initiation. At 7 h after an allergen challenge at week 9, sputum eosinophilia was significantly attenuated in the benralizumab group compared to placebo (least squares mean difference -5.81%, 95% CI -10.69- -0.94%; p=0.021); however, the LAR was not significantly different (least squares mean difference 2.54%, 95% CI 3.05-8.12%; p=0.363). Adverse events were reported for seven (30.4%) and 14 (60.9%) participants in the benralizumab and placebo groups, respectively. CONCLUSION Benralizumab administration over 8 weeks resulted in a significant attenuation of blood, bone marrow and sputum eosinophilia in participants with mild allergic asthma; however, there was no change in the LAR, suggesting that eosinophils alone are not a key component of allergen-induced bronchoconstriction.
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Affiliation(s)
- Gail M Gauvreau
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Roma Sehmi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - J Mark FitzGerald
- Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
- J.M. Fitzgerald passed away in early 2022; all authors agreed to his inclusion as an author
| | | | | | - Beth E Davis
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, QC, Canada
| | - Dhuha Al-Sajee
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Brittany M Salter
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ruth P Cusack
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Terence Ho
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Nadia Alsaji
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Imran Satia
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kieran J Killian
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Iain P Magee
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Celine Bergeron
- Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Paul M O'Byrne
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Wilson GE, Knight J, Liu Q, Shelar A, Stewart E, Wang X, Yan X, Sanders J, Visness C, Gill M, Gruchalla R, Liu AH, Kattan M, Khurana Hershey GK, Togias A, Becker PM, Altman MC, Busse WW, Jackson DJ, Montgomery RR, Chupp GL. Activated sputum eosinophils associated with exacerbations in children on mepolizumab. J Allergy Clin Immunol 2024; 154:297-307.e13. [PMID: 38485057 PMCID: PMC11305967 DOI: 10.1016/j.jaci.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND MUPPITS-2 was a randomized, placebo-controlled clinical trial that demonstrated mepolizumab (anti-IL-5) reduced exacerbations and blood and airway eosinophils in urban children with severe eosinophilic asthma. Despite this reduction in eosinophilia, exacerbation risk persisted in certain patients treated with mepolizumab. This raises the possibility that subpopulations of airway eosinophils exist that contribute to breakthrough exacerbations. OBJECTIVE We aimed to determine the effect of mepolizumab on airway eosinophils in childhood asthma. METHODS Sputum samples were obtained from 53 MUPPITS-2 participants. Airway eosinophils were characterized using mass cytometry and grouped into subpopulations using unsupervised clustering analyses of 38 surface and intracellular markers. Differences in frequency and immunophenotype of sputum eosinophil subpopulations were assessed based on treatment arm and frequency of exacerbations. RESULTS Median sputum eosinophils were significantly lower among participants treated with mepolizumab compared with placebo (58% lower, 0.35% difference [95% CI 0.01, 0.74], P = .04). Clustering analysis identified 3 subpopulations of sputum eosinophils with varied expression of CD62L. CD62Lint and CD62Lhi eosinophils exhibited significantly elevated activation marker and eosinophil peroxidase expression, respectively. In mepolizumab-treated participants, CD62Lint and CD62Lhi eosinophils were more abundant in participants who experienced exacerbations than in those who did not (100% higher for CD62Lint, 0.04% difference [95% CI 0.0, 0.13], P = .04; 93% higher for CD62Lhi, 0.21% difference [95% CI 0.0, 0.77], P = .04). CONCLUSIONS Children with eosinophilic asthma treated with mepolizumab had significantly lower sputum eosinophils. However, CD62Lint and CD62Lhi eosinophils were significantly elevated in children on mepolizumab who had exacerbations, suggesting that eosinophil subpopulations exist that contribute to exacerbations despite anti-IL-5 treatment.
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Affiliation(s)
- Gabriella E Wilson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - James Knight
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Conn
| | - Qing Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Ashish Shelar
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Conn
| | - Emma Stewart
- Committee on Immunology, University of Chicago, Chicago, Ill
| | - Xiaomei Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Xiting Yan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | | | - Michelle Gill
- Department of Pediatric Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Mo
| | - Rebecca Gruchalla
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Andrew H Liu
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Meyer Kattan
- Department of Pediatric Pulmonology, Columbia University Irving Medical Center, New York, NY
| | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Patrice M Becker
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Geoffrey L Chupp
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
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Bourdin A, Chupp G, Jackson DJ, Cohen D, Emerath U, Shavit A, Kurdyukova Y, Menzies-Gow A. MELTEMI and COLUMBA: 5-Year Comparative Safety Analysis of Benralizumab and Mepolizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2074-2083.e4. [PMID: 38677588 DOI: 10.1016/j.jaip.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Benralizumab and mepolizumab are interleukin (IL)-5Rα/interleukin-5-targeted monoclonal antibodies indicated as add-on treatments for patients with uncontrolled severe eosinophilic asthma (SEA). OBJECTIVE To evaluate and compare the safety of benralizumab and mepolizumab among patients with SEA treated in MELTEMI and COLUMBA open-label, long-term extension studies, respectively. METHODS MELTEMI was an extension study of benralizumab every 4 weeks (q4w) or every 8 weeks (q8w) for adults (aged 18-75 y) with SEA. MELTEMI participants transitioned from the BORA extension, preceded by participation in 1 of 3 placebo-controlled studies (SIROCCO, CALIMA, or ZONDA). COLUMBA was an extension study of mepolizumab for patients (aged ≥ 12 y) with SEA who transitioned from the dose-ranging DREAM study. Safety endpoints were presented as drug exposure patient-years (MELTEMI, q4w 784.28, q8w 797.03; COLUMBA 1,201) for nonserious adverse events, serious adverse events, and infections; malignancies were counted numerically. RESULTS This analysis included 446 MELTEMI patients (benralizumab q4w 220; benralizumab q8w 226) and 347 COLUMBA patients (mepolizumab q4w). Viral upper respiratory tract infection was the most common nonserious adverse event in both studies (MELTEMI q8w 46.5%; q4w 47.3%; COLUMBA, 48.7%). Asthma-related events were the most common serious adverse events in both studies: MELTEMI 8.0% (q8w) and 8.6% (q4w) and COLUMBA 9.5%. Serious infections included pneumonia (MELTEMI q8w, 2 [0.9%]; COLUMBA, 6 [1.7%]); cellulitis (MELTEMI q8w, 1 [0.4%]; COLUMBA, 2 [0.6%]); and respiratory tract infections (COLUMBA, 2 [0.6%]). COLUMBA reported 6 malignancies and MELTEMI reported 4 malignancies in each group. CONCLUSIONS This analysis demonstrated generally similar safety events between mepolizumab and benralizumab in patients with SEA.
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Affiliation(s)
- Arnaud Bourdin
- Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France.
| | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St. Thomas' NHS Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - David Cohen
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Ulrika Emerath
- Biopharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Anat Shavit
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | | | - Andrew Menzies-Gow
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Cambridge, UK
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8
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Emson C, Han JK, Hopkins C, Asimus S, Cann JA, Chain D, Wu Y, Reddy Y, McCrae C, Cohen D, Kreindler JL, Werkström V, Jison M, Wagenmann M, Bachert C. Pharmacokinetics/pharmacodynamics of benralizumab in chronic rhinosinusitis with nasal polyps: Phase III, randomized, placebo-controlled OSTRO trial. Br J Clin Pharmacol 2024; 90:1952-1963. [PMID: 38715387 DOI: 10.1111/bcp.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Benralizumab, a humanized, afucosylated monoclonal antibody against the interleukin 5 receptor, α subunit, causes rapid depletion of eosinophils by antibody-dependent cellular cytotoxicity. We investigated the pharmacokinetic and pharmacodynamic effects of benralizumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) from the phase III OSTRO trial. METHODS Patients received a placebo or 30 mg of benralizumab by subcutaneous injection every 8 weeks (first three doses every 4 weeks) to week 48; a subset of patients continued in an extended follow-up period to assess treatment durability to week 80. Serum benralizumab concentrations and blood eosinophil and basophil counts were assessed to week 80. Biomarker assessments were performed on nasal polyp tissue biopsies at week 56 and nasal lining fluid at weeks 24 and 56 to examine changes in immune cells and inflammatory mediators. RESULTS Among 185 patients in this analysis, 93 received benralizumab. Serum benralizumab concentrations reached a steady state by week 24 (median concentration 385.52 ng mL-1); blood eosinophils were almost fully depleted and blood basophils were reduced between weeks 16 and 56. Nasal polyp tissue eosinophils decreased with benralizumab from 57.6 cells mm-2 at baseline to 0 cells mm-2 at week 56 (P < .001 vs placebo), and tissue mast cells were numerically reduced. In nasal lining fluid, eosinophil-derived neurotoxin was significantly reduced at weeks 24 and 56 (P < .001) and interleukin-17 at week 56 (P < .05) with benralizumab. CONCLUSION Benralizumab treatment led to rapid, sustained, nearly complete depletion of eosinophils from blood and nasal polyp tissue in patients with CRSwNP.
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Affiliation(s)
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | | | | | | | - Yuling Wu
- AstraZeneca, Gaithersburg, Maryland, USA
| | - Yasa Reddy
- AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | - James L Kreindler
- Department of Medical Affairs, Vertex Pharmaceuticals, Boston, Massachusetts, USA
| | | | | | - Martin Wagenmann
- Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Claus Bachert
- University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
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9
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Leiferman KM, Gleich GJ. The true extent of eosinophil involvement in disease is unrecognized: the secret life of dead eosinophils. J Leukoc Biol 2024; 116:271-287. [PMID: 38922831 DOI: 10.1093/jleuko/qiae052] [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: 11/18/2023] [Revised: 01/21/2024] [Accepted: 01/29/2024] [Indexed: 06/28/2024] Open
Abstract
Eosinophil-mediated pathophysiology is tissue destructive and tissue altering with proinflammatory, prothrombotic, and profibrotic effects. The distinctive morphology of an eosinophil reveals a cytoplasm chockfull of unique granules, and the granule proteins have numerous toxic effects on cells, tissues, and organs. Eosinophils are not found in most human tissues, and eosinophil involvement in diseased tissues generally is identified by cell infiltration on histopathologic examination. However, eosinophils characteristically lose their structural integrity and deposit granules and granule proteins at sites of inflammation. Hence, their participation in tissue damage may be underrecognized or entirely overlooked. The eosinophil major basic protein 1 is a toxic granule protein and, when deposited, persists in tissues. Major basic protein 1 deposition can be regarded as a footprint of eosinophil activity. Analyses of numerous eosinophil-related diseases have demonstrated clear-cut evidence of major basic protein 1 deposition in affected tissues where eosinophils were not recognized by hematoxylin and eosin tissue staining and light microscopy. Eosinophil granule protein deposition, as exemplified by localization of major basic protein 1, especially when disproportionately greater than cellular infiltration, emerges as a biomarker of hidden eosinophil-related pathophysiology. Consequently, current assessments of recognized eosinophils may vastly underestimate their role in disease.
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Affiliation(s)
- Kristin M Leiferman
- Department of Dermatology, University of Utah Health, Helix Building, 1st Floor South, 30 North Mario Capecchi Drive, Salt Lake City, UT, 84112United States
| | - Gerald J Gleich
- Department of Dermatology, University of Utah Health, Helix Building, 1st Floor South, 30 North Mario Capecchi Drive, Salt Lake City, UT, 84112United States
- Department of Internal Medicine, University of Utah Health, Helix Building, 3rd Floor North, 30 North Mario Capechhi Drive, Salt Lake City, UT, 84112United States
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10
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Denburg JA, O'Byrne PM, Gauvreau GM. Eosinophil plasticity and diversity: proceedings of the 2023 International Eosinophil Society Symposium. J Leukoc Biol 2024; 116:244-246. [PMID: 38626296 DOI: 10.1093/jleuko/qiae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
This issue highlights and details the program and scientific presentations at the International Eosinophil Society's 12th biennial symposium, which was held in Hamilton, Ontario, Canada, in July 2023. The meeting included sessions on regulation of eosinophil development; cell death, stress, and autophagy in eosinophils; local immunity interactions of eosinophils with multiple cell types; eosinophils in host defense; eosinophils and mast cells in gastrointestinal disorders; reciprocal interactions between eosinophils and the microbiome in homeostasis and dysbiosis; and eosinophils in tissue injury and repair and in tumor biology and cancer therapy. There was a mixture of special invited lectures and cutting-edge abstracts on specific aspects of eosinophil science, as well as enlivened pro-con debates on targeting eosinophils with biologics. A major thrust and overarching theme was that eosinophils exhibit remarkable plasticity and heterogeneity in executing their functions both in homeostasis and in pathobiology; there is a new "eo-verse" to understand. We trust that this special volume of the Journal of Leukocyte Biology will be of interest across many disciplines and medical subspecialties in biomedical sciences and demonstrate both the complexity and versatility of the eosinophil in biology and medicine.
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Affiliation(s)
- Judah A Denburg
- Division of Allergy and Immunology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Paul M O'Byrne
- Division of Respirology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Gail M Gauvreau
- Division of Allergy and Immunology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
- Division of Respirology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
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11
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Altrichter S, Giménez-Arnau AM, Bernstein JA, Metz M, Bahadori L, Bergquist M, Brooks L, Ho CN, Jain P, Lukka PB, Rodriguez-Suárez E, Walton C, Datto CJ. Benralizumab does not elicit therapeutic effect in patients with chronic spontaneous urticaria: results from the phase IIb multinational randomized double-blind placebo-controlled ARROYO trial. Br J Dermatol 2024; 191:187-199. [PMID: 38367194 DOI: 10.1093/bjd/ljae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a relatively common skin disease associated with hives and angio-oedema. Eosinophils play a role in CSU pathogenesis. Benralizumab, an anti-interleukin-5 receptor-α monoclonal antibody, has been shown to induce nearly complete depletion of eosinophils. OBJECTIVES To determine the clinical efficacy and safety of benralizumab in patients with CSU who were symptomatic despite H1 antihistamine treatment. METHODS The 24-week, randomized, double-blind, placebo-controlled, phase IIb portion of the ARROYO trial enrolled adult patients with CSU who were currently on H1 antihistamine treatment. Patients were randomized to one of five treatment groups according to benralizumab dose and regimen for a 24-week treatment period. The primary endpoint was change from baseline in Itch Severity Score (ISS)7 at week 12. The key secondary endpoint was change from baseline in Urticaria Activity Score (UAS)7 at week 12. Additional secondary endpoints included other metrics to assess CSU at week 24, blood eosinophil levels, and pharmacokinetics and immunogenicity assessments. Exploratory subgroup analyses were conducted to explore responses according to demographics, clinical features and biomarkers. Safety was assessed in all treatment groups. RESULTS Of 155 patients, 59 were randomized to benralizumab 30 mg, 56 to benralizumab 60 mg and 40 to placebo. Baseline and disease characteristics were consistent with what was expected for patients with CSU. There were no significant differences in change from baseline in ISS7 score at week 12 between benralizumab and placebo [benralizumab 30 mg vs. placebo, least-squares mean difference -1.01, 95% confidence interval (CI) -3.28 to 1.26; benralizumab 60 mg vs. placebo, least-squares mean difference -1.79, 95% CI -4.09 to 0.50] nor in change from baseline in UAS7 score at week 12 between benralizumab and placebo (benralizumab 30 mg vs. placebo, P = 0.407; benralizumab 60 mg vs. placebo, P = 0.082). Depletion of blood eosinophil levels was observed at week 24 in patients treated with benralizumab. All other secondary endpoints and exploratory/subgroup analyses indicated no significant differences between benralizumab and placebo. Safety results were consistent with the known profile of benralizumab. CONCLUSIONS Although benralizumab resulted in near-complete depletion of blood eosinophils, there was no clinical benefit over placebo.
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Affiliation(s)
- Sabine Altrichter
- Department of Dermatology and Venerology, Johannes Kepler University Hospital, Linz, Austria
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
- Johannes Kepler University Linz, Center for Medical Research, Linz, Austria
| | | | - Jonathan A Bernstein
- University of Cincinnati College of Medicine and Bernstein Clinical Research Center, LLC, Cincinnati, OH, USA
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Lila Bahadori
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Maria Bergquist
- Late-stage Clinical Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Laura Brooks
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Calvin N Ho
- Patient Centered Science, BioPharmaceuticals Medical Evidence, AstraZeneca, Gaithersburg, MD, USA
| | - Priya Jain
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Pradeep B Lukka
- Clinical and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Eva Rodriguez-Suárez
- Translational Science and Experimental Medicine, Early Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Claire Walton
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Catherine J Datto
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
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12
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Pyne AL, Uchida AM, Hazel MW, Stubben CJ, Chang JW, Bailey DD, Gonsalves N, Allen-Brady K, Peterson KA, Pletneva MA. Effect of benralizumab on histopathology and inflammatory signatures in a clinical cohort of eosinophilic esophagitis. Dis Esophagus 2024:doae031. [PMID: 38986036 DOI: 10.1093/dote/doae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/12/2024]
Abstract
A preliminary report from the recent phase 3 trial of benralizumab, a monoclonal antibody that binds to interleukin-5 receptor alpha (IL5Rα), in patients with EoE revealed that medication use led to tissue eosinophil eradication but did not meet the clinical endpoint of symptom resolution. Here, we characterized the clinical, endoscopic, histologic, and transcriptional changes in patients with active EoE following benralizumab treatment. We retrospectively examined patients with EoE treated with benralizumab at the University of Utah (n = 11) and reviewed reported clinical symptoms, circulating and tissue eosinophilia, and endoscopic and histologic scores. Gene expression profiles from available esophageal tissue from benralizumab-treated patients were compared to those from patients with remission EoE (n = 5), active EoE (n = 10), and controls (n = 22). Benralizumab treatment resulted in partial symptom improvement and significant reduction in tissue eosinophilia, and endoscopic and histologic disease scoring (P < 0.01). Histologic score reductions were driven by eosinophil feature scores, while scores for epithelial features (basal cell hyperplasia and dilated intercellular spaces) were similar to those in active EoE. The gene signatures in benralizumab-treated patients mimicked those of active EoE (e.g. upregulation of POSTN, CDH26, CCL26, and downregulation of DSG1). RNA profiles and pathways support histologic findings of impaired epithelial function that persists despite benralizumab treatment. In conclusion, despite eosinophil eradication, patients treated with benralizumab had persistent epithelial injury at the histologic and transcriptional level. In this cohort, benralizumab therapy failed to eradicate inflammation and epithelial dysfunction showing that interleukin-5 receptor alpha blockade monotherapy is insufficient to control EoE.
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Affiliation(s)
- Ashley L Pyne
- Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amiko M Uchida
- Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mark W Hazel
- Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chris J Stubben
- Cancer Bioinformatics Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Joy W Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology & Hepatology, Northwestern University - Feinberg School of Medicine, Chicago, IL, USA
| | - Kristina Allen-Brady
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kathryn A Peterson
- Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Maria A Pletneva
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
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13
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Kim H, Kim MG, Kim SR, Lee JH, Byun Y, Park J, Kim K. Comparative efficacy of biologics for patients with inadequately controlled asthma: A network meta-analysis. World Allergy Organ J 2024; 17:100934. [PMID: 39091592 PMCID: PMC11293571 DOI: 10.1016/j.waojou.2024.100934] [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: 11/02/2023] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Background Few studies have evaluated the comparative efficacy of biologics for asthma. This network meta-analysis aimed to compare the efficacy of biologics. Methods This study included randomized controlled trials (RCTs) evaluating the efficacy of a biologic compared to a placebo or another biologic in patients with inadequately controlled asthma despite high-intensity treatment, published by January 6, 2022. Two researchers independently searched the PubMed, Embase, Web of Science, and Scopus and assessed the risk of bias using the Cochrane tool. The outcomes of interest were the annual asthma exacerbation rate (AER), forced expiratory volume per second before bronchodilator use (preBD FEV1), the asthma control questionnaire (ACQ), and asthma quality of life questionnaire (AQLQ) results. A frequentist network meta-analysis was conducted, and a random effects model was used to draw pooled incidence rate ratio or standardized mean differences. Results Twenty-three RCTs with 8376 participants were retrieved. All biologics included in this study were associated with significantly better effects than placebo in AER, preBD FEV1, and ACQ outcomes. Although there were no significant differences between the biologics in the overall study population, patients with eosinophil levels ≥300 cells/μL or eosinophilic asthma showed that dupilumab and tezepelumab were significantly better than anti-IL-5 biologics in improving preBD FEV1. Additionally, in patients with eosinophil levels ≥300 cells/μL, benralizumab, unlike reslizumab, performed significantly better than placebo in improving ACQ and AQLQ outcomes. Conclusion The comparative effects of biologics can be considered with phenotypes and biomarkers to help clinicians select an appropriate treatment for inadequately controlled asthma.
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Affiliation(s)
- Hayeon Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Ryeol Kim
- Yongin Severance Hospital, Yonsei University College of Medicine, Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Gyeonggi-do, Republic of Korea
| | - Jae-Hyun Lee
- Yonsei University College of Medicine, Division of Allergy and Immunology, Department of Internal Medicine, Seoul, Republic of Korea
| | - Youngjoo Byun
- College of Pharmacy, Korea University, Sejong, Republic of Korea
- Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Jiwon Park
- College of Pharmacy, Korea University, Sejong, Republic of Korea
| | - Kyungim Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea
- Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
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14
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Pasha MA, Hopp RJ, Habib N, Tang DD. Biomarkers in asthma, potential for therapeutic intervention. J Asthma 2024:1-16. [PMID: 38805392 DOI: 10.1080/02770903.2024.2361783] [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: 03/26/2024] [Accepted: 05/26/2024] [Indexed: 05/30/2024]
Abstract
Asthma is a heterogeneous disease characterized by multiple phenotypes with varying risk factors and therapeutic responses. This Commentary describes research on biomarkers for T2-"high" and T2-"low" inflammation, a hallmark of the disease. Patients with asthma who exhibit an increase in airway T2 inflammation are classified as having T2-high asthma. In this endotype, Type 2 cytokines interleukins (IL)-4, IL-5, and IL-13, plus other inflammatory mediators, lead to increased eosinophilic inflammation and elevated fractional exhaled nitric oxide (FeNO). In contrast, T2-low asthma has no clear definition. Biomarkers are considered valuable tools as they can help identify various phenotypes and endotypes, as well as treatment response to standard treatment or potential therapeutic targets, particularly for biologics. As our knowledge of phenotypes and endotypes expands, biologics are increasingly integrated into treatment strategies for severe asthma. These treatments block specific inflammatory pathways or single mediators. While single or composite biomarkers may help to identify subsets of patients who might benefit from these treatments, only a few inflammatory biomarkers have been validated for clinical application. One example is sputum eosinophilia, a particularly useful biomarker, as it may suggest corticosteroid responsiveness or reflect non-compliance to inhaled corticosteroids. As knowledge develops, a meaningful goal would be to provide individualized care to patients with asthma.
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Affiliation(s)
- M Asghar Pasha
- Department of Medicine, Division of Allergy and Immunology, Albany Medical College, Albany, NY, USA
| | - Russell J Hopp
- Department of Pediatrics, University of NE Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Nazia Habib
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Dale D Tang
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
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15
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Arva NC, Bernieh A, Lopez-Nunez O, Pletneva M, Yang GY, Collins MH. Histopathology of Eosinophilic Gastrointestinal Diseases Beyond Eosinophilic Esophagitis. Immunol Allergy Clin North Am 2024; 44:369-381. [PMID: 38575230 DOI: 10.1016/j.iac.2024.01.008] [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] [Indexed: 04/06/2024]
Abstract
Eosinophilic gastrointestinal diseases (EGID), such as eosinophilic gastritis (EoG), eosinophilic enteritis, and eosinophilic colitis (EoC), are chronic inflammatory conditions characterized by persistent gastrointestinal symptoms and elevated levels of activated eosinophils in the gastrointestinal tract. EoG and eosinophilic duodenitis (EoD) are strongly associated with food allergen triggers and TH2 inflammation, whereas EoC shows minimal transcriptomic overlap with other EGIDs. The level of expression of certain genes associated with TH2 immune response is associated with certain histopathologic findings of EoG, EoD, and EoC. Current immune therapy for EoG depletes tissue eosinophilia with persistence of other histopathologic features of disease.
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Affiliation(s)
- Nicoleta C Arva
- Department of Pathology, Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA.
| | - Anas Bernieh
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Oscar Lopez-Nunez
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Maria Pletneva
- Department of Pathology, University of Utah, 2000 Circle of Hope, Room 3100, Salt Lake City, UT 84112, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, ML1035, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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16
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Mandl HK, Miller JE, Beswick DM. Current and Novel Biologic Therapies for Patients with Asthma and Nasal Polyps. Otolaryngol Clin North Am 2024; 57:225-242. [PMID: 37684154 DOI: 10.1016/j.otc.2023.08.006] [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] [Indexed: 09/10/2023]
Abstract
A substantial portion of asthma and nasal polyps (NPs) share a common pathogenesis, which includes type 2-mediated inflammation. Distinct endotypes and phenotypes characterizing asthma and chronic rhinosinusitis have been identified. With emerging evidence describing pathophysiology, novel targets for biologic monoclonal antibody treatments have been developed. There are currently six biologic therapies approved by the US Food and Drug Administration to treat asthma, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab, three of these-omalizumab, mepolizumab, and dupilumab-are also approved for NPs.
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Affiliation(s)
- Hanna K Mandl
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
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17
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Russell RJ, Boulet LP, Brightling CE, Pavord ID, Porsbjerg C, Dorscheid D, Sverrild A. The airway epithelium: an orchestrator of inflammation, a key structural barrier and a therapeutic target in severe asthma. Eur Respir J 2024; 63:2301397. [PMID: 38453256 PMCID: PMC10991852 DOI: 10.1183/13993003.01397-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Asthma is a disease of heterogeneous pathology, typically characterised by excessive inflammatory and bronchoconstrictor responses to the environment. The clinical expression of the disease is a consequence of the interaction between environmental factors and host factors over time, including genetic susceptibility, immune dysregulation and airway remodelling. As a critical interface between the host and the environment, the airway epithelium plays an important role in maintaining homeostasis in the face of environmental challenges. Disruption of epithelial integrity is a key factor contributing to multiple processes underlying asthma pathology. In this review, we first discuss the unmet need in asthma management and provide an overview of the structure and function of the airway epithelium. We then focus on key pathophysiological changes that occur in the airway epithelium, including epithelial barrier disruption, immune hyperreactivity, remodelling, mucus hypersecretion and mucus plugging, highlighting how these processes manifest clinically and how they might be targeted by current and novel therapeutics.
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Affiliation(s)
- Richard J Russell
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ian D Pavord
- Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Celeste Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Del Dorscheid
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Asger Sverrild
- Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
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18
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Cameli P, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Caruso C, Centanni S, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Senna G, Vultaggio A, Benci M, Boarino S, Menzella F. Sustained Effectiveness of Benralizumab in Naïve and Biologics-Experienced Severe Eosinophilic Asthma Patients: Results from the ANANKE Study. J Asthma Allergy 2024; 17:273-290. [PMID: 38562251 PMCID: PMC10982664 DOI: 10.2147/jaa.s438981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Severe eosinophilic asthma (SEA) patients often present overlapping inflammatory features rendering them eligible for multiple biologic therapies; switching biologic treatment is a strategy adopted to optimize asthma control when patients show partial or no response to previous biologics. Patients and Methods ANANKE is a retrospective, multicenter Italian study (NCT04272463). Here, we outline the characteristics and long-term clinical outcomes in naïve-to-biologics and biologics-experienced patients treated with benralizumab for up to 96 weeks. Bio-experienced patients were split into omalizumab and mepolizumab subsets according to the type of biologic previously used. Results A total of 124 (76.5%) naïve and 38 (23.5%) bio-experienced patients were evaluated at index date; 13 patients (34.2%) switched from mepolizumab, 21 patients (55.3%) switched from omalizumab, and four patients (10.5%) received both biologics. The mepolizumab subset was characterized by the longest SEA duration (median of 4.6 years), the highest prevalence of chronic rhinosinusitis with nasal polyposis (CRSwNP) (76.5%), and the greatest oral corticosteroid (OCS) daily dosage (median of 25 mg prednisone equivalent). The omalizumab group showed the highest severe annual exacerbation rate (AER) (1.70). At 96 weeks, treatment with benralizumab reduced any and severe AER by more than 87% and 94%, respectively, across all groups. Lung function was overall preserved, with major improvements observed in the mepolizumab group, which also revealed a 100% drop of the median OCS dose. Asthma Control Test (ACT) score improved in the naïve group while its increment was more variable in bio-experienced patients; among these, a marked difference was noticed between omalizumab and mepolizumab subsets (median ACT score of 23.5 and 18, respectively). Conclusion Benralizumab promotes durable and profound clinical benefits in naïve and bio-experienced groups, indicating that a nearly complete depletion of eosinophils is highly beneficial in the control of SEA, independently of previous biologic use.
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Affiliation(s)
- Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese (MI), Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, Università degli Studi di Torino; SCDU Immunologia e Allergologia, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Centanni
- Respiratory Unit ASST Santi Paolo e Carlo, Department of Health Sciences Universita’ degli Studi di Milano, Milano, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Roma, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Roma, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti (BA), Italy
| | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Marco Benci
- Medical Affairs R&I, AstraZeneca, Milano, Italy
| | | | - Francesco Menzella
- Pulmonology Unit, Ospedale “S. Valentino”, AULSS 2 Marca Trevigiana, Montebelluna (TV), Italy
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Wechsler ME, Nair P, Terrier B, Walz B, Bourdin A, Jayne DRW, Jackson DJ, Roufosse F, Börjesson Sjö L, Fan Y, Jison M, McCrae C, Necander S, Shavit A, Walton C, Merkel PA. Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med 2024; 390:911-921. [PMID: 38393328 DOI: 10.1056/nejmoa2311155] [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] [Indexed: 02/25/2024]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Benralizumab, a monoclonal antibody against the interleukin-5α receptor expressed on eosinophils, may be an option for treating EGPA. METHODS We conducted a multicenter, double-blind, phase 3, randomized, active-controlled noninferiority trial to evaluate the efficacy and safety of benralizumab as compared with mepolizumab. Adults with relapsing or refractory EGPA who were receiving standard care were randomly assigned in a 1:1 ratio to receive benralizumab (30 mg) or mepolizumab (300 mg) subcutaneously every 4 weeks for 52 weeks. The primary end point was remission at weeks 36 and 48 (prespecified noninferiority margin, -25 percentage points). Secondary end points included the accrued duration of remission, time to first relapse, oral glucocorticoid use, eosinophil count, and safety. RESULTS A total of 140 patients underwent randomization (70 assigned to each group). The adjusted percentage of patients with remission at weeks 36 and 48 was 59% in the benralizumab group and 56% in the mepolizumab group (difference, 3 percentage points; 95% confidence interval [CI], -13 to 18; P = 0.73 for superiority), showing noninferiority but not superiority of benralizumab to mepolizumab. The accrued duration of remission and the time to first relapse were similar in the two groups. Complete withdrawal of oral glucocorticoids during weeks 48 through 52 was achieved in 41% of the patients who received benralizumab and 26% of those who received mepolizumab. The mean (±SD) blood eosinophil count at baseline was 306.0±225.0 per microliter in the benralizumab group and 384.9±563.6 per microliter in the mepolizumab group, decreasing to 32.4±40.8 and 71.8±54.4 per microliter, respectively, at week 52. Adverse events were reported in 90% of the patients in the benralizumab group and 96% of those in the mepolizumab group; serious adverse events were reported in 6% and 13%, respectively. CONCLUSIONS Benralizumab was noninferior to mepolizumab for the induction of remission in patients with relapsing or refractory EGPA. (Funded by AstraZeneca; MANDARA ClinicalTrials.gov number, NCT04157348.).
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Affiliation(s)
- Michael E Wechsler
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Parameswaran Nair
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Benjamin Terrier
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Bastian Walz
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Arnaud Bourdin
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - David R W Jayne
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - David J Jackson
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Florence Roufosse
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Lena Börjesson Sjö
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Ying Fan
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Maria Jison
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Christopher McCrae
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Sofia Necander
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Anat Shavit
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Claire Walton
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
| | - Peter A Merkel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); the Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, and Université Paris Cité, Paris (B.T.), and the Department of Respiratory Diseases, University of Montpellier, Centre Hospitalier Universitaire Montpellier, INSERM, Centre National de la Recherche Scientifique, Montpellier (A.B.) - all in France; the Department of Internal Medicine, Rheumatology, and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany (B.W.); the Department of Medicine, University of Cambridge (D.R.W.J.), and BioPharmaceuticals Medical (A.S.) and Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (C.W.), AstraZeneca, Cambridge, and Guy's Severe Asthma Centre, School of Immunology and Microbial Sciences, King's College London, London (D.J.J.) - all in the United Kingdom; the Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels (F.R.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (L.B.S., S.N.); Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development (Y.F., M.J.), and Translational Science and Experimental Medicine, Early Respiratory and Immunology, BioPharmaceuticals Research and Development (C.M.), AstraZeneca, Gaithersburg, MD; and the Division of Rheumatology, Department of Medicine, and the Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (P.A.M.)
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Wedner HJ, Fujisawa T, Guilbert TW, Ikeda M, Mehta V, Tam JS, Lukka PB, Asimus S, Durżyński T, Johnston J, White WI, Shah M, Werkström V, Jison ML. Benralizumab in children with severe eosinophilic asthma: Pharmacokinetics and long-term safety (TATE study). Pediatr Allergy Immunol 2024; 35:e14092. [PMID: 38491795 DOI: 10.1111/pai.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Benralizumab is an anti-interleukin-5 receptor α monoclonal antibody approved as an add-on maintenance treatment for patients with uncontrolled severe asthma. Prior Phase 3 studies have evaluated benralizumab in patients aged ≥12 years with severe uncontrolled asthma. The TATE study evaluated the pharmacokinetics (PK), pharmacodynamics (PD), and safety of benralizumab treatment in children. METHODS TATE was an open-label, Phase 3 study of benralizumab in children aged 6-11 years from the United States and Japan (plus participants aged 12-14 years from Japan) with severe eosinophilic asthma. Participants received benralizumab 10/30 mg according to weight (<35/≥35 kg). Primary endpoints included maximum serum concentration (Cmax ), clearance, half-life (t1/2 ), and blood eosinophil count. Clearance and t1/2 were derived from a population PK (popPK) analysis. Safety and tolerability were also assessed. RESULTS Twenty-eight children aged 6-11 years were included, with an additional two participants from Japan aged 12-14 years also included in the popPK analysis. Mean Cmax was 1901.2 and 3118.7 ng/mL in the 10 mg/<35 kg and 30 mg/≥35 kg groups, respectively. Clearance was 0.257, and mean t1/2 was 14.5 days. Near-complete depletion of blood eosinophils was shown across dose/weight groups. Exploratory efficacy analyses found numerical improvements in mean FEV1 , mean ACQ-IA, patient/clinician global impression of change, and exacerbation rates. Adverse events occurred in 22/28 (78.6%) of participants; none led to discontinuation/death. CONCLUSION PK, PD, and safety data support long-term benralizumab in children with severe eosinophilic asthma, and were similar to findings in adolescents and adults. TRIAL REGISTRATION ClinicalTrials.gov-ID: NCT04305405.
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Affiliation(s)
- H James Wedner
- Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Masanori Ikeda
- Okayama University School of Medicine, Okayama, Japan
- Department of Pediatrics, Fukuyama Municipal Hospital, Fukuyama, Hiroshima, Japan
| | - Vinay Mehta
- Allergy, Asthma and Immunology Associates, Lincoln, Nebraska, USA
| | - Jonathan S Tam
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Pradeep B Lukka
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Sara Asimus
- Clinical Pharmacology & Quantitative Pharmacology, R&D, AstraZeneca, Gothenburg, Sweden
| | - Tomasz Durżyński
- Late R&I Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - James Johnston
- Biostatistics, R&I Biologics and Vaccine Products, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Wendy I White
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Mihir Shah
- Late R&I Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Viktoria Werkström
- Late R&I Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria L Jison
- Late R&I Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
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21
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Oprescu B, Raduna O, Mihaicuta S, Frent S. Severe Asthma or Chronic Obstructive Pulmonary Disease with Eosinophilic Inflammation? From Uncertainty to Remission under Anti IL-5R Therapy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:387. [PMID: 38541113 PMCID: PMC10972318 DOI: 10.3390/medicina60030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy has been shown to be highly effective in severe eosinophilic asthma but has not demonstrated significant benefit in patients with COPD with the eosinophilic phenotype. Our aim was to illustrate this issue in the form of a case report. Materials and Methods: We present the case of a 67-year-old patient who is a former smoker with late-onset severe uncontrolled asthma (ACT score < 15) who experienced frequent exacerbations requiring treatment with systemic corticosteroids. The patient's lung function gradually worsened to a nadir FEV1 = 18%, despite a high dose of ICS in combination with a LABA and intermittent courses of OCS, with negative allergic skin-tests, but with high blood eosinophils level. Biological treatment with an anti-IL5R monoclonal antibody (benralizumab) was initiated, despite the difficulty in the differential diagnosis between asthma and COPD with eosinophilic inflammation. Results: The patient's evolution was favorable; clinical remission was effectively achieved with significant improvement in lung function (FEV1 > 100%), but with persistence of residual mild fixed airway obstructive dysfunction (FEV1/FVC < 0.7). The therapeutic response has been maintained to date. Conclusions: Benralizumab was shown to be very effective in a patient with late-onset severe eosinophilic asthma presenting features of chronic obstructive disease-habitual exposure to tobacco and inhaled noxious substances, and persistent airflow limitation on spirometry.
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Affiliation(s)
- Bianca Oprescu
- Pulmonology Department, Infectious Diseases and Pulmonology Hospital “Victor Babes” Timisoara, 300310 Timisoara, Romania; (B.O.); (S.M.); (S.F.)
| | - Oana Raduna
- Pulmonology Department, Infectious Diseases and Pulmonology Hospital “Victor Babes” Timisoara, 300310 Timisoara, Romania; (B.O.); (S.M.); (S.F.)
| | - Stefan Mihaicuta
- Pulmonology Department, Infectious Diseases and Pulmonology Hospital “Victor Babes” Timisoara, 300310 Timisoara, Romania; (B.O.); (S.M.); (S.F.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Stefan Frent
- Pulmonology Department, Infectious Diseases and Pulmonology Hospital “Victor Babes” Timisoara, 300310 Timisoara, Romania; (B.O.); (S.M.); (S.F.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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22
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Hussain M, Liu G. Eosinophilic Asthma: Pathophysiology and Therapeutic Horizons. Cells 2024; 13:384. [PMID: 38474348 PMCID: PMC10931088 DOI: 10.3390/cells13050384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is a prevalent chronic non-communicable disease, affecting approximately 300 million people worldwide. It is characterized by significant airway inflammation, hyperresponsiveness, obstruction, and remodeling. Eosinophilic asthma, a subtype of asthma, involves the accumulation of eosinophils in the airways. These eosinophils release mediators and cytokines, contributing to severe airway inflammation and tissue damage. Emerging evidence suggests that targeting eosinophils could reduce airway remodeling and slow the progression of asthma. To achieve this, it is essential to understand the immunopathology of asthma, identify specific eosinophil-associated biomarkers, and categorize patients more accurately based on the clinical characteristics (phenotypes) and underlying pathobiological mechanisms (endotypes). This review delves into the role of eosinophils in exacerbating severe asthma, exploring various phenotypes and endotypes, as well as biomarkers. It also examines the current and emerging biological agents that target eosinophils in eosinophilic asthma. By focusing on these aspects, both researchers and clinicians can advance the development of targeted therapies to combat eosinophilic pathology in severe asthma.
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Affiliation(s)
- Musaddique Hussain
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gang Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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23
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Li W, Tang SC, Jin L. Adverse events of anti-IL-5 drugs in patients with eosinophilic asthma: a meta-analysis of randomized controlled trials and real-world evidence-based assessments. BMC Pulm Med 2024; 24:70. [PMID: 38308249 PMCID: PMC10837872 DOI: 10.1186/s12890-024-02885-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND We aimed to clarify comprehensively the safety profiles of anti-IL-5 drugs and pinpoint potential safety concerns that may arise in their post-marketing phase. METHODS Two researchers conducted comprehensive searches of PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to September 2022. Additionally, we investigated the FDA AE Reporting System for post-marketing adverse event (AE) reports related to anti-IL-5 drugs. The outcomes fulfilled the proportional reporting rate criteria and the Bayesian confidence propagation neural network. RESULTS We included 24 published studies in our analysis. The anti-IL-5 treatment group showed an incidence of AEs comparable to the placebo group, and it exhibited a significantly lower frequency of serious AEs. Common AEs were asthma, nasopharyngitis, headache, upper respiratory tract infection (URTI), and bronchitis. The post-marketing data included 28,478 case reports associated with the suspect drugs and 75 suspect safety observations affecting 16 system organ classes. New suspect observations included incomplete therapeutic product effect, URTIs, and pulmonary mass in reports related to mepolizumab. Reports associated with mepolizumab and benralizumab also indicated issues with incorrect technique in device usage and product issues. CONCLUSIONS Individual anti-IL-5 drugs' safety profiles largely matched their product inserts. We identified issues like improper device usage, product issue, and URTIs as potential concerns for mepolizumab and benralizumab. Additionally, all anti-IL-5 drugs showed signs of incomplete therapeutic effects.
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Affiliation(s)
- Wen Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shi-Chao Tang
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lei Jin
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
- Department of Rheumatology, Immunology & Allergy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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24
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Giossi R, Pani A, Schroeder J, Scaglione F. Exploring the risk of infection events in patients with asthma receiving anti-IL-5 monoclonal antibodies: A rapid systematic review and a meta-analysis. Heliyon 2024; 10:e23725. [PMID: 38268596 PMCID: PMC10805771 DOI: 10.1016/j.heliyon.2023.e23725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Benralizumab, mepolizumab, and reslizumab are novel monoclonal antibodies approved for asthma, targeting eosinophilic inflammation. Benralizumab is directed against IL-5 receptor (IL-5R), while mepolizumab and reslizumab are directed against IL-5. The three drugs cause a reduction in eosinophils, but benralizumab also causes a cytotoxic effect on eosinophils and basophils. Recently, it has been reported that suboptimal responders to benralizumab presented exacerbations associated with concomitant infections and sputum neutrophilia and the incidence of infections was greater in patients receiving benralizumab compared to mepolizumab and reslizumab. For this reason, we wanted to explore potential differences in terms of infectious adverse events between the three different anti-IL-5 antibodies. Methods We performed a rapid systematic review on PubMed up to April 28, 2022. We included randomized controlled trials (RCTs) evaluating benralizumab, mepolizumab, or reslizumab in patients with asthma. Included outcomes were the reporting of any respiratory tract infection and any emergency department (ED) or hospital admission for infection or asthma exacerbation. A Mantel-Haenszel meta-analysis was performed with Cochrane RevMan 5.4 to estimate pooled odds ratios (OR) with 95 % confidence intervals (CI). A subgroup analysis for the different active treatments was performed. Results From 163 references we included 21 studies reporting the results of 23 different RCTs for a total population of 9156 patients. All studies compared anti-IL-5 antibodies against placebo. Anti-IL-5 treatment resulted in non-significant differences compared to placebo in the odds for nasopharyngitis (OR = 0.90; 95 % CI from 0.76 to 1.07), pharyngitis (OR = 1.45; 95 % CI from 0.92 to 2.28), upper respiratory tract infection (URTI) (OR = 0.97; 95 % CI from 0.82 to 1.15), rhinitis (OR = 1.01; 95 % CI from 0.71 to 1.44), pneumonia (OR = 0.56; 95 % CI from 0.10 to 2.01), and influenza (OR = 0.84; 95 % CI from 0.65 to 1.09). We observed significant reductions in the reporting of sinusitis (OR = 0.75; 95 % CI from 0.53 to 1.06), bronchitis (OR = 0.71; 95 % CI from 0.59 to 0.86), and ED or hospital admission due to asthma exacerbation for overall anti-IL-5 antibodies compared to placebo (OR = 0.59; 95 % CI from 0.40 to 0.88). We were not able to discriminate whether exacerbations were associated with infections or to increased sputum eosinophilia. From the subgroup analysis, we observed differences in directions and magnitudes of the effect size in the reporting of some events. Benralizumab was associated with increased odds of pharyngitis (OR = 1.56; 95 % CI from 0.97 to 2.52) and a similar trend was observed for mepolizumab in the reporting of rhinitis (OR = 1.85; 95 % CI from 0.72 to 4.78), both non-statistically significant. In terms of effect size, benralizumab also showed higher odds for bronchitis and pneumonia in comparison to mepolizumab and reslizumab (OR = 0.76, OR = 0.69, and OR = 0.60 for bronchitis and OR = 0.80, OR = 0.20, and OR = 0.45, respectively, all non-significant). Conclusion Anti-IL-5 treatments might have different effects on the reporting of some infection events in patients with asthma. However, the evidence is limited by sample size and far than conclusive and suggest the need of future studies to evaluate the risk of infections in patients with asthma receiving anti-IL-5 treatments.
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Affiliation(s)
- Riccardo Giossi
- Chemical-Clinical Analyses Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Jan Schroeder
- Allergology and Immunology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical Analyses Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
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25
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Kai Y, Kataoka R, Suzuki K, Nakamura E, Takano M, Muro S. Successful discontinuation of corticosteroids through remission induction therapy with benralizumab for chronic eosinophilic pneumonia. Respirol Case Rep 2024; 12:e01279. [PMID: 38239332 PMCID: PMC10794867 DOI: 10.1002/rcr2.1279] [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: 11/18/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
Chronic eosinophilic pneumonia (CEP) is an eosinophilic lung disease. Treatment for CEP includes corticosteroids; however, CEP often recurs. A 53-year-old woman was referred to our hospital because of poorly controlled asthma. She was treated with combination of moderate-dose inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and betamethasone/dexchlorpheniramine. She was switched to single-inhaler triple therapy, after which her asthma control improved; thus, betamethasone/dexchlorpheniramine was discontinued. Ten weeks later, she was diagnosed with CEP due to marked eosinophilia and pulmonary eosinophilic infiltrates. Oral corticosteroid treatment was initiated, symptoms improved, and peripheral blood eosinophilia decreased with improved infiltrative shadows. Remission induction therapy was initiated with benralizumab combined with corticosteroid therapy. Eosinophilia and inflammatory responses decreased. After 7 months, corticosteroid was discontinued, and she was treated with benralizumab alone. She remained in remission for 4 months. This case suggests that benralizumab may be useful as a remission induction therapy in patients with CEP.
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Affiliation(s)
- Yoshiro Kai
- Department of Respiratory MedicineMinami‐Nara General Medical CenterNaraJapan
| | - Ryosuke Kataoka
- Department of Respiratory MedicineMinami‐Nara General Medical CenterNaraJapan
| | - Kentaro Suzuki
- Department of Respiratory MedicineMinami‐Nara General Medical CenterNaraJapan
| | - Eriko Nakamura
- Department of Respiratory MedicineNara Medical UniversityNaraJapan
| | - Masato Takano
- Department of Diagnostic PathologyMinami‐Nara General Medical CenterNaraJapan
| | - Shigeo Muro
- Department of Respiratory MedicineNara Medical UniversityNaraJapan
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26
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Gleich GJ, Hendershot R. Episodic angioedema associated with eosinophilia: Benralizumab-induced complete remission. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:259-261. [PMID: 37832821 DOI: 10.1016/j.jaip.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Gerald J Gleich
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.
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27
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Yonezawa H, Ohmura SI, Ohkubo Y, Otsuki Y, Miyamoto T. New-onset of eosinophilic granulomatosis with polyangiitis without eosinophilia and eosinophilic infiltration under benralizumab treatment: A case report. Mod Rheumatol Case Rep 2023; 8:145-149. [PMID: 37243733 DOI: 10.1093/mrcr/rxad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a small- to medium-vessel necrotising vasculitis and eosinophilic inflammation. Mepolizumab, an anti-interleukin-5 (IL-5) monoclonal antibody has been approved in Japan since 2018 for refractory EGPA treatment. Benralizumab, an anti-IL-5 receptor monoclonal antibody, also has been reported to reduce the glucocorticoid dose in patients with refractory EGPA. On the other hand, several investigators have demonstrated new-onset EGPA under biologics, and it is unclear whether this treatment for severe allergic diseases can prevent the development of EGPA. Herein, we report a case of new-onset EGPA under benralizumab treatment. The patient had fever, weight loss, muscle pain, and paraesthesia, the serum eosinophil count was 0/μL, and the biopsy showed necrotizing vasculitis without eosinophilic infiltration. She was diagnosed as having EGPA and treated with high-dose glucocorticoid and intravenous cyclophosphamide, with a good response. Our case report indicates that anti-IL-5 agents may mask the development of EGPA and clinicians should be aware of the development of EGPA during anti-IL-5 agents.
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Affiliation(s)
- Haruka Yonezawa
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Shin-Ichiro Ohmura
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yusuke Ohkubo
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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28
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You M, Chen F, Yu C, Chen Y, Wang Y, Liu X, Guo X, Zhou B, Wang X, Zhang B, Fang M, Zhang T, Yue P, Wang Y, Yuan Q, Luo W. A glycoengineered therapeutic anti-HBV antibody that allows increased HBsAg immunoclearance improves HBV suppression in vivo. Front Pharmacol 2023; 14:1213726. [PMID: 38205373 PMCID: PMC10777313 DOI: 10.3389/fphar.2023.1213726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/30/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: The effective and persistent suppression of hepatitis B surface antigen (HBsAg) in patients with chronic HBV infection (CHB) is considered to be a promising approach to achieve a functional cure of hepatitis B. In our previous study, we found that the antibody E6F6 can clear HBsAg through FcγR-mediated phagocytosis, and its humanized form (huE6F6 antibody) is expected to be a new tool for the treatment of CHB. Previous studies have shown that the glycosylation of Fc segments affects the binding of antibodies to FcγR and thus affects the biological activity of antibodies in vivo. Methods: To further improve the therapeutic potential of huE6F6, in this study, we defucosylated huE6F6 (huE6F6-fuc-), preliminarily explored the developability of this molecule, and studied the therapeutic potential of this molecule and its underlying mechanism in vitro and in vivo models. Results: huE6F6-fuc- has desirable physicochemical properties. Compared with huE6F6-wt, huE6F6-fuc- administration resulted in a stronger viral clearance in vivo. Meanwhile, huE6F6-fuc- keep a similar neutralization activity and binding activity to huE6F6-wt in vitro. Immunological analyses suggested that huE6F6-fuc- exhibited enhanced binding to hCD32b and hCD16b, which mainly contributed to its enhanced therapeutic activity in vivo. Conclusions: In summary, the huE6F6-fuc- molecule that was developed in this study, which has desirable developability, can clear HBsAg more efficiently in vivo, providing a promising treatment for CHB patients. Our study provides new guidance for antibody engineering in other disease fields.
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Affiliation(s)
- Min You
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Fentian Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Chao Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Yuanzhi Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Yue Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Xue Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Xueran Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Bing Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- The 2nd Affiliated Hospital, South University of Science and Technology, Shenzhen, China
| | - Xin Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- The 2nd Affiliated Hospital, South University of Science and Technology, Shenzhen, China
| | - Boya Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
| | - Mujin Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- Xiang An Biomedicine Laboratory, Xiamen, China
| | - Tianying Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- Xiang An Biomedicine Laboratory, Xiamen, China
| | - Ping Yue
- School of Biology and Engineering (School of Health Medicine Modern Industry), Immune Cells and Antibody Engineering Research Center in University of Guizhou Province, Guizhou Medical University, Guiyang, China
| | - Yingbin Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- Xiang An Biomedicine Laboratory, Xiamen, China
| | - Quan Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- Xiang An Biomedicine Laboratory, Xiamen, China
| | - Wenxin Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, School of Life Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China
- Xiang An Biomedicine Laboratory, Xiamen, China
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29
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Jesenak M, Diamant Z, Simon D, Tufvesson E, Seys SF, Mukherjee M, Lacy P, Vijverberg S, Slisz T, Sediva A, Simon HU, Striz I, Plevkova J, Schwarze J, Kosturiak R, Alexis NE, Untersmayr E, Vasakova MK, Knol E, Koenderman L. Eosinophils-from cradle to grave: An EAACI task force paper on new molecular insights and clinical functions of eosinophils and the clinical effects of targeted eosinophil depletion. Allergy 2023; 78:3077-3102. [PMID: 37702095 DOI: 10.1111/all.15884] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023]
Abstract
Over the past years, eosinophils have become a focus of scientific interest, especially in the context of their recently uncovered functions (e.g. antiviral, anti-inflammatory, regulatory). These versatile cells display both beneficial and detrimental activities under various physiological and pathological conditions. Eosinophils are involved in the pathogenesis of many diseases which can be classified into primary (clonal) and secondary (reactive) disorders and idiopathic (hyper)eosinophilic syndromes. Depending on the biological specimen, the eosinophil count in different body compartments may serve as a biomarker reflecting the underlying pathophysiology and/or activity of distinct diseases and as a therapy-driving (predictive) and monitoring tool. Personalized selection of an appropriate therapeutic strategy directly or indirectly targeting the increased number and/or activity of eosinophils should be based on the understanding of eosinophil homeostasis including their interactions with other immune and non-immune cells within different body compartments. Hence, restoring as well as maintaining homeostasis within an individual's eosinophil pool is a goal of both specific and non-specific eosinophil-targeting therapies. Despite the overall favourable safety profile of the currently available anti-eosinophil biologics, the effect of eosinophil depletion should be monitored from the perspective of possible unwanted consequences.
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Affiliation(s)
- Milos Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
| | - Zuzana Diamant
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
- Department Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Manali Mukherjee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Firestone Institute for Respiratory Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Paige Lacy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne Vijverberg
- Amsterdam UMC Location University of Amsterdam, Pulmonary Diseases, Amsterdam, The Netherlands
| | - Tomas Slisz
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Ilja Striz
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jurgen Schwarze
- Child Life and Health and Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Radovan Kosturiak
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Outpatient Clinic for Clinical Immunology and Allergology, Nitra, Slovak Republic
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Paediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Martina Koziar Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Edward Knol
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Hu M, Scheffel J, Elieh-Ali-Komi D, Maurer M, Hawro T, Metz M. An update on mechanisms of pruritus and their potential treatment in primary cutaneous T-cell lymphoma. Clin Exp Med 2023; 23:4177-4197. [PMID: 37555911 PMCID: PMC10725374 DOI: 10.1007/s10238-023-01141-x] [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: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
Primary cutaneous T-cell lymphomas (CTCL), which include mycosis fungoides (MF) and Sézary syndrome (SS), are a group of lymphoproliferative disorders characterized by clonal accumulation of neoplastic T-lymphocytes in the skin. Severe pruritus, one of the most common and distressing symptoms in primary CTCL, can significantly impair emotional well-being, physical functioning, and interpersonal relationships, thus greatly reducing quality of life. Unfortunately, effectively managing pruritus remains challenging in CTCL patients as the underlying mechanisms are, as of yet, not fully understood. Previous studies investigating the mechanisms of itch in CTCL have identified several mediators and their corresponding antagonists used for treatment. However, a comprehensive overview of the mediators and receptors contributing to pruritus in primary CTCL is lacking in the current literature. Here, we summarize and review the mediators and receptors that may contribute to pruritus in primary CTCL to explore the mechanisms of CTCL pruritus and identify effective therapeutic targets using the PubMed and Web of Science databases. Studies were included if they described itch mediators and receptors in MF and SS. Overall, the available data suggest that proteases (mainly tryptase), and neuropeptides (particularly Substance P) may be of greatest interest. At the receptor level, cytokine receptors, MRGPRs, and TRP channels are most likely important. Future drug development efforts should concentrate on targeting these mediators and receptors for the treatment of CTCL pruritus.
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Affiliation(s)
- Man Hu
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Jörg Scheffel
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Daniel Elieh-Ali-Komi
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Tomasz Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany.
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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Lin YT, Lin CF, Liao CK, Yeh TH. Comprehensive evaluation of type 2 endotype and clinical features in patients with chronic rhinosinusitis with nasal polyps in Taiwan: a cross-sectional study. Eur Arch Otorhinolaryngol 2023; 280:5379-5389. [PMID: 37439928 DOI: 10.1007/s00405-023-08118-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Endotype-driven treatment has been introduced in the management of chronic rhinosinusitis with nasal polyps (CRSwNP), and an understanding of the associations between phenotypes and endotypes of CRSwNP will be beneficial in identifying responders. We aimed to determine the correlations between clinical manifestations and type 2 inflammatory mediators of sinonasal tissues. METHODS Adult patients undergoing endoscopic sinus surgery for bilateral CRSwNP were prospectively enrolled. Tissue eosinophilia and type 2 mediator expression in tissue homogenates were assessed and correlated with clinical features, including symptoms, comorbidities, blood eosinophil counts, specific allergen immunoglobulin (IgE) testing, computed tomography (CT) scan findings, and Sino-Nasal Outcome Test-22 scores. RESULTS A total of 93 subjects were recruited in our study. Fifty-nine (63.4%) cases were identified as the eosinophilic endotype, demonstrating with higher rates of comorbidity of asthma, blood eosinophilia and a high ethmoid-maxillary ratio on CT images. To correlate of phenotypes with the inflammatory mediator profile, multivariate analyses revealed the associations of IgE expression in nasal polyp tissues with allergen sensitization (p = 0.042), CT ethmoid-maxillary ratio (p = 0.001) and tissue eosinophil counts (p = 0.022); the association of interleukin (IL-5) expression with the blood eosinophil percentage (p = 0.020); and the association of IL-13 expression with white blood cell count (p = 0.002) and central compartment-type inflammation (p < 0.001). CONCLUSION We demonstrated associations of IgE and IL-5 expression with clinical features of eosinophilic-type inflammation and a significantly elevated level of IL-13 in patients with central-compartment-type CRSwNP. These observations may be useful when considering the use of type 2 biologic treatment and require further validation studies.
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Affiliation(s)
- Yi-Tsen Lin
- Department of Otolaryngology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Chih-Feng Lin
- Department of Otolaryngology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Chun-Kang Liao
- Department of Otolaryngology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
- Department of Otolaryngology, National Taiwan University Yunlin Branch, Yunlin, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Jenkins CR, Singh D, Ducharme FM, Raherison C, Lavoie KL. Asthma and Rhinitis Through the Lifespan of Nonpregnant Women. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3578-3584. [PMID: 37802256 DOI: 10.1016/j.jaip.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
Increasingly, clinical practice guidelines advocate a precision medicine-based approach to care for asthma. This focus requires knowledge of not only different asthma phenotypes and their associated biomarkers but also sex and gender differences through the lifespan. Evidence continues to build in favor of different lifetime prevalence, clinical presentations, responses to management, and long-term prognosis of asthma. Women transition through many biological and psychosocial phases in their lives, all of which may interact with, and influence, their health and well-being. Historically, explanations have focused on hormonal effects on asthma in reproductive life, but a greater understanding of mechanisms starting before birth and changing over a lifetime is now possible, with immunologic, inflammatory, and hormonal factors playing a role. This article describes the evidence for the differences in asthma and rhinitis between men and women at different stages of life, the potential underlying mechanisms that contribute to this, and the implications for management and research. Future research studies should systematically report sex differences in asthma so that this knowledge can be used to develop a personalized approach to care, to achieve best possible outcomes for all.
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Affiliation(s)
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University, Manchester, United Kingdom; NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Francine M Ducharme
- Department of Pediatrics, University of Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Chantal Raherison
- Department of Pulmonology, CHU Guadeloupe, French West Indies University, Guadeloupe, French West Indies
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montréal (UQAM), Montréal, QC, Canada; Montréal Behavioural Medicine Centre (MBMC), CIUSSS-NIM, Hopital du Sacre-Coeur de Montreal, Montréal, QC, Canada
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Siddiqui S, Wenzel SE, Bozik ME, Archibald DG, Dworetzky SI, Mather JL, Killingsworth R, Ghearing N, Schwartz JT, Ochkur SI, Jacobsen EA, Busse WW, Panettieri RA, Prussin C. Safety and Efficacy of Dexpramipexole in Eosinophilic Asthma (EXHALE): A randomized controlled trial. J Allergy Clin Immunol 2023; 152:1121-1130.e10. [PMID: 37277072 DOI: 10.1016/j.jaci.2023.05.014] [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: 02/03/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for new and effective oral asthma therapies. Dexpramipexole, an oral eosinophil-lowering drug, has not previously been studied in asthma. OBJECTIVE We sought to evaluate the safety and efficacy of dexpramipexole in lowering blood and airway eosinophilia in subjects with eosinophilic asthma. METHODS We performed a randomized, double-blind, placebo-controlled proof-of-concept trial in adults with inadequately controlled moderate to severe asthma and blood absolute eosinophil count (AEC) greater than or equal to 300/μL. Subjects were randomly assigned (1:1:1:1) to dexpramipexole 37.5, 75, or 150 mg BID (twice-daily) or placebo. The primary end point was the relative change in AEC from baseline to week 12. Prebronchodilator FEV1 week-12 change from baseline was a key secondary end point. Nasal eosinophil peroxidase was an exploratory end point. RESULTS A total of 103 subjects were randomly assigned to dexpramipexole 37.5 mg BID (N = 22), 75 mg BID (N = 26), 150 mg BID (N = 28), or placebo (N = 27). Dexpramipexole significantly reduced placebo-corrected AEC week-12 ratio to baseline, in both the 150-mg BID (ratio, 0.23; 95% CI, 0.12-0.43; P < .0001) and the 75-mg BID (ratio, 0.34; 95% CI, 0.18-0.65; P = .0014) dose groups, corresponding to 77% and 66% reductions, respectively. Dexpramipexole reduced the exploratory end point of nasal eosinophil peroxidase week-12 ratio to baseline in the 150-mg BID (median, 0.11; P = .020) and the 75-mg BID (median, 0.17; P = .021) groups. Placebo-corrected FEV1 increases were observed starting at week 4 (nonsignificant). Dexpramipexole displayed a favorable safety profile. CONCLUSIONS Dexpramipexole demonstrated effective eosinophil lowering and was well tolerated. Additional larger clinical trials are needed to understand the clinical efficacy of dexpramipexole in asthma.
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Affiliation(s)
- Salman Siddiqui
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sally E Wenzel
- University of Pittsburgh School of Public Health, Environmental & Occupational Health, Pittsburgh, Pa
| | | | | | | | | | | | - Natasha Ghearing
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Justin T Schwartz
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sergei I Ochkur
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, The State University of New Jersey, New Brunswick, NJ
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Luis MRJ, Del Carmen LEE, Arroyo ARM, Jorge SH, Mauricio CV, Monserrat EP, Del Carmen CSM. Benralizumab in severe eosinophilic asthma: A real-world, single-center, observational study from Mexico. Allergol Immunopathol (Madr) 2023; 51:8-15. [PMID: 37937490 DOI: 10.15586/aei.v51i6.852] [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: 02/26/2023] [Accepted: 06/20/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Urbanization has increased the prevalence of asthma in lower- and middle-income countries. Severe eosinophilic asthma (SEA), a subtype of asthma, can be refractory to standard therapy. Biologics such as benralizumab target interleukin-5 and have demonstrated effectiveness in managing SEA. There exists no real-world evidence on the effectiveness of benralizumab in Mexico. Therefore, this study presents data on the role of benralizumab in managing SEA in Mexican patients. OBJECTIVE The effectiveness of benralizumab on the quality of life (QoL), asthma control, lung function, symptoms of asthma, and benralizumab's safety profile were assessed. METHODS The study sample comprised 10 patients with SEA treated with a subcutaneous (SC) administration of benralizumab 30 mg once in 4 weeks for the first three doses followed by a dose every 8 weeks for 2 years. Laboratory tests, resting spirometry, and skin prick tests were conducted. Levels of fractional exhaled nitric oxide (FeNO) were evaluated, when possible, with the intent to phenotype asthma, as T2 high or non-T2, before starting benralizumab therapy. The Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), and Asthma Control Test (ACT) were administered to evaluate the effectiveness of benralizumab on asthma control and QoL. RESULTS All patients showed significant symptom control, QoL, and lung function over 2 years. Mild adverse effects, such as headache and arthralgia, were observed. CONCLUSION Benralizumab appears to be a promising agent in controlling SEA. This study has focused on measuring tangible outcomes, such as a reduction in symptoms, a reduction in exacerbation, and an improvement in QoL. Thus, benralizumab may constitute an important addition to the arsenal of medications against SEA.
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Affiliation(s)
| | | | | | - Salas Hernández Jorge
- National Institute of Respiratory Diseases, Ismael Cosio Villegas, Mexico City, Mexico
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35
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Anaev EK. [Eosinophilic chronic obstructive pulmonary disease: A review]. TERAPEVT ARKH 2023; 95:696-700. [PMID: 38158908 DOI: 10.26442/00403660.2023.08.202316] [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: 08/04/2022] [Indexed: 01/03/2024]
Abstract
Over the past decades, chronic obstructive pulmonary disease (COPD) has become a major public health problem due to increasing morbidity and mortality. COPD is characterized by airflow limitation due to inflammation of the bronchial tree and remodeling of the small airways. In 20-40% of patients with COPD, eosinophilic inflammation of the airways is observed, as in bronchial asthma. Eosinophilic COPD has recently been shown to be a distinct disease and is associated with more pronounced airway remodeling. Although the role of eosinophils in the pathogenesis of COPD is not fully understood, the level of eosinophils can be used in the prognosis and administration of corticosteroids, and their effectiveness is higher in eosinophilia. Currently, monoclonal antibodies directed against interleukins (IL-5, IL-4 and IL-13) or their receptors are being tested in the T2 endotype of COPD. This review focuses on the mechanisms of eosinophilia in COPD, the use of blood and sputum eosinophils as a biomarker, and the advisability of using monoclonal antibodies in the treatment of eosinophilic COPD.
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Affiliation(s)
- E K Anaev
- Pirogov Russian National Research Medical University
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36
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Siddiqui S, Bachert C, Bjermer L, Buchheit KM, Castro M, Qin Y, Rupani H, Sagara H, Howarth P, Taillé C. Eosinophils and tissue remodeling: Relevance to airway disease. J Allergy Clin Immunol 2023; 152:841-857. [PMID: 37343842 DOI: 10.1016/j.jaci.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
The ability of human tissue to reorganize and restore its existing structure underlies tissue homeostasis in the healthy airways, but in disease can persist without normal resolution, leading to an altered airway structure. Eosinophils play a cardinal role in airway remodeling both in health and disease, driving epithelial homeostasis and extracellular matrix turnover. Physiological consequences associated with eosinophil-driven remodeling include impaired lung function and reduced bronchodilator reversibility in asthma, and obstructed airflow in chronic rhinosinusitis with nasal polyps. Given the contribution of airway remodeling to the development and persistence of symptoms in airways disease, targeting remodeling is an important therapeutic consideration. Indeed, there is early evidence that eosinophil attenuation may reduce remodeling and disease progression in asthma. This review provides an overview of tissue remodeling in both health and airway disease with a particular focus on eosinophilic asthma and chronic rhinosinusitis with nasal polyps, as well as the role of eosinophils in these processes and the implications for therapeutic interventions. Areas for future research are also noted, to help improve our understanding of the homeostatic and pathological roles of eosinophils in tissue remodeling, which should aid the development of targeted and effective treatments for eosinophilic diseases of the airways.
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Affiliation(s)
- Salman Siddiqui
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Claus Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, Münster, Germany; First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China; Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory Medicine, and Allergology, Lund University, Lund, Sweden
| | - Kathleen M Buchheit
- Jeff and Penny Vinik Center for Allergic Diseases Research, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass
| | - Mario Castro
- Division of Pulmonary, Critical Care Medicine, University of Kansas School of Medicine, Kansas City, NC
| | - Yimin Qin
- Global Medical Affairs, Global Specialty and Primary Care, GlaxoSmithKline, Research Triangle Park, NC
| | - Hitasha Rupani
- Department of Respiratory Medicine, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University, School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Peter Howarth
- Global Medical, Global Specialty and Primary Care, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Camille Taillé
- Pneumology Department, Reference Center for Rare Pulmonary Diseases, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unit 1152, University of Paris Cité, Paris, France
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Talwar D, Yadav M, Maturu N, Sharma R, Meshram P, Das S. An early Indian experience with benralizumab - A compendium on severe asthma cases: a case series. F1000Res 2023; 12:1225. [PMID: 38434642 PMCID: PMC10904938 DOI: 10.12688/f1000research.132704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Severe eosinophilic asthma (SEA), one of the phenotypes of asthma that is characterized by elevated blood eosinophil counts, is a common cause of uncontrolled asthma. Patients with SEA often experience severe persistent symptoms and have frequent exacerbations despite optimal inhaler therapy. They also have poor lung function and quality of life (QoL). Benralizumab (Fasenra), a monoclonal antibody, has been approved for managing cases of SEA. This series of six cases, the first of its kind from India, aims to add to the real-world evidence of benralizumab in India. Methods: Benralizumab 30 mg (once in four weeks for the first three doses followed by a dose every eight weeks for two years) was administered in six patients with symptoms of cough, breathlessness on exertion, and wheezing, diagnosed with SEA. The following were the endpoints assessed: (i) overlap between high immunoglobulin E (IgE) and eosinophilic asthma; (ii) reduction of exacerbations; (iii) withdrawal of oral corticosteroids; and (iv) improvement in lung function and QoL. Results: In all cases, management with benralizumab resulted in optimal clinical and functional improvement, a decline in systemic steroid use, and improved QoL. Conclusions: The cases presented here are the first of their kind in the Indian asthmatic population with all SEA patients demonstrating significant improvement in symptoms with the use of benralizumab.
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Affiliation(s)
- Deepak Talwar
- Pulmonology and Sleep Medicine, Metro Hospitals and Heart Institute, Noida, Uttar Pradesh, 201301, India
| | - Manoj Yadav
- Pulmonology, Kailash Hospital, Centre for Respiratory Disease, Vadodara, Gujrat, 390007, India
| | - Nagarjuna Maturu
- Pulmonology, Yashodha Hospital, Hyderabad, Telangana, 500036, India
| | - Rahul Sharma
- Pulmonology, Yatharth Superspeciality Hospital, Noida, Uttar Pradesh, 201304, India
| | - Priti Meshram
- Pulmonology Medicine, GGMC and JJ Hospital, Mumbai, Maharashtra, 400008, India
| | - Soumya Das
- Pulmonology, B.P Poddar Hospital and Medical Research Centre, Kolkata, West Bengal, 700053, India
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Tanaka A, Fujimura Y, Fuke S, Izumi K, Ujiie H. A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma. J Dermatol 2023; 50:1199-1202. [PMID: 37122191 DOI: 10.1111/1346-8138.16811] [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: 02/06/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
Bullous pemphigoid (BP) is an autoimmune disease characterized by itchy erythema and tense blisters on the whole body. Recent reports have unveiled the pathogenic roles of eosinophils in BP (e.g., dermal-epidermal separation, generation of pruritus). Thus, eosinophils are considered a therapeutic target. Benralizumab is an anti-IL-5 receptor alpha (IL-5Rα) monoclonal antibody (mAb) that is widely used to treat severe eosinophilic asthma. By affecting IL-5Rα, benralizumab depletes eosinophils and basophils due to apoptosis through antibody-dependent cell-mediated cytotoxicity. The efficacies of benralizumab and other biologics, including bertilimumab (anti-eotaxin-1 mAb) and mepolizumab (anti-IL-5 mAb), were evaluated in several clinical trials. Also, reslizumab, an anti-IL-5 mAb, was reported as a successful treatment option in a case of BP. We present a case of severe asthma treated with benralizumab at 8-week intervals for 3 years before BP developed. Histologically, subepidermal blisters without eosinophilic infiltration were observed. Methylprednisolone pulse therapy followed by 40 mg/day (1 mg/kg/day) of oral prednisolone (PSL) was initiated, but the skin lesions worsened. Additional intravenous immunoglobulin and oral azathioprine enabled the oral PSL to be tapered. The benralizumab was discontinued after the onset of BP because the asthma did not worsen. To the best of our knowledge, there have been no reports of BP developing during anti-eosinophil therapy. BP may occur paradoxically via various pathways during treatment with drugs that are typically effective against BP.
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Affiliation(s)
- Arisa Tanaka
- Department of Dermatology, KKR Sapporo Medical Center, Sapporo, Japan
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yu Fujimura
- Department of Dermatology, KKR Sapporo Medical Center, Sapporo, Japan
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Fuke
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Kliewer KL, Murray-Petzold C, Collins MH, Abonia JP, Bolton SM, DiTommaso LA, Martin LJ, Zhang X, Mukkada VA, Putnam PE, Kellner ES, Devonshire AL, Schwartz JT, Kunnathur VA, Rosenberg CE, Lyles JL, Shoda T, Klion AD, Rothenberg ME. Benralizumab for eosinophilic gastritis: a single-site, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Gastroenterol Hepatol 2023; 8:803-815. [PMID: 37336228 PMCID: PMC10529697 DOI: 10.1016/s2468-1253(23)00145-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND In eosinophilic gastrointestinal diseases, the role of eosinophils in disease pathogenesis and the effect of eosinophil depletion on patient outcomes are unclear. Benralizumab, an eosinophil-depleting monoclonal antibody that targets the interleukin-5 receptor α, might eliminate gastric tissue eosinophils and improve outcomes in eosinophilic gastritis. We aimed to assess the efficacy and safety of benralizumab in patients with eosinophilic gastritis. METHODS We conducted a single-site, randomised, double-blind, placebo-controlled, phase 2 trial at Cincinnati Children's Hospital Medical Center (Cincinnati, OH, USA). Individuals aged 12-60 years with symptomatic, histologically active eosinophilic gastritis (peak gastric eosinophil count ≥30 eosinophils per high-power field [eos/hpf] in at least five hpfs) and blood eosinophilia (>500 eosinophils per μL [eos/μL]) were randomly assigned (1:1, block size of four) to benralizumab 30 mg or placebo, stratified by the use of glucocorticoids for gastric disease. Investigators, study staff, and study participants were masked to treatment assignment; statisticians were unmasked when analysing data. Treatments were administered subcutaneously once every 4 weeks for a 12-week double-blind period (three total injections). The primary endpoint was the proportion of patients who achieved histological remission (peak gastric eosinophil count <30 eos/hpf) at week 12. Key secondary endpoints were the changes from baseline to week 12 in peak gastric eosinophil count, blood eosinophil count, eosinophilic gastritis histology (total, inflammatory, and structural feature scores), Eosinophilic Gastritis Endoscopic Reference System (EG-REFS) score, and patient-reported outcome symptom measures (Severity of Dyspepsia Assessment [SODA] and Patient-Reported Outcome Measurement Information System [PROMIS] short-form questionnaire). After the 12-week double-blind period, patients were eligible for entry into two open-label extension (OLE) periods up to week 88, in which all patients received benralizumab. Efficacy was analysed in the intention-to-treat (ITT) population and safety was assessed in all patients who received at least one dose of study drug. The trial was registered on ClinicalTrials.gov, NCT03473977, and is completed. FINDINGS Between April 23, 2018, and Jan 13, 2020, 34 patients were screened, and 26 were subsequently randomly assigned to benralizumab (n=13) or placebo (n=13) and included in the ITT and safety populations (mean age 19·5 years [SD 7·3]; 19 [73%] male patients and seven [27%] female patients). At week 12, ten (77% [95% CI 50 to 92]) of 13 patients who received benralizumab and one (8% [1 to 33]) of 13 who received placebo achieved histological remission (difference 69 percentage points [95% CI 32 to 85]; p=0·0010). Changes from baseline to week 12 were significantly greater in the benralizumab group versus the placebo group for peak gastric eosinophil counts (mean -137 eos/hpf [95% CI -186 to -88] vs -38 eos/hpf [-94 to 18]; p=0·0080), eosinophilic gastritis histology total score (mean -0·31 [-0·42 to -0·20] vs -0·02 [-0·16 to 0·12]; p=0·0016), histology inflammatory score (mean -0·46 [-0·60 to -0·31] vs -0·04 [-0·22 to 0·13]; p=0·0006), and blood eosinophil counts (median -1060 eos/μL [IQR -1740 to -830] vs -160 eos/μL [-710 to 120]; p=0·0044). Changes were not significantly different between the groups for eosinophilic gastritis histology structural score (mean -0·07 [95% CI -0·19 to 0·05] vs 0·03 [-0·09 to 0·15]; p=0·23), EG-REFS score (mean -1·0 [-2·3 to 0·3] vs -0·5 [-2·0 to 1·0]; p=0·62), or in patient-reported outcomes (SODA and PROMIS). During the double-blind period, treatment-emergent adverse events occurred in 11 (85%) of 13 patients in the benralizumab group and six (46%) of 13 in the placebo group; the most common treatment-emergent adverse events were headache (six [46%] vs two [15%] patients), nausea (three [23%] vs two [15%]), and vomiting (two [15%] vs three [23%]). There were no treatment-related deaths. Two patients had serious adverse events (dizziness and rhabdomyolysis in one patient; aspiration in one patient) during the OLE periods, which were considered unrelated to study treatment. INTERPRETATION Benralizumab treatment induced histological remission, as defined by absence of tissue eosinophilia, in most patients with eosinophilic gastritis. However, the persistence of histological, endoscopic, and other features of the disease suggest a co-existing, eosinophil-independent pathogenic mechanism and the need for broader targeting of type 2 immunity. FUNDING AstraZeneca and the Division of Intramural Research (National Institute of Allergy and Infectious Diseases, US National Institutes of Health).
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Affiliation(s)
- Kara L Kliewer
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cristin Murray-Petzold
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Juan P Abonia
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott M Bolton
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lauren A DiTommaso
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Xue Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erinn S Kellner
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Justin T Schwartz
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vidhya A Kunnathur
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chen E Rosenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John L Lyles
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tetsuo Shoda
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amy D Klion
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Romero-Tapia SDJ, Guzmán Priego CG, Del-Río-Navarro BE, Sánchez-Solis M. Advances in the Relationship between Respiratory Viruses and Asthma. J Clin Med 2023; 12:5501. [PMID: 37685567 PMCID: PMC10488270 DOI: 10.3390/jcm12175501] [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: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
Several studies have reported that viral infection is closely associated with the onset, progression, and exacerbation of asthma. The purpose of this review is to summarize the role that viral infections have in the pathogenesis of asthma onset and exacerbations, as well as discuss interrelated protective and risk factors of asthma and current treatment options. Furthermore, we present current knowledge of the innate immunological pathways driving host defense, including changes in the epithelial barrier. In addition, we highlight the importance of the genetics and epigenetics of asthma and virus susceptibility. Moreover, the involvement of virus etiology from bronchiolitis and childhood wheezing to asthma is described. The characterization and mechanisms of action of the respiratory viruses most frequently related to asthma are mentioned.
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Affiliation(s)
- Sergio de Jesús Romero-Tapia
- Health Sciences Academic Division (DACS), Juarez Autonomous University of Tabasco (UJAT), Villahermosa 86040, Tabasco, Mexico
| | - Crystell Guadalupe Guzmán Priego
- Cardiometabolism Laboratory, Research Center, Health Sciences Academic Division (DACS), Juarez Autonomous University of Tabasco (UJAT), Villahermosa 86040, Tabasco, Mexico;
| | | | - Manuel Sánchez-Solis
- Paediatric Pulmonology Unit, Virgen de la Arrixaca University Children’s Hospital, University of Murcia, 30120 Murcia, Spain;
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
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41
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Saglani S, Yates L, Lloyd CM. Immunoregulation of asthma by type 2 cytokine therapies: Treatments for all ages? Eur J Immunol 2023; 53:e2249919. [PMID: 36932669 DOI: 10.1002/eji.202249919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
Asthma is classically considered to be a disease of type 2 immune dysfunction, since many patients exhibit the consequences of excess secretion of cytokines such as IL-4, IL-5, and IL-13 concomitant with inflammation typified by eosinophils. Mouse and human disease models have determined that many of the canonical pathophysiologic features of asthma may be caused by these disordered type 2 immune pathways. As such considerable efforts have been made to develop specific drugs targeting key cytokines. There are currently available multiple biologic agents that successfully reduce the functions of IL-4, IL-5, and IL-13 in patients, and many improve the course of severe asthma. However, none are curative and do not always minimize the key features of disease, such as airway hyperresponsiveness. Here, we review the current therapeutic landscape targeting type 2 immune cytokines and discuss evidence of efficacy and limitations of their use in adults and children with asthma.
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Affiliation(s)
- Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Laura Yates
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London, London, UK
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42
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Singh D, Criner GJ, Agustí A, Bafadhel M, Söderström J, Luporini Saraiva G, Song Y, Licaj I, Jison M, Martin UJ, Psallidas I. Benralizumab Prevents Recurrent Exacerbations in Patients with Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis. Int J Chron Obstruct Pulmon Dis 2023; 18:1595-1599. [PMID: 37533773 PMCID: PMC10390712 DOI: 10.2147/copd.s418944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Exacerbations in chronic obstructive pulmonary disease (COPD), which tend to occur in clusters and increase with disease severity, come with high societal and economic burdens. Prevention and delay of recurrent exacerbations is an unmet and significant therapeutic need for patients with COPD. GALATHEA (NCT02138916) and TERRANOVA (NCT02155660) were trials assessing efficacy of benralizumab in patients with frequent COPD exacerbations despite treatment. Although these studies found that benralizumab given as an add-on treatment did not significantly reduce annual rates of COPD exacerbations after 56 weeks of treatment, in the following exploratory post hoc analysis of the GALATHEA and TERRANOVA trials we identified a potential responder population in which treatment with benralizumab prevents recurrent COPD exacerbations during 30- and 90-day periods following an initial exacerbation, a vulnerable period for an exacerbation to occur. This responder population was characterized by high blood eosinophil counts and frequent previous exacerbations despite optimized triple therapy. These results highlight the importance of targeted therapies for high-risk populations and merit further research into the benefits of biologic therapies for COPD exacerbations.
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Affiliation(s)
- Dave Singh
- Manchester University NHS Foundation Hospital Trust, the University of Manchester, Manchester, UK
| | - Gerard J Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Alvar Agustí
- Respiratory Institute (Hospital Clinic), IDIBAPS, CIBERES, Catedra Salud Respiratoria (University of Barcelona), Barcelona, Spain
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Johan Söderström
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gabriela Luporini Saraiva
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Yue Song
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | - Maria Jison
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Ubaldo J Martin
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Ioannis Psallidas
- Late-Stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
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43
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Harker JA, Lloyd CM. T helper 2 cells in asthma. J Exp Med 2023; 220:214104. [PMID: 37163370 PMCID: PMC10174188 DOI: 10.1084/jem.20221094] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
Allergic asthma is among the most common immune-mediated diseases across the world, and type 2 immune responses are thought to be central to pathogenesis. The importance of T helper 2 (Th2) cells as central regulators of type 2 responses in asthma has, however, become less clear with the discovery of other potent innate sources of type 2 cytokines and innate mediators of inflammation such as the alarmins. This review provides an update of our current understanding of Th2 cells in human asthma, highlighting their many guises and functions in asthma, both pathogenic and regulatory, and how these are influenced by the tissue location and disease stage and severity. It also explores how biologics targeting type 2 immune pathways are impacting asthma, and how these have the potential to reveal hitherto underappreciated roles for Th2 cell in lung inflammation.
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Affiliation(s)
- James A Harker
- National Heart and Lung Institute, Imperial College London , London, UK
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London , London, UK
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Louis R, Harrison TW, Chanez P, Menzella F, Philteos G, Cosio BG, Lugogo NL, de Luiz G, Burden A, Adlington T, Keeling N, Kwiatek J, Garcia Gil E. Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1759-1770.e7. [PMID: 36948488 DOI: 10.1016/j.jaip.2023.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. OBJECTIVE Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. METHODS Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. RESULTS For non-OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. CONCLUSIONS These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction.
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Affiliation(s)
- Renaud Louis
- Department of Pneumology CHU Liége, GIGAI3, University of Liége, Liége, Belgium
| | - Tim W Harrison
- Respiratory Research Unit, Nottingham Respiratory NIHR BRC, University of Nottingham, Nottingham, UK; Global Medical Affairs, AstraZeneca, Cambridge, UK.
| | - Pascal Chanez
- Department of Respiratory CIC Nord INSERMINRAE C2VN, Aix Marseille University, Marseille, France
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, Local Health Authority, Montebelluna, Italy
| | - George Philteos
- Royal University Hospital, University of Saskatchewan, Saskatoon, Sask, Canada
| | - Borja G Cosio
- Hospital Son Espases-IdISBa and Ciberes, Palma de Mallorca, Spain
| | | | - Gustavo de Luiz
- Clinical Research and Respiratory Medicine Department, Vithas Xanit International Hospital, Benalmadena, Málaga, Spain
| | - Annie Burden
- Biometrics, Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Timothy Adlington
- Biometrics, Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Nanna Keeling
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Justin Kwiatek
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Del
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Sakai N, Koya T, Murai Y, Tsubokawa F, Tanaka K, Naramoto S, Aoki A, Shima K, Kimura Y, Watanabe S, Hasegawa T, Kikuchi T. Effect of Benralizumab on Mucus Plugs in Severe Eosinophilic Asthma. Int Arch Allergy Immunol 2023; 184:783-791. [PMID: 37231966 DOI: 10.1159/000530392] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/22/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Mucus plugs are associated with airway obstruction in severe asthma and are involved in the formation of activated eosinophils. Benralizumab, an anti-interleukin-5 receptor antibody, markedly reduces not only peripheral blood eosinophils but also airway eosinophils; however, its effects on mucus plugs have not been clarified. In this study, we examined the efficacy of benralizumab on mucus plugs using computed tomography (CT) imaging. METHODS Twelve patients who were administered benralizumab and underwent CT before and approximately 4 months after the introduction of benralizumab were included in this study, and the number of mucus plugs before and after benralizumab administration was compared. The correlation between the clinical background and treatment effect was also examined. RESULTS The number of mucus plugs significantly decreased after the introduction of benralizumab. The number of mucus plugs was correlated with sputum eosinophil percentage and eosinophil cationic protein in the sputum supernatants and inversely correlated with forced expiratory volume in 1 s (FEV1). Benralizumab induction resulted in a marked decrease in blood and sputum eosinophil levels and a significant improvement in asthma symptoms, quality of life scores, FEV1, and exacerbation frequency. Furthermore, there was a significant correlation between the reduction in mucus plugs and changes in the symptom score or FEV1. DISCUSSION/CONCLUSION These data suggest that benralizumab may have the potential to improve symptoms and respiratory function in patients with severe eosinophilic asthma by reducing mucus plugs.
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Affiliation(s)
- Natsumi Sakai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiyuki Koya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yui Murai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fumito Tsubokawa
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kentaro Tanaka
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shun Naramoto
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ami Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenjiro Shima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Kimura
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Hasegawa
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Walsh GM. Recent developments in the use of monoclonal antibodies targeting the type 2 cytokines for severe asthma treatment. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 98:31-54. [PMID: 37524491 DOI: 10.1016/bs.apha.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Severe or refractory asthma is seen in approximately 5% of asthmatic subjects who have unsatisfactory symptom control despite adherence to high-dose inhaled glucocorticoid therapies resulting in significant morbidity, reduced quality of life with attendant implications for healthcare costs. Marked heterogeneity in symptoms and at the molecular phenotypic level are hallmarks of asthma resulting in the requirement of specifically targeted treatments to block the key pathways of the disease. Monoclonal antibody (mAb)-based biologics targeted at inhibition of the type 2 cytokines IL-4, IL-5 and IL-13 have become established as effective treatments for severe asthma, with significant clinical benefit seen in carefully selected patient populations that take asthma phenotypes and endotypes into account. The further development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these interventions.
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Affiliation(s)
- Garry M Walsh
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom.
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Wu Y, Huang M, Zhong J, Lu Y, Gan K, Yang R, Liu Y, Li J, Chen J. The clinical efficacy of type 2 monoclonal antibodies in eosinophil-associated chronic airway diseases: a meta-analysis. Front Immunol 2023; 14:1089710. [PMID: 37114057 PMCID: PMC10126252 DOI: 10.3389/fimmu.2023.1089710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Background Anti-type 2 inflammation therapy has been proposed as a treatment strategy for eosinophil-associated chronic airway disorders that could reduce exacerbations and improve lung function. We performed a meta-analysis of randomized controlled trials to assess the effectiveness of type 2 monoclonal antibodies (anti-T2s) for eosinophil-associated chronic airway disorders. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched from their inception to 21 August 2022. Randomized clinical trials evaluating the effectiveness of anti-T2s versus placebo in the treatment of chronic airway diseases were selected. The outcomes were exacerbation rate and change in pre-bronchodilator forced expiratory volume in 1 s (FEV1) from baseline. The Cochrane Risk of Bias Assessment Tool 1.0 was used to evaluate the risk of bias, and the random-effects or fixed-effect model were used to pool the data. Results Thirty-eight articles concerning forty-one randomized clinical trials with 17,115 patients were included. Compared with placebo, anti-T2s therapy yielded a significant reduction in exacerbation rate in COPD and asthma (Rate Ratio (RR)=0.89, 95%CI, 0.83-0.95, I2 = 29.4%; RR= 0.59, 95%CI, 0.52-0.68, I2 = 83.9%, respectively) and improvement in FEV1 in asthma (Standard Mean Difference (SMD)=0.09, 95%CI, 0.08-0.11, I2 = 42.6%). Anti-T2s therapy had no effect on FEV1 improvement in COPD (SMD=0.05, 95%CI, -0.01-0.10, I2 = 69.8%). Conclusion Despite inconsistent findings across trials, anti-T2s had a positive overall impact on patients' exacerbation rate in asthma and COPD and FEV1 in asthma. Anti-T2s may be effective in treating chronic airway illnesses related to eosinophils. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022362280.
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Affiliation(s)
- Yuan Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengfen Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinyao Zhong
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Lu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Kao Gan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Rongyuan Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
| | - Yuntao Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
| | - Jiqiang Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
| | - Jiankun Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, China
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Tomomatsu K, Yasuba H, Ishiguro T, Imokawa S, Hara J, Soeda S, Harada N, Tsurikisawa N, Oda N, Katoh S, Numata T, Sugino Y, Yamada M, Kamimura M, Terashima T, Okada N, Tanaka J, Oguma T, Asano K. Real-world efficacy of anti-IL-5 treatment in patients with allergic bronchopulmonary aspergillosis. Sci Rep 2023; 13:5468. [PMID: 37015988 PMCID: PMC10073186 DOI: 10.1038/s41598-023-32246-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
Despite standard treatment with systemic corticosteroids and/or antifungal triazoles, a substantial proportion of patients with allergic bronchopulmonary aspergillosis (ABPA) experience frequent relapses and require long-term treatment despite unfavorable adverse effects. We investigated the efficacy and safety of anti-interleukin (IL)-5/IL-5 receptor α chain (Rα) monoclonal antibodies (mAbs) in patients with ABPA complicated by asthma. ABPA cases treated with anti-IL-5/IL-5Rα mAbs were collected from 132 medical institutes in 2018 and published case reports in Japan. Clinical outcomes, laboratory and physiological data, and radiographic findings during 32 weeks before and after treatment were retrospectively evaluated. We analyzed 29 cases of ABPA: 20 treated with mepolizumab and nine with benralizumab. Treatment with anti-IL-5/IL-5Rα mAbs reduced the frequency of exacerbations (p = 0.03), decreased the dose of oral corticosteroids (p < 0.01), and improved pulmonary function (p = 0.01). Mucus plugs in the bronchi shrank or diminished in 18 patients (82%). Despite the clinical/radiographical improvement, serum levels of total IgE, the key biomarker for the pharmacological response in ABPA, were unchanged. Anti-IL-5/IL-5Rα mAbs that directly target eosinophils are promising candidates for the treatment of patients with ABPA, especially those with mucus plugs in the bronchi.
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Affiliation(s)
- Katsuyoshi Tomomatsu
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hirotaka Yasuba
- Department of Airway Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Shizuoka, Japan
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Seiko Soeda
- Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Naomi Tsurikisawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Hiroshima, Japan
| | - Shigeki Katoh
- Department of General Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuteru Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Aichi, Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsuhiro Kamimura
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Naoki Okada
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Jun Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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49
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Subsets of Eosinophils in Asthma, a Challenge for Precise Treatment. Int J Mol Sci 2023; 24:ijms24065716. [PMID: 36982789 PMCID: PMC10052006 DOI: 10.3390/ijms24065716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
The existence of eosinophils was documented histopathologically in the first half of the 19th century. However, the term “eosinophils” was first used by Paul Ehrlich in 1878. Since their discovery and description, their existence has been associated with asthma, allergies, and antihelminthic immunity. Eosinophils may also be responsible for various possible tissue pathologies in many eosinophil-associated diseases. Since the beginning of the 21st century, the understanding of the nature of this cell population has undergone a fundamental reassessment, and in 2010, J. J. Lee proposed the concept of “LIAR” (Local Immunity And/or Remodeling/Repair), underlining the extensive immunoregulatory functions of eosinophils in the context of health and disease. It soon became apparent that mature eosinophils (in line with previous morphological studies) are not structurally, functionally, or immunologically homogeneous cell populations. On the contrary, these cells form subtypes characterized by their further development, immunophenotype, sensitivity to growth factors, localization, role and fate in tissues, and contribution to the pathogenesis of various diseases, including asthma. The eosinophil subsets were recently characterized as resident (rEos) and inflammatory (iEos) eosinophils. During the last 20 years, the biological therapy of eosinophil diseases, including asthma, has been significantly revolutionized. Treatment management has been improved through the enhancement of treatment effectiveness and a decrease in the adverse events associated with the formerly ultimately used systemic corticosteroids. However, as we observed from real-life data, the global treatment efficacy is still far from optimal. A fundamental condition, “sine qua non”, for correct treatment management is a thorough evaluation of the inflammatory phenotype of the disease. We believe that a better understanding of eosinophils would lead to more precise diagnostics and classification of asthma subtypes, which could further improve treatment outcomes. The currently validated asthma biomarkers (eosinophil count, production of NO in exhaled breath, and IgE synthesis) are insufficient to unveil super-responders among all severe asthma patients and thus give only a blurred picture of the adepts for treatment. We propose an emerging approach consisting of a more precise characterization of pathogenic eosinophils in terms of the definition of their functional status or subset affiliation by flow cytometry. We believe that the effort to find new eosinophil-associated biomarkers and their rational use in treatment algorithms may ameliorate the response rate to biological therapy in patients with severe asthma.
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50
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Frøssing L, Klein DK, Hvidtfeldt M, Obling N, Telg G, Erjefält JS, Bodtger U, Porsbjerg C. Distribution of type 2 biomarkers and association with severity, clinical characteristics and comorbidities in the BREATHE real-life asthma population. ERJ Open Res 2023; 9:00483-2022. [PMID: 36949964 PMCID: PMC10026007 DOI: 10.1183/23120541.00483-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background Type 2 (T2) high asthma is recognised as a heterogenous entity consisting of several endotypes; however, the prevalence and distribution of the T2 biomarkers in the general asthma population, across asthma severity, and across compartments is largely unknown. The objective of the present study was to describe expression and overlaps of airway and systemic T2 biomarkers in a clinically representative asthma population. Methods Patients with asthma from the real-life BREATHE cohort referred to a specialist centre were included and grouped according to T2 biomarkers: blood and sputum eosinophilia (≥0.3×109 cells·L-1 and 3% respectively), total IgE (≥150 U·mL-1), and fractional exhaled nitric oxide (≥25 ppb). Results Patients with mild-to-moderate asthma were younger (41 versus 49 years, p<0.001), had lower body mass index (25.9 versus 28.0 kg·m-2, p=0.002) and less atopy (47% versus 58%, p=0.05), higher forced expiratory volume in 1 s (3.2 versus 2.8 L, p<0.001) and forced vital capacity (4.3 versus 3.9 L, p<0.001) compared with patients with severe asthma, who had higher blood (0.22×109 versus 0.17×109 cells·L-1, p=0.01) and sputum (3.0% versus 1.5%, p=0.01) eosinophils. Co-expression of all T2 biomarkers was a particular characteristic of severe asthma (p<0.001). In patients with eosinophilia, sputum eosinophilia without blood eosinophilia was present in 45% of patients with mild-to-moderate asthma and 35% with severe asthma. Conclusion Severe asthma is more commonly associated with activation of several T2 pathways, indicating that treatments targeting severe asthma may need to act more broadly on T2 inflammatory pathways. Implementation of airway inflammometry in clinical care is of paramount importance, as the best treatable trait is otherwise is overlooked in a large proportion of patients irrespective of disease severity.
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Affiliation(s)
- Laurits Frøssing
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Contributed equally
- Corresponding author: Laurits Frøssing ()
| | - Ditte K. Klein
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Contributed equally
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Nicolai Obling
- Respiratory Research Unit PLUZ, Dept of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | | | | | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Dept of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Dept of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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