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Bult L, Thelen JC, Rauh SP, Veen JCCMI', Braunstahl GJ. Dupilumab responder types and predicting factors in patients with type 2 severe asthma: A real-world cohort study. Respir Med 2024; 231:107720. [PMID: 38992817 DOI: 10.1016/j.rmed.2024.107720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Severe asthma (SA) presents a considerable healthcare challenge despite optimal standard treatment. Dupilumab, which is effective in type 2 (T2) SA patients, demonstrates variable responses, categorizing patients as non-responders, partial responders, or those achieving clinical remission. However, real-world response rates remain underexplored. Additionally, understanding the characteristics of patients achieving clinical remission is crucial for predicting favourable responses to dupilumab. OBJECTIVE To investigate responder types and identify predictors of clinical remission and non-response induced by dupilumab in a real-world cohort of SA patients. METHODS We analyzed retrospective data from SA patients undergoing dupilumab treatment in a study conducted at Franciscus Gasthuis & Vlietland hospital. Data were collected at baseline and at a 12 to 24-months follow-up (T = 12). Response rates were evaluated at T = 12. Predictors of non-response and clinical remission were investigated using multivariate logistic regression analysis with a stepwise forward variable selection approach. RESULTS Among the 175 patients screened, 136 met the inclusion criteria. At T = 12, 31.6 % achieved clinical remission, 47.1 % were partial responders and 21.3 % were non-responders. Predictors associated with clinical remission included high baseline blood eosinophil counts (BEC) and male sex. Conversely, younger age at baseline, low baseline total immunoglobin E (IgE) and low baseline fractional exhaled nitric oxide (FeNO) levels were identified as predictors of non-response. CONCLUSIONS Dupilumab results in clinical disease remission in one-third of the treated patients. Clinical remission is predicted by high BEC and male sex, whereas low total IgE, low FeNO and younger age indicate a lower likelihood of response.
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Affiliation(s)
- L Bult
- Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands; Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J C Thelen
- Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - S P Rauh
- Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - J C C M In 't Veen
- Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands; Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - G J Braunstahl
- Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands; Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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2
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Fisch M, Fajt ML, Wenzel SE, Petrov AA. A real-world study of symptomatic eosinophilia in moderate-to-severe asthma patients on dupilumab therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2183-2186. [PMID: 38685475 DOI: 10.1016/j.jaip.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/20/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Matthew Fisch
- University of Pittsburgh Medical School, Pittsburgh, Pa
| | - Merritt L Fajt
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa; University of Pittsburgh Asthma and Environmental Lung Health Institute at UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - Sally E Wenzel
- University of Pittsburgh Asthma and Environmental Lung Health Institute at UPMC, University of Pittsburgh, Pittsburgh, Pa; Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Andrej A Petrov
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa; University of Pittsburgh Asthma and Environmental Lung Health Institute at UPMC, University of Pittsburgh, Pittsburgh, Pa.
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3
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Bleecker E, Blaiss M, Jacob-Nara J, Huynh L, Guo T, Ye M, Stanford RH, Wang Z, Soler X, Nag A, Nair R, Borsos K. Real-world effectiveness of dupilumab versus benralizumab and mepolizumab. Allergy Asthma Proc 2024; 45:219-231. [PMID: 38760161 DOI: 10.2500/aap.2024.45.240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Introduction: In the United States, this real-world study compared the effectiveness of dupilumab, benralizumab, and mepolizumab in reducing exacerbations and systemic corticosteroid (SCS) prescriptions among patients with asthma. Methods: Patients (≥12 years old) who initiated dupilumab, benralizumab, or mepolizumab (index) between November 2018 and September 2020 were identified by using electronic medical record data. Subjects were included if they had ≥ 12 months of data before and after the index date and two or more severe asthma-related exacerbations before the index date. Differences in baseline characteristics were addressed by using inverse probability treatment weighting (IPTW). Pairwise comparisons between dupilumab and benralizumab, or mepolizumab were conducted by using negative binomial regression, adjusting for baseline rates and unbalance characteristics (≥10% standardized differences) after IPTW. Results: Overall, a total of 1737 subjects met all criteria: 825 dupilumab, 461 benralizumab, and 451 mepolizumab initiators. In the postindex period, dupilumab was associated with a 24% and 28% significant reduction in the risk of severe asthma exacerbations versus benralizumab (incidence rate ratio [IRR] 0.76 [95% confidence interval {CI}, 0.67-0.86)] and mepolizumab (IRR 0.72 [95% CI, 0.63-0.82]), respectively. In addition, dupilumab treatment significantly reduced SCS prescriptions by 16% and 25% versus benralizumab and mepolizumab, respectively (p < 0.05). Conclusion: This study represents one of the largest real-world comparisons of biologics (dupilumab, benralizumab, and mepolizumab) for asthma in the United States to date. This analysis shows that the use of dupilumab was associated with a significantly greater reduction in both severe asthma exacerbations and SCS prescriptions compared with benralizumab and mepolizumab.
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Affiliation(s)
- Eugene Bleecker
- From the University of Arizona College of Medicine, Tucson, Arizona
| | - Michael Blaiss
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Lynn Huynh
- Analysis Group, Inc, Boston, Massachusetts
| | - Tracy Guo
- Analysis Group, Inc, Boston, Massachusetts
| | | | | | - Zhixiao Wang
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, and
| | - Xavier Soler
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, and
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4
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Caminati M, Maule M, Benoni R, Bagnasco D, Beghè B, Braido F, Brussino L, Cameli P, Candeliere MG, Carpagnano GE, Costanzo G, Crimi C, D’Amato M, Del Giacco S, Guarnieri G, Yacoub MR, Micheletto C, Nicola S, Olivieri B, Pini L, Schiappoli M, Vaia R, Vianello A, Visca D, Spanevello A, Senna G. Dupilumab Efficacy on Asthma Functional, Inflammatory, and Patient-Reported Outcomes across Different Disease Phenotypes and Severity: A Real-Life Perspective. Biomedicines 2024; 12:390. [PMID: 38397992 PMCID: PMC10886692 DOI: 10.3390/biomedicines12020390] [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: 12/30/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Dupilumab is currently approved for the treatment of Type 2 severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies have specifically reported on dupilumab efficacy on asthma outcomes as a primary objective in a real-life setting, in patients with and without CRSwNP. Our study aimed to explore the efficacy of dupilumab on functional, inflammatory, and patient-reported outcomes in asthma patients across different disease phenotypes and severity, including mild-to-moderate asthma coexisting with CRSwNP. Data from 3, 6, and 12 months follow-up were analyzed. Asthma (FEV1%, Tiffeneau%, ACT, FeNO, oral steroid use, exacerbation rate, and blood eosinophilia) and polyposis (SNOT22, VAS, NPS) outcomes showed a rapid (3 months) and sustained (6 and 12 months) significant change from baseline, despite most of the patients achieving oral steroid withdrawal. According to the sensitivity analysis, the improvement was not conditioned by either the presence of polyposis or severity of asthma at baseline. Of note, even in the case of milder asthma forms, a significant further improvement was recorded during dupilumab treatment course. Our report provides short-, medium-, and long-term follow-up data on asthma outcomes across different diseases phenotypes and severity, contributing to the real-world evidence related to dupilumab efficacy on upper and lower airways T2 inflammation.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Matteo Maule
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Roberto Benoni
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy;
| | - Diego Bagnasco
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Bianca Beghè
- AOU of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Fulvio Braido
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, 10137 Torino, Italy; (L.B.); (S.N.)
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Maria Giulia Candeliere
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department Translational Biomedicine and Neuroscience, University “Aldo Moro”, 70121 Bari, Italy;
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (S.D.G.)
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy;
- Respiratory Medicine Unit, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Mariella D’Amato
- Respiratory Department, Monaldi Hospital AO Dei Colli, Federico II University, 80131 Naples, Italy; (M.D.); (A.V.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (S.D.G.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy;
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Claudio Micheletto
- Pulmonology Unit, Verona Integrated University Hospital, 37126 Verona, Italy;
| | - Stefania Nicola
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, 10137 Torino, Italy; (L.B.); (S.N.)
| | - Bianca Olivieri
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Laura Pini
- Respiratory Medicine Unit, ASST—“Spedali Civili” of Brescia, 25123 Brescia, Italy;
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Rachele Vaia
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Andrea Vianello
- Respiratory Department, Monaldi Hospital AO Dei Colli, Federico II University, 80131 Naples, Italy; (M.D.); (A.V.)
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy; (D.V.); (A.S.)
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy; (D.V.); (A.S.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
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Yamaguchi M, Nishimura Y, Takumi Y, Hayashi N, Sakamoto K, Tohda Y. Real-World Safety and Effectiveness of Benralizumab in Japanese Patients with Severe Asthma: A Multicenter Prospective Observational Study. J Asthma Allergy 2024; 17:45-60. [PMID: 38268535 PMCID: PMC10807277 DOI: 10.2147/jaa.s432695] [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: 07/27/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction This study aimed to demonstrate whether benralizumab maintained the safety and effectiveness profiles established in randomized controlled trials among all patients with severe uncontrolled asthma initially prescribed benralizumab in the real-world setting in Japan. Methods This was a prospective, observational, multicenter post-marketing study (ClinicalTrial.gov, NCT03588546). The safety and tolerability of benralizumab over 1 year were assessed by the incidence of adverse events (AEs), serious AEs, adverse drug reactions (ADRs), and serious ADRs. Patient background characteristics indicating a more frequent onset of ADRs with benralizumab were explored. The main effectiveness assessment was the change in Asthma Control Questionnaire-5 (ACQ-5) score from baseline. Patients with baseline ACQ-5 scores ≥1.5 were defined as having severe uncontrolled asthma. Results In total, 632 patients were evaluated for safety and 274 for effectiveness; 139 patients were included in the severe uncontrolled asthma subgroup. ADRs were reported in 12.7% and serious AEs in 13.0% of patients. Serious infections occurred in 3.8%, serious hypersensitivity in 0.3%, and malignancy in 0.3% of patients. No helminthic infections occurred. In the effectiveness population, benralizumab improved the mean (standard deviation [95% confidence interval]) ACQ-5 score by -1.16 (1.40 [-1.36, -0.96]) from baseline; forced expiratory volume in 1 second by 0.151 (0.440 [0.09, 0.21]) L; and Mini-Asthma Quality of Life questionnaire score by 1.16 (1.29 [0.94, 1.38]) at the last observation. The annual asthma exacerbation rate was 0.42. A greater ACQ-5 score improvement was observed among patients with eosinophilic asthma characteristics. Conclusion No new safety concerns were raised, and patients experienced benefits consistent with previous studies of benralizumab, thus supporting the use of benralizumab for the add-on maintenance treatment of patients with eosinophilic severe uncontrolled asthma.
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Affiliation(s)
- Masao Yamaguchi
- Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | | | - Yuko Takumi
- Patient Safety Division, Research and Development, AstraZeneca K.K., Osaka, Japan
| | - Nobuya Hayashi
- Data Science and Innovation Division, Research and Development, AstraZeneca K.K., Osaka, Japan
| | - Kei Sakamoto
- Patient Safety Division, Research and Development, AstraZeneca K.K., Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan
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Rogers L, Jesenak M, Bjermer L, Hanania NA, Seys SF, Diamant Z. Biologics in severe asthma: A pragmatic approach for choosing the right treatment for the right patient. Respir Med 2023; 218:107414. [PMID: 37776915 DOI: 10.1016/j.rmed.2023.107414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
The development of monoclonal antibody therapies targeting specific components of the pathways relevant to asthma pathophysiology has revolutionized treatment of severe asthma both in adults and children and helped to further unravel the heterogeneity of this disease. However, the availability of multiple agents, often with overlapping eligibility criteria, creates a need for pragmatic guidance for specialists undertaking care of patients with severe asthma. In this review, we provide an overview of the data supporting the clinical efficacy of biologics in distinct asthma phenotypes/endotypes. We also focus on the role of biomarkers and treatable traits, including comorbidities, in the choice of asthma biologics, highlight which treatments have been demonstrated to be steroid sparing in corticosteroid dependent asthma, and provide practical guidance that can drive shared decision making on treatment choice with patients. In addition, we summarize what is known to date regarding long-term safety of these drugs, and lastly, discuss future directions in biologics research.
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Affiliation(s)
- Linda Rogers
- Mount Sinai National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Milos Jesenak
- Department of Pediatrics, Department of Pulmonology and Phthisiology, Department of Allergology and Clinical Immunology, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Nicola A Hanania
- Section of Pulmonary /Critical Care/Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Zuzana Diamant
- Department Clin Pharm & Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands; Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Belgium; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
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7
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Carstens D, Maselli DJ, Mu F, Cook EE, Yang D, Young JA, Betts KA, Genofre E, Chung Y. Real-World Effectiveness Study of Benralizumab for Severe Eosinophilic Asthma: ZEPHYR 2. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2150-2161.e4. [PMID: 37146880 DOI: 10.1016/j.jaip.2023.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Benralizumab is an mAb therapy for severe eosinophilic asthma. Real-world data on its clinical impact in various patient populations such as patients with varying eosinophil levels, previous biologic use, and extended follow-up in the United States are limited. OBJECTIVE To determine the effectiveness of benralizumab in different asthmatic patient cohorts and its long-term clinical impact. METHODS Patients with asthma treated with benralizumab from November 2017 to June 2019 with 2 or more exacerbations in the 12 months before benralizumab initiation (index) were included in this pre-post cohort study that used medical, laboratory, and pharmacy US insurance claims. Asthma exacerbation rates in the 12 months pre and post index were compared. Nonmutually exclusive patient cohorts were defined by blood eosinophil counts (<150, ≥150, 150-<300, <300, and ≥300 cells/μL), a switch from another biologic, or follow-up for 18 or 24 months post index. RESULTS There were 429 patients in the eosinophil cohort, 349 in the biologic-experienced cohort, and 419 in the extended follow-up cohort. In all eosinophil cohort subgroups, the asthma exacerbation rate decreased from 3.10-3.55 per patient-year (PPY) pre index to 1.11-1.72 PPY post index (52%-64% decrease; P < .001). Similar decreases were observed in patients switching from omalizumab (3.25 to 1.25 PPY [62%]) or mepolizumab (3.81 to 1.78 PPY [53%]) to benralizumab and those followed up for 18 months (3.38 to 1.18 PPY [65%]) or 24 months (3.38 to 1.08 PPY [68%]) (all P < .001). In the extended follow-up cohort, 39% and 49% had no exacerbations in the 0 to 12 months and the 12 to 24 months post index, respectively. CONCLUSIONS Benralizumab achieved significantly improved asthma control in real-world patients with different blood eosinophil counts, including eosinophil counts ranging from less than 150 to greater than or equal to 300 cells/μL, switching from other biologics, or treated for up to 24 months.
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Affiliation(s)
- Donna Carstens
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Del
| | - Diego J Maselli
- Division of Pulmonary Diseases & Critical Care, University of Texas Health, San Antonio, Tex
| | - Fan Mu
- Analysis Group, Boston, Mass
| | | | | | | | | | | | - Yen Chung
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Del.
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8
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Paçacı Çetin G, Kepil Özdemir S, Can Bostan Ö, Öztop N, Çelebi Sözener Z, Karakaya G, Gelincik Akkor A, Yılmaz İ, Mungan D, Bavbek S. [Biologics for the treatment of severe asthma: Current status report 2023]. Tuberk Toraks 2023; 71:176-187. [PMID: 37345400 PMCID: PMC10795269 DOI: 10.5578/tt.20239921] [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: 03/25/2023] [Accepted: 04/21/2023] [Indexed: 06/23/2023] Open
Abstract
Severe asthma is associated with increased use of healthcare services, significant deterioration in the quality of life, and high disease and economic burden on patients and societies. Additional treatments are required for severe forms of asthma. Biological agents are recommended for the treatment of severe asthma. In this current status report, we aimed to evaluate the efficacy, effectiveness, and safety data of approved biologics; omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab, in the treatment of severe asthma and appropriate patient profiles for these biologics. Pubmed and Cochrane databases based on randomized controlled trials, posthoc analyses, meta-analyses, and real-life studies examining the efficacy and effectiveness of biologics in severe asthma were searched, and the results of these studies on important asthma outcomes were reviewed. Existing studies have shown that all the approved biologic agents targeting cells, receptors, and mediators involved in type 2 inflammation in the bronchial wall in severe asthma significantly reduce asthma exacerbations, reduce the need for oral corticosteroids, and improve asthma control, quality of life, and pulmonary functions. Characterizing the asthma endotype and phenotype in patients with severe asthma and determining which treatment would be more appropriate for a particular patient is an essential step in personalized treatment.
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Affiliation(s)
- G. Paçacı Çetin
- Division of Immunology and Allergy, Department of Chest Diseases,
Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - S. Kepil Özdemir
- Division of Allergy and Immunology, Department of Chest Diseases,
University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery
Training and Research Hospital, İzmir, Türkiye
| | - Ö. Can Bostan
- Division of Immunology and Allergy, Department of Chest Diseases,
Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - N. Öztop
- Clinic of Adult Immunology and Allergy, Başakşehir Cam and
Sakura City Hospital, İstanbul, Türkiye
| | - Z. Çelebi Sözener
- Clinic of Immunology and Allergy, Ankara Bilkent City Hospital,
Ankara, Türkiye
| | - G. Karakaya
- Division of Immunology and Allergy, Department of Chest Diseases,
Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - A. Gelincik Akkor
- Division of Immunology and Allergic Diseases, Department of Internal
Medicine, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - İ. Yılmaz
- Division of Immunology and Allergy, Department of Chest Diseases,
Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - D. Mungan
- Division of Immunology and Allergy, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
| | - S. Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
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9
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Pelaia C, Benfante A, Busceti MT, Caiaffa MF, Campisi R, Carpagnano GE, Crimi N, D’Amato M, Foschino Barbaro MP, Maglio A, Minenna E, Nolasco S, Paglino G, Papia F, Pelaia G, Portacci A, Ricciardi L, Scichilone N, Scioscia G, Triggiani M, Valenti G, Vatrella A, Crimi C. Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Front Immunol 2023; 14:1121237. [PMID: 37063895 PMCID: PMC10098307 DOI: 10.3389/fimmu.2023.1121237] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundThe efficacy of dupilumab as biological treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) depends on its ability to inhibit the pathophysiologic mechanisms involved in type 2 inflammation.ObjectiveTo assess in a large sample of subjects with severe asthma, the therapeutic impact of dupilumab in real-life, with regard to positive or negative skin prick test (SPT) and CRSwNP presence or absence.MethodsClinical, functional, and laboratory parameters were measured at baseline and 24 weeks after the first dupilumab administration. Moreover, a comparative evaluation was carried out in relation to the presence or absence of SPT positivity and CRSwNP.ResultsAmong the 127 recruited patients with severe asthma, 90 had positive SPT, while 78 reported CRSwNP. Compared with the 6 months preceding the first dupilumab injection, asthma exacerbations decreased from 4.0 (2.0-5.0) to 0.0 (0.0-0.0) (p < 0.0001), as well as the daily prednisone intake fell from 12.50 mg (0.00-25.00) to 0.00 mg (0.00-0.00) (p < 0.0001). In the same period, asthma control test (ACT) score increased from 14 (10-18) to 22 (20-24) (p < 0.0001), and sino-nasal outcome test (SNOT-22) score dropped from 55.84 ± 20.32 to 19.76 ± 12.76 (p < 0.0001). Moreover, we observed relevant increases in forced expiratory volume in one second (FEV1) from the baseline value of 2.13 L (1.62-2.81) to 2.39 L (1.89-3.06) (p < 0.0001). Fractional exhaled nitric oxide (FeNO) values decreased from 27.0 ppb (18.0-37.5) to 13.0 ppb (5.0-20.0) (p < 0.0001). These improvements were quite similar in subgroups of patients characterized by SPT negativity or positivity, and CRSwNP absence or presence. No statistically significant correlations were detected between serum IgE levels, baseline blood eosinophils or FeNO levels and dupilumab-induced changes, with the exception of FEV1 increase, which was shown to be positively correlated with FeNO values (r = 0.3147; p < 0.01).ConclusionOur results consolidate the strategic position of dupilumab in its role as an excellent therapeutic option currently available within the context of modern biological treatments of severe asthma and CRSwNP, frequently driven by type 2 airway inflammation.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- *Correspondence: Corrado Pelaia,
| | - Alida Benfante
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Maria Teresa Busceti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | | | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria D’Amato
- Department of Respiratory Medicine, University “Federico II” of Naples, Naples, Italy
| | | | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena Minenna
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Paglino
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Andrea Portacci
- Department of Basic Medical Science, Neuroscience and Sense Organs, University “Aldo Moro”, Bari, Italy
| | - Luisa Ricciardi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nicola Scichilone
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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10
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Tiotiu A, Bikov A, Gonzalez-Barcala FJ, Novakova S, Novakova P, Chong-Neto H, Santus P, Ansotegui I, Ivancevich JC, Kowal K, Mihaicuta S, Nedeva D, Canonica GW, Bernstein JA, Boulet LP, Braido F. Criteria to evaluate efficacy of biologics in asthma: a Global Asthma Association survey. Expert Rev Respir Med 2023; 17:507-516. [PMID: 37313643 DOI: 10.1080/17476348.2023.2223986] [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: 02/22/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Currently, there are no universally accepted criteria to measure the response to biologics available as treatment for severe asthma. This survey aims to establish consensus criteria to use for the evaluation of response to biologics after 4 months of treatment. METHOD Using Delphi methodology, a questionnaire including 10 items was validated by 13 international experts in asthma. The electronic survey circulated within the Interasma Scientific Network platform. For each item, five answers were proposed graduated from 'no importance' to 'very high importance' and by a score (A = 2 points; B = 4 points; C = 6 points; D = 8 points; E = 10 points). The final criteria were selected if the median score for the item was ≥7 and > 60% of responses according 'high importance' and 'very high importance'. All selected criteria were validated by the experts. RESULTS Four criteria were identified: reduce daily systemic corticosteroids dose by ≥50%; decrease the number of asthma exacerbations requiring systemic corticosteroids by ≥50%; have no/minimal side effects; and obtain asthma control according validated questionnaires. The consensual decision was that ≥3 criteria define a good response to biologics. CONCLUSIONS Specific criteria were defined by an international panel of experts and could be used as tool in clinical practice.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France
- Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control Unit (EA 3450 DevAh), University of Lorraine, Nancy, France
| | - Andras Bikov
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Francisco-Javier Gonzalez-Barcala
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Spanish Biomedical Research Networking Centre-CIBERES, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Complexo Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, Milano, Italy
- Division of Respiratory Diseases, "L. Sacco" University Hospital, Milano, Italy
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | | | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine and Pharmacy, Timisoara, Romania
- Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Asthma and Allergology, UMBAL Alexandrovska, Medical University Sofia, Sofia, Bulgaria
| | - Gorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Asthma & Allergy Unit-IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | - Louis Philippe Boulet
- Department of Medicine, Québec Heart and Lung Institute-Laval University, Quebec, Canada
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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11
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Papaioannou AI, Fouka E, Bartziokas K, Kallieri M, Vontetsianos A, Porpodis K, Rovina N, Loukides S, Bakakos P. Defining response to therapy with biologics in severe asthma: from global evaluation to super response and remission. Expert Rev Respir Med 2023; 17:481-493. [PMID: 37318035 DOI: 10.1080/17476348.2023.2226392] [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: 03/05/2023] [Accepted: 06/13/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In recent years, monoclonal antibodies targeting Type-2 inflammatory pathways have been developed for severe asthma treatment. However, even when patients are carefully selected, the response to treatment varies. AREAS COVERED Different studies have evaluated response to therapy with biologics such as exacerbation reduction, symptom improvement, pulmonary function increase, improvement in QoL, or decrease of oral corticosteroids, showing that all patients do not respond to all disease aspects and leading to an extensive debate regarding the definition of response. EXPERT OPINION Assessing response to therapy is of great importance, but since there is no uniform definition of treatment response, the recognition of patients who really benefit from these therapies remains an unmet need. In the same context, identifying non-responding patients in which biologic therapy should be switched or substituted by alternative treatment options is of paramount importance. In this review, we present the road trip of the definition of therapeutic response to biologics in severe asthmatics by presenting the current relevant medical literature. We also present the suggested predictors of response, with an emphasis on the so-called super-responders. Finally, we discuss the recent insights regarding asthma remission as a feasible treatment goal and provide a simple algorithm for the evaluation of response.
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Affiliation(s)
- Andriana I Papaioannou
- 1st Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Evangelia Fouka
- Medical School, Department of Respiratory Medicine, General Hospital G. Papanikolaou, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Maria Kallieri
- Medical School, 2nd Respiratory Medicine Department, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Vontetsianos
- 1 Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Konstantinos Porpodis
- Medical School, Department of Respiratory Medicine, General Hospital G. Papanikolaou, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoletta Rovina
- 1 Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Stelios Loukides
- Medical School, 2 Respiratory Medicine Department, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Bakakos
- 1 Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, "Sotiria" Chest Hospital, Athens, Greece
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