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Dargentolle G, Georges M, Beltramo G, Poisson C, Bonniaud P. [Adverse events in biologics for severe asthma]. Rev Mal Respir 2024; 41:372-381. [PMID: 38653607 DOI: 10.1016/j.rmr.2024.04.001] [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: 07/22/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Asthma is a pathology that remains severe and is inadequately controlled in 4% of patients. Identification of multiple pathophysiological mechanisms has led to the development of biomedicines, of which there are currently five available in France, with a safety profile that appears favorable but remains uncertain due to a lack of real-life experience with these new molecules. STATE OF KNOWLEDGE Although relatively benign, the adverse effects of biologics are diverse. Headache, joint pain, skin reactions at the injection site, fever and asthenia are commonly observed during the different treatments. Ophthalmological complications seem restricted to dupilumab, with numerous cases of keratitis and conjunctivitis in patients with atopic dermatitis. Several respiratory complications have also been observed, essentially consisting in pharyngitis and other upper respiratory infections. Hypereosinophilia may occur, mainly with dupilumab, requiring investigation of systemic repercussions or vasculitis. Allergic reactions are uncommon but require careful monitoring during initial injections. CONCLUSION Biologics for severe asthma are recent drugs with a favorable safety profile, but with little real-life experience, justifying increased vigilance by prescribing physicians.
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Affiliation(s)
- G Dargentolle
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Georges
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre des sciences du goût et de l'alimentation, UMR CNRS 6225, INRA 1324, université de Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, Dijon, France.
| | - G Beltramo
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France; F-CRIN, Clinical Research Initiative In Severe Asthma: a Lever for Innovation & Science (CRISALIS), Toulouse, France; UFR des sciences de santé, université de Bourgogne, Dijon, France
| | - C Poisson
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France; F-CRIN, Clinical Research Initiative In Severe Asthma: a Lever for Innovation & Science (CRISALIS), Toulouse, France; UFR des sciences de santé, université de Bourgogne, Dijon, France
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Cutroneo PM, Arzenton E, Furci F, Scapini F, Bulzomì M, Luxi N, Caminati M, Senna G, Moretti U, Trifirò G. Safety of Biological Therapies for Severe Asthma: An Analysis of Suspected Adverse Reactions Reported in the WHO Pharmacovigilance Database. BioDrugs 2024; 38:425-448. [PMID: 38489062 PMCID: PMC11055782 DOI: 10.1007/s40259-024-00653-6] [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] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The management of uncontrolled severe asthma has greatly improved since the advent of novel biologic therapies. Up to August 2022, five biologics have been approved for the type 2 asthma phenotype: anti-IgE (omalizumab), anti-IL5 (mepolizumab, reslizumab, benralizumab), and anti-IL4 (dupilumab) monoclonal antibodies. These drugs are usually well tolerated, although long-term safety information is limited, and some adverse events have not yet been fully characterized. Spontaneous reporting systems represent the cornerstone for the detection of potential signals and evaluation of the real-world safety of all marketed drugs. OBJECTIVE The aim of this study was to provide an overview of safety data of biologics for severe asthma using VigiBase, the World Health Organization global pharmacovigilance database. METHODS We selected all de-duplicated individual case safety reports (ICSRs) attributed to five approved biologics for severe asthma in VigiBase, up to 31st August 2022 (omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab). Descriptive frequency analyses of ICSRs were carried out both as a whole class and as individual products. Reporting odds ratios (ROR) with 95% confidence intervals (CIs) were used as the measure of disproportionality for suspected adverse drug reactions (ADRs) associated with the study drugs compared with either all other suspected drugs (Reference Group 1, RG1) or inhaled corticosteroids plus long-acting β-agonists (ICSs/LABAs) (Reference Group 2, RG2) or with oral corticosteroids (OCSs) (Reference Group 3, RG3). RESULTS Overall, 31,724,381 ICSRs were identified in VigiBase and 167,282 (0.5%) were related to study drugs; the remaining reports were considered as RG1. Stratifying all biologic-related ICSRs by therapeutic indication, around 29.4% (n = 48,440) concerned asthma use; omalizumab was mainly indicated as the suspected drug (n = 20,501), followed by dupilumab, mepolizumab, benralizumab and reslizumab. Most asthma ICSRs concerned adults (57%) and women (64.1%). Asthma biologics showed a higher frequency of serious suspected ADR reporting than RG1 (41.3% vs 32.3%). The most reported suspected ADRs included asthma, dyspnea, product use issue, drug ineffective, cough, headache, fatigue and wheezing. Asthma biologics were disproportionally associated with several unknown or less documented adverse events, such as malignancies, pulmonary embolism and deep vein thrombosis with omalizumab; alopecia and lichen planus with dupilumab; alopecia and herpes infections with mepolizumab; alopecia, herpes zoster and eosinophilic granulomatosis with polyangiitis related to benralizumab; and alopecia with reslizumab. CONCLUSIONS The most frequently reported suspected ADRs of asthma biologics in VigiBase confirmed the presence of well-known adverse effects such as general disorders, injection-site reactions, nasopharyngitis, headache and hypersensitivity, while some others (e.g. asthma reactivation or therapeutic failure) could be ascribed to the indication of use. Moreover, the analysis of signals of disproportionate reporting suggests the presence of malignancies, effects on the cardiovascular system, alopecia and autoimmune conditions, requiring further assessment and investigation.
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Affiliation(s)
- Paola Maria Cutroneo
- Unit of Clinical Pharmacology, Sicily Pharmacovigilance Regional Centre, University Hospital of Messina, Messina, Italy
| | - Elena Arzenton
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabiana Furci
- Provincial Healthcare Unit, Section of Allergy, Vibo Valentia, Italy
| | - Fabio Scapini
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Bulzomì
- Unit of Clinical Pharmacology, Sicily Pharmacovigilance Regional Centre, University Hospital of Messina, Messina, Italy
| | - Nicoletta Luxi
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, Verona, Italy
| | - Ugo Moretti
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gianluca Trifirò
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
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Dupin C, Valéry S, Guilleminault L, Devouassoux G, Merveilleau M, Russier M, Mourin G, Pradelli J, Bonniaud P, Le Brun M, Ebstein E, Juge PA, Lillo-Lelouet A, Taillé C. Articular manifestations related to anti-interleukin-5 therapies in severe asthma: a case series. ERJ Open Res 2024; 10:00935-2023. [PMID: 38410709 PMCID: PMC10895420 DOI: 10.1183/23120541.00935-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024] Open
Abstract
Articular manifestations should be screened before and during anti-IL-5/5R biologic treatment in severe asthma. Rigorous multidisciplinary team discussion should be carried out to assess the risk-benefit balance of withholding effective treatment. https://bit.ly/3vfPn4k.
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Affiliation(s)
- Clairelyne Dupin
- Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
- CRISALIS F-CRIN network, Paris, France
- C. Dupin and S. Valéry contributed equally to the submitted work
| | - Solène Valéry
- Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
- C. Dupin and S. Valéry contributed equally to the submitted work
| | - Laurent Guilleminault
- CRISALIS F-CRIN network, Paris, France
- Service de Pneumologie, Hôpital Larrey, CHU de Toulouse, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 – CNRS UMR5051 – Université Toulouse III, Toulouse, France
| | - Gilles Devouassoux
- CRISALIS F-CRIN network, Paris, France
- Service de Pneumologie, Hôpital de la Croix Rousse, Lyon, France
| | | | - Maud Russier
- Cabinet de Pneumologie, Maison Médicale du Larry, Olivet, France
| | | | - Johana Pradelli
- Service de Pneumologie-Allergologie, CHU de Nice, Nice, France
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, CHU Dijon-Bourgogne, Dijon, France
| | - Mathilde Le Brun
- Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
- CRISALIS F-CRIN network, Paris, France
| | - Esther Ebstein
- Service de Rhumatologie, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
| | - Pierre-Antoine Juge
- Service de Rhumatologie, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
| | - Agnès Lillo-Lelouet
- Centre Régional de Pharmacovigilance de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Camille Taillé
- Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
- CRISALIS F-CRIN network, Paris, France
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Olewicz-Gawlik A, Kowala-Piaskowska A. Self-reactive IgE and anti-IgE therapy in autoimmune diseases. Front Pharmacol 2023; 14:1112917. [PMID: 36755957 PMCID: PMC9899859 DOI: 10.3389/fphar.2023.1112917] [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: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
Growing evidence indicates the pathogenic role of autoreactive IgE in autoimmune diseases. Incidence of autoimmune and allergic diseases in the industrialized countries is consistently icreasing, thus leading to concerted efforts to comprehend the regulation of IgE-mediated mechanisms. The first reports of a presence of IgE autoantibodies in patients with autoimmune diseases have been published a long time ago, and it is now recognized that self-reactive IgE can mediate inflammatory response in bullous pemhigoid, systemic lupus erythematosus, chronic urticaria, and atopic dermatitis. The advances in understanding the pathomechanisms of these disorders brought to a successful use of anti-IgE strategies in their management. The present review discusses the current state of knowledge on the IgE-mediated autoimmunity and anti-IgE treatment, and pave the way for further exploration of the subject.
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Affiliation(s)
- Anna Olewicz-Gawlik
- Department of Immunology, Poznan University of Medical Sciences, Poznan, Poland,Department of Infectious Diseases, Hepatology and Acquired Immunodeficiencies, Poznan University of Medical Sciences, Poznan, Poland,*Correspondence: Anna Olewicz-Gawlik,
| | - Arleta Kowala-Piaskowska
- Department of Infectious Diseases, Hepatology and Acquired Immunodeficiencies, Poznan University of Medical Sciences, Poznan, Poland
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