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Schepel IRM, Banzon TM, Phipatanakul W. Future of biologics in pediatric asthma: Optimizing response, early introduction, and equitable access to treatment. Ann Allergy Asthma Immunol 2024; 132:13-20. [PMID: 37652232 PMCID: PMC10842489 DOI: 10.1016/j.anai.2023.08.597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To evaluate the current evidence, its limitations, and future research directions for the use of biologics in pediatric asthma, with a particular focus on the potential use of biologics to prevent pediatric asthma and equity issues in access to biologic treatment and research participation. DATA SOURCES PubMed articles about the use of biologics in pediatric asthma were searched up to May 2023. STUDY SELECTIONS Recent (2019-2023) original research articles and reviews were prioritized. RESULTS Although there are now 5 U.S. Food and Drug Administration-approved biologics for use in pediatric asthma, there are important knowledge gaps that ongoing research seeks to address, which include (1) the long-term efficacy and safety of using biologics in children, (2) the comparative efficacy of different biologics, (3) multi-omics-based classification of asthma endotypes and phenotypes in children to find potential new therapeutic targets and enable identification and validation of new biomarkers that may predict and help monitor response to treatment, and (4) whether starting biologics in early childhood can modify the natural history of asthma and potentially prevent asthma development. SUMMARY To promote equitable access to biologics and optimize asthma outcomes, future research should recruit patients across the full spectrum of socioeconomic and racial/ethnic backgrounds. Large-scale national and international collaborations between asthma researchers and clinicians are also necessary to fully understand the role of biologics in pediatric asthma.
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Affiliation(s)
- Ianthe R M Schepel
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Witonsky J, Elhawary JR, Millette LA, Holweg CTJ, Ko J, Raut P, Borrell LN. Similar response to omalizumab in children with allergic asthma from different racial backgrounds. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2911-2913. [PMID: 37088376 DOI: 10.1016/j.jaip.2023.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Jonathan Witonsky
- Department of Pediatrics, University of California San Francisco, San Francisco, Calif
| | - Jennifer R Elhawary
- Department of Medicine, University of California San Francisco, San Francisco, Calif
| | | | | | - Jinnie Ko
- Genentech, Inc., South San Francisco, Calif
| | | | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health & Health Policy, New York, NY
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Chen F, Liang L, Chu FF, Lu C, Xu C. Effects of omalizumab combined with budesonide formoterol on clinical efficacy, pulmonary function, immune function, and adverse reactions in children with moderate and severe allergic asthma. Allergol Immunopathol (Madr) 2023; 51:182-188. [PMID: 37422796 DOI: 10.15586/aei.v51i4.926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of combining omalizumab with budesonide formoterol to treat children with moderate and severe allergic asthma, and investigate the effect of this combination therapy on pulmonary and immune functions. METHODS The data of 88 children with moderate and severe allergic asthma, who were admitted to our hospital between July 2021 and July 2022, were included in the study. The patients were randomly assigned either to control group (n = 44; received budesonide formoterol inhalation therapy) or experimental group (n = 44; received omalizumab subcutaneous injection + budesonide formoterol inhalation therapy) using computer-generated randomization. The clinical efficacy, asthma control (measured using childhood Asthma-Control Test [C-ACT] score), pulmonary function (forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow), immune function (cluster of differentiation 3 cells [CD3+ cells], cluster of differentiation 4 cells [CD4+ cells], immunoglobulin G, immunoglobulin A, and immunoglobulin E), and adverse reactions were observed and compared between both groups. RESULTS After treatment, the experimental group had improved levels of pulmonary function and immune function indexes, higher C-ACT scores, and a higher overall response rate than the control group (P < 0.05). In addition, the incidence of adverse reactions was not significantly different between both groups (P > 0.05). CONCLUSION The combination of omalizumab with budesonide formoterol for treating moderate and severe allergic asthma in children demonstrated promising clinical efficacy and improved their pulmonary and immune functions, leading to more rational asthma control. The combined regimen demonstrated satisfactory clinical safety and deserved clinical promotion.
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Affiliation(s)
- Fuzhe Chen
- Department of Respiratory, Anhui Provincial Children's Hospital, Hefei City, Anhui Province, China
| | - Lei Liang
- Department of Respiratory, Anhui Provincial Children's Hospital, Hefei City, Anhui Province, China;
| | - Fang Fang Chu
- Department of Respiratory, Anhui Provincial Children's Hospital, Hefei City, Anhui Province, China
| | - Changlong Lu
- Department of Respiratory, Anhui Provincial Children's Hospital, Hefei City, Anhui Province, China
| | - Chongyu Xu
- Department of Respiratory, Anhui Provincial Children's Hospital, Hefei City, Anhui Province, China
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Anderson WC, Banzon TM, Chawes B, Papadopoulos NG, Phipatanakul W, Szefler SJ. Factors to Consider in Prescribing Asthma Biologic Therapies to Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:693-701. [PMID: 36646381 DOI: 10.1016/j.jaip.2022.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
The increasing availability of biologics, both by expanding age indications and by development of new therapies, provides additional options to treat children and adolescents with severe asthma. However, the evidence for these biologics in these populations is limited compared with that for adult studies. As such, before initiation of therapy, possible alternative therapies that can also provide asthma control, confirmation of the diagnosis of asthma, management of comorbidities, and assessment of adherence should be explored. The choice of a biologic should be a shared decision-making process between providers and families, balancing biologic efficacy, goals of care, administration, and ability to treat multiple conditions. Response to treatment should be periodically evaluated not only to ensure an ineffective treatment is not continued but also to consider when to potentially discontinue therapy should it be beneficial. The utilization of biologics in children and adolescents with severe asthma also leads to unanswered questions on their role in disease remission and long-term outcomes.
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Affiliation(s)
- William C Anderson
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Wanda Phipatanakul
- Division of Asthma, Allergy, Dermatology, Rheumatology, Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Stanley J Szefler
- Section of Pediatric Pulmonary and Sleep Medicine, Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Maurer M, Saini SS, McLendon K, Wabnitz P, Kim S, Ahn K, Kim S, Lee S, Grattan C. Pharmacokinetic equivalence of CT-P39 and reference omalizumab in healthy individuals: A randomised, double-blind, parallel-group, Phase 1 trial. Clin Transl Allergy 2022; 12:e12204. [PMID: 36434739 PMCID: PMC9665328 DOI: 10.1002/clt2.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/17/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND CT-P39 is being developed as a biosimilar of reference omalizumab. This study aimed to assess the pharmacokinetic equivalence of CT-P39 to European Union-approved and United States-licensed reference omalizumab (EU- and US-omalizumab, respectively). METHODS This two-part, randomised, parallel-group, double-blind Phase 1 trial (NCT04018313) was conducted in healthy individuals with a total immunoglobulin E (IgE) level ≤100 international units (IU)/ml at screening. In part 2, described herein, participants were randomised (1:1:1) to receive a single 150 mg subcutaneous dose of CT-P39, EU-omalizumab, or US-omalizumab. The primary endpoint was pharmacokinetic equivalence in terms of area under the concentration-time curve (AUC) from time zero to the last quantifiable concentration (AUC0-last ), AUC from time zero to infinity (AUC0-inf ), and maximum serum concentration (Cmax ). Equivalence was concluded if 90% confidence intervals (CIs) of the geometric least-squares means ratios were contained within the predefined 80%-125% equivalence margin. Additional pharmacokinetic parameters, pharmacodynamics, safety, and immunogenicity were also evaluated. RESULTS Overall, 146 participants were randomised (CT-P39, N = 47; EU-omalizumab, N = 49; US-omalizumab, N = 50). For all primary pharmacokinetic parameters, 90% CIs for pairwise treatment comparisons were within the 80%-125% equivalence margin, demonstrating pharmacokinetic equivalence. Decreases in free IgE and increases in total IgE serum concentrations were comparable across groups. CT-P39 was well tolerated. Safety endpoints were comparable across groups: there were no treatment-related serious adverse events, deaths, or discontinuations due to treatment-emergent adverse events. CONCLUSIONS CT-P39 was well tolerated and demonstrated pharmacokinetic equivalence with EU-omalizumab and US-omalizumab following administration of a single dose in healthy individuals.
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Affiliation(s)
- Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology (ITMP)BerlinGermany
| | - Sarbjit S. Saini
- Johns Hopkins University School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | | | | | | | - Sewon Lee
- Celltrion, Inc.IncheonRepublic of Korea
| | - Clive Grattan
- St John's Institute of DermatologyGuy's HospitalLondonUK
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Greiner B, Nicks S, Adame M, McCracken J. Pathophysiology, Diagnosis, and Management of Chronic Spontaneous Urticaria: A Literature Review. Clin Rev Allergy Immunol 2022; 63:381-389. [PMID: 36048326 DOI: 10.1007/s12016-022-08952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
Chronic spontaneous urticaria (CSU) is characterized by recurring wheals that last 6 weeks or longer without an identifiable cause. The estimated point prevalence of CSU worldwide is 1%. Furthermore, it has a significant impact on quality of life in both adults and pediatric patients and their families. Although it is most often a self-limited disease, some patients have urticaria refractory to first-line treatment: second-generation H1 antihistamines. In these patients, the use of targeted monoclonal antibodies is necessary. While omalizumab is the only Food and Drug Administration-approved monoclonal antibody for CSU, others, including ligelizumab, dupilumab, benralizumab, and several orally administered Bruton's tyrosine kinase inhibitors, are also promising therapeutics for reducing the morbidity of CSU. Novel therapies, among others discussed here, are rapidly being developed with new trials and therapeutics being released nearly monthly. Thus, we performed a scoping literature review of randomized controlled trials studying targeted therapies for CSU. We also discuss the pathophysiology, diagnosis, prognosis, and future research directions in CSU.
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Affiliation(s)
- Benjamin Greiner
- Department of Internal Medicine, Medical Branch, University of Texas, 301 University Blvd, Galveston, TX, USA. .,Division of Allergy & Immunology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Savannah Nicks
- Department of Otolaryngology, McLaren Oakland Hospital, Pontiac, MI, USA
| | - Michael Adame
- Department of Internal Medicine, Medical Branch, University of Texas, 301 University Blvd, Galveston, TX, USA.,Division of Allergy & Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jennifer McCracken
- Department of Internal Medicine, Medical Branch, University of Texas, 301 University Blvd, Galveston, TX, USA.,Division of Allergy & Immunology, University of Texas Medical Branch, Galveston, TX, USA
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Angel DM, Schatz M, Zeiger RS, Sicherer SH, Khan DA. Diversity, Equity, and Inclusion: What Can a Journal Do? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3853-3856. [PMID: 34563739 DOI: 10.1016/j.jaip.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Dawn M Angel
- American Academy of Allergy and Clinical Immunology, Denver, Colo.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Care Program, San Diego, Calif
| | - Robert S Zeiger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, Pasadena, Calif
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
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