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Kayser MZ, Suhling H, Fuge J, Hinze CA, Drick N, Kneidinger N, Behr J, Taube C, Welte T, Haasler I, Milger K. Long-term multicenter comparison shows equivalent efficacy of monoclonal antibodies in severe asthma therapy. BMC Pulm Med 2024; 24:149. [PMID: 38515071 PMCID: PMC10956233 DOI: 10.1186/s12890-024-02964-4] [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: 07/26/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Monoclonal antibodies (biologics) drastically changed severe asthma therapy. Mepolizumab (anti-interleukin (IL) 5), benralizumab (anti-IL5 receptor alpha), and dupilumab (anti-IL4/13) are the most used biologics in this context. While all biologics are efficient individually, the choice of biologic is complicated by insufficient data on their comparative long-term treatment efficacy. Here, we compare the real-life efficacy of these biologics in asthma therapy over 12 months. METHODS 280 severe asthma patients treated with mepolizumab (129/280, 46%), benralizumab (83/280, 30%) or dupilumab (68/280, 24%) for one year were analyzed retrospectively. Data were collected at baseline and after 6 and 12 months of therapy. Endpoints were changes pulmonary function (PF), exacerbation rate, oral corticosteroid (OCS) use and dose, asthma control test (ACT) score and fractional exhaled nitric oxide (FeNO) levels as well as responder status measured by the recently published "Biologic Asthma Response Score" (BARS). RESULTS All biologics led to significant improvements in PF, ACT and OCS dose. Only Mepolizumab and Benralizumab significantly decreased the exacerbation rate, while only Mepolizumab and Dupilumab significantly decreased FeNO. Responder rates measured by BARS were high across all groups: roughly half of all patients achieved full response and most of the remainder achieved at least partial responder status. Overall, outcomes were similar between groups after both 6 and 12 months. CONCLUSIONS All biologics showed great efficacy in individual parameters and high responder rates measured by BARS without a clinically relevant advantage for any antibody. Response was usually achieved after 6 months and retained at 12 months, emphasizing the utility of early response assessment.
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Affiliation(s)
- Moritz Z Kayser
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany.
| | - Hendrik Suhling
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany
| | - Jan Fuge
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Christopher A Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany
| | - Nora Drick
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Lower Saxony, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Ina Haasler
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU, Munich, Germany
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Abi Saleh W, Alameh Z, Aoun Bacha Z, Bahous J, Bou Khalil P, Chahine Z, Chami H, Dabar G, Dheiny H, Dib A, Farhat D, Irani C, Juvelekian G, Kanj N, Mansour B, Riachi M, Waked M, Yassine M, Youakim C, Zeinedine S, Zaitoun F. PRevalence of the Eosinophilic Phenotype Among SeveRE asthma patients in Lebanon: results of the PREPARE study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:80. [PMID: 37684679 PMCID: PMC10492315 DOI: 10.1186/s13223-023-00815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/14/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The prevalence of eosinophilic asthma in Lebanon, one of the most severe phenotypes among severe asthma, is not known. This study aimed at determining the prevalence of the eosinophilic phenotype defined as an eosinophil count ≥ 300 cells/mm3 among severe asthma patients in Lebanon. METHODS The Lebanese Chapter of the PREPARE study was a national, multicenter, cross-sectional observational study. Patients aged ≥ 12 years with severe asthma were identified and prospectively enrolled during clinic visits and completed the Global Initiative for Asthma (GINA) assessment of asthma control questionnaire. Patients' health characteristics were collected from medical records and blood samples were obtained for measurement of serum IgE levels and blood eosinophils count. RESULTS Overall, 101 patients (with mean age of 46.3 ± 17.0 years and 73.27% females) with severe asthma were included and, among them, 37% had eosinophilic phenotype, 67.3% had atopic phenotype with IgE > 100 IU/mL and 25.7% patients had overlapping atopic and eosinophilic phenotypes. Close to 80% had late-onset asthma, beyond 12 years of age, and around 85% had at least one severe exacerbation in the 12 months prior to study enrolment. The majority of participants [64.4%] had uncontrolled asthma, 24.7% had partially controlled symptoms and 10.9% had controlled symptoms. 19.8% of participants were on chronic oral corticosteroids, 78.2% had short course treatment of corticosteroids and all were prescribed a combination of inhaled corticosteroids and long-acting beta-agonist. CONCLUSIONS The majority of patients with severe asthma were uncontrolled of which 37% present with an eosinophilic phenotype, which should be taken into consideration for better management of these patients in view of the novel phenotype-specific therapeutic options.
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Affiliation(s)
- Wajdi Abi Saleh
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zuhair Alameh
- Pulmonology Practice, Private Practice, Beirut, Lebanon
| | - Zeina Aoun Bacha
- Department of Pulmonology and Critical Care, Hôtel-Dieu De France Medical Center (UMC), Saint-Joseph University (USJ), P.O. Box 2064-6613, Beirut, 1104 2020, Lebanon.
| | - Joudy Bahous
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zahia Chahine
- Department of Pneumology, NINI Hospital, Tripoli, Lebanon
| | - Hassan Chami
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Georges Dabar
- Department of Pulmonology and Critical Care, Hôtel-Dieu De France Medical Center (UMC), Saint-Joseph University (USJ), P.O. Box 2064-6613, Beirut, 1104 2020, Lebanon
| | - Hassan Dheiny
- Respiratory Diseases, Allergies and Sleep Medicine, Private Practice, Beirut, Lebanon
| | - Alfred Dib
- Department of Internal Medicine, Division of Pulmonology, Sacre-Coeur Hospital, Baabda, Lebanon
| | | | - Carla Irani
- Department of Internal Medicine & Clinical Immunology at Hôtel-Dieu de France, St Joseph University, Beirut, Lebanon
| | - Georges Juvelekian
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Nadim Kanj
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassam Mansour
- Department of Pulmonary and Critical Care Medicine, Zahraa Hospital, Beirut, Lebanon
| | - Moussa Riachi
- Department of Pulmonology and Critical Care, Hôtel-Dieu De France Medical Center (UMC), Saint-Joseph University (USJ), P.O. Box 2064-6613, Beirut, 1104 2020, Lebanon
| | - Mirna Waked
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Carole Youakim
- Department of Internal Medicine, Division of Pulmonary, Mount Lebanon Hospital Balamand University Medical Center, Beirut, Lebanon
| | - Salah Zeinedine
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Zaitoun
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Padró-Casas C, Basagaña M, Rivera-Ortún ML, García-Olivé I, Pollan-Guisasola C, Teniente-Serra A, Martínez-Cáceres E, Navarro JT, Abad-Capa J, Rosell A, Roger A, Martínez-Rivera C. Characterization and Factors Associated with Poor Asthma Control in Adults with Severe Eosinophilic Asthma. J Pers Med 2023; 13:1173. [PMID: 37511786 PMCID: PMC10381894 DOI: 10.3390/jpm13071173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
A study was conducted in 98 adult patients diagnosed with severe eosinophilic asthma (73.5% women, mean age 47.2 years) and followed prospectively for 1 year. The aim of the study was to characterize this population and to identify factors associated with poor prognosis at 1 year of follow-up. At the initial visit, uncontrolled severe asthma was diagnosed in 87.7% of patients. Allergic sensitization was observed in 81.7% (polysensitization in 17.3%), with clinically significant allergic asthma in 45%. The mean percentage of sputum eosinophils was 4.7% (standard deviation(SD) 6.3%) and the mean (SD) blood eosinophil count 467 (225) cells/µL. Almost half of the patients (48.3%) had sputum eosinophilia (>3% eosinophils). Sputum eosinophils correlated significantly with peripheral eosinophilia (p = 0.004) and, to a lesser extent, with fractional exhaled nitric oxide (FeNO) (p = 0.04). After 1 year, 48 patients (49%) had uncontrolled asthma in all visits, and 50 (51%) had controlled asthma in some visits. Airway obstruction (FEV1 < 80% predicted) was the main reason for uncontrolled asthma. In the multivariate analysis, an obstructive pattern (odds ratio (OR) 7.45, 95% confidence interval (CI) 2.41-23.03, p < 0.0001) and the patient's age (OR 1.045, 95% CI 1.005-1.086, p = 0.026) were independent predictors of poor asthma control. In adult-onset and long-standing asthma, serum interleukin (IL) IL-17 was higher in the uncontrolled asthma group. This study contributes to characterizing patients with severe eosinophilic asthma in real-world clinical practice.
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Affiliation(s)
- Clara Padró-Casas
- Severe Asthma Unit, Allergy Section, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - María Basagaña
- Severe Asthma Unit, Allergy Section, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - María Luisa Rivera-Ortún
- Severe Asthma Unit, Department of Pneumology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Ignasi García-Olivé
- Severe Asthma Unit, Department of Pneumology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Carlos Pollan-Guisasola
- Severe Asthma Unit, Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Aina Teniente-Serra
- Severe Asthma Unit, Immunology Department, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Eva Martínez-Cáceres
- Severe Asthma Unit, Head of the Immunology Department, Department of Cell Biology, Physiology and Immunology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Associate Professor of Immunology, Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - José-Tomás Navarro
- Department of Hematology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Jorge Abad-Capa
- Severe Asthma Unit, Department of Pneumology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Antoni Rosell
- Severe Asthma Unit, Department of Pneumology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Albert Roger
- Severe Asthma Unit, Allergy Section, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Carretera de Canyet s/n, E-08916 Badalona, Spain
| | - Carlos Martínez-Rivera
- Severe Asthma Unit, Department of Pneumology, Hospital Universitari Germans Trias i Pujol, The Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, E-08916 Badalona, Spain
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Solomon Y, Malkamu B, Berhan A, Eyayu T, Almaw A, Legese B, Woldu B. Peripheral blood eosinophilia in adult asthmatic patients and its association with the severity of asthma. BMC Pulm Med 2023; 23:96. [PMID: 36949398 PMCID: PMC10031890 DOI: 10.1186/s12890-023-02383-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Asthma is a diverse disease with various etiologic bases. Severe asthma can be associated with increased mortality, hospitalization, and decreased quality of life for asthma patients. High blood eosinophil counts were associated with severe asthma, but recent studies have failed to confirm this as a marker of severe asthma among adult asthma patients. As a result, the purpose of this study was to determine the association between the severity of asthma and high blood eosinophil count. METHODOLOGY A simple random sampling technique was used to select 291 asthmatic patients for an institution-based cross-sectional study. Socio-demographic, behavioral, and clinical characteristics were collected by using a pre-tested structured questionnaire. Four milliliters of venous blood were collected from asthmatic patients for complete blood count and peripheral morphology assessment. The eosinophil count was analyzed by the Unicel DxH 800 (Beckman Coulter, Ireland) analyzer. A statistical package for social science version 20 (SPSS) software was used to analyze the data. The non-parametric (Mann-Whitney U) test was used to compare the eosinophil count with different background variables. A binary logistic regression analysis was used to assess the factors associated with eosinophilia. A p-value less than 0.05 in multivariable logistic regression analysis was considered statistically significant. RESULT In this study, the overall magnitude of eosinophilia was 19.6% (95% CI = 14.8-24.1). Being admitted to the emergency department (AOR = 0.25; 95% CI: 0.09-0.69, p = 0.007) and being female (AOR = 0.49; 95% CI: 0.26-0.9, p = 0.025) were shown to have a statistically significant association with eosinophilia. Moreover, the absolute eosinophil count was significantly higher among asthmatic patients infected with intestinal parasitic infection (p < 0.045). CONCLUSION Being female and admission to the emergency department were negatively associated with eosinophilia. Lack of eosinophilia can be related to the low-T2 asthma phenotype. The absolute eosinophil counts were higher among intestinal parasite-infected patients. Therefore, different biomarkers will be considered for the proper diagnosis and management of adult asthma patients.
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Affiliation(s)
- Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia.
| | - Birhanemaskal Malkamu
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Ayenew Berhan
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Andargachew Almaw
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Biruk Legese
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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Ko FWS, Wang JKL, Hui DSC, Chan JWM, Cheung PS, Yeung YC, Sin KM, Ip MSM. A Multi-Center Study of the Prevalence and Characteristics of Eosinophilic Phenotype and High IgE Levels Among Chinese Patients with Severe Asthma. J Asthma Allergy 2023; 16:173-182. [PMID: 36721738 PMCID: PMC9884446 DOI: 10.2147/jaa.s391970] [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: 10/02/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023] Open
Abstract
Background Patients with severe asthma have higher total- and asthma-related health burden than those whose disease is not severe. Recent medical advances in biologic therapies allow better control of asthma characterized by type 2 inflammation. Objective To study the prevalence of eosinophilic phenotype and IgE levels in Chinese with severe asthma, and the relationship of these type 2 characteristics with asthma control, exacerbations and lung function. Methods This was a multicenter cross-sectional observational study in Hong Kong, in Chinese adults with asthma on Step 4 or 5 of GINA treatment. Their blood eosinophil counts and total IgE levels were measured, and the relationship of these phenotypic parameters to the number of exacerbations in the past 12 months, and to symptom control in the past 4 weeks, were investigated. Results A total of 232 subjects were recruited from 6 centers. The mean age was 53.9±12.9 years, with 86 (37.1%) male, and the duration of diagnosed asthma was 26.2±15.7 years. A T-helper 2 (Th2) phenotype indicated by elevated eosinophils and/or IgE was present in 169 (72.8%) of patients. Of 232 patients, 43% had an eosinophilic phenotype (blood eosinophil count ≥300 cell/mm3), while 59% had high total IgE levels of >100 IU/mL (overlap with eosinophilic phenotype in 30%) and 44% had IgE levels of >150 IU/mL (overlap with eosinophilic phenotype in 22%). Subjects with eosinophilic phenotype and IgE >150 IU/mL had a higher rate (1.8 times) of uncontrolled asthma compared with those without such a combination. Conclusion In Chinese adults with severe asthma defined by the use of conventional maintenance medication regimens, the prevalence of Th2 inflammation is comparable to that reported from other ethnic populations. Those with both eosinophil count ≥300 cell/mm3 and high IgE levels >150 IU/mL had a higher rate of uncontrolled asthma compared with those without a combination of these features.
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Affiliation(s)
- Fanny Wai-San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Julie K L Wang
- Department of Medicine, Queen Mary Hospital, Hong Kong, People’s Republic of China
| | - David S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Johnny W M Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, People’s Republic of China
| | - Pik-Shan Cheung
- Department of Medicine, United Christian Hospital, Hong Kong, People’s Republic of China
| | - Yiu-Cheong Yeung
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People’s Republic of China
| | - Kit Man Sin
- Department of Medicine, Tuen Mun Hospital, Hong Kong, People’s Republic of China
| | - Mary Sau-Man Ip
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, People’s Republic of China,Correspondence: Mary Sau-Man Ip, Division of Respiratory Medicine, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, 4/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, People’s Republic of China, Email
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Hamada Y, Nakatani E, Nagahama T, Nagai K, Nagayama K, Tomita Y, Sekiya K, Taniguchi M, Fukutomi Y. Identification of asthma cases in Japan using health insurance claims data: Positive and negative predictive values of proposed discrimination criteria: A single-center study. Allergol Int 2023; 72:75-81. [PMID: 35965192 DOI: 10.1016/j.alit.2022.07.001] [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: 03/11/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Asthma cases have been increasingly investigated using claims data. However, the validity of defining asthma cases using health insurance claims in Japan is unclear. This study aims to assess the positive and negative predictive values of our proposed discrimination criteria for asthma. METHODS We developed discrimination criteria for asthma based on both the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 disease codes for asthma and health insurance claims data for prescriptions and the treatment of asthma. Inclusion criteria were patients aged ≥16 years with at least one health insurance claim from April 2018 to March 2019 in all departments of our hospital. Physician-diagnosed asthma documented in the charts was used as the reference standard. Positive and negative predictive values of the discrimination criteria for physician-diagnosed asthma were estimated and compared with those estimated from discrimination criteria based solely on ICD-10 codes. RESULTS The new discrimination criteria had a high positive predictive value (PPV) of 86.0%, which was significantly higher than the PPV for the criteria defined solely by the ICD-10 codes (61.5%) (P < 0.01). The negative predictive values for both criteria were 100%. Allergic rhinitis and chronic cough were frequently misclassified as asthma using the discrimination criteria based solely on ICD-10 codes but were more likely to be appropriately classified using our proposed criteria. CONCLUSIONS Our proposed criteria adequately identified asthma subjects using health insurance claims data in Japan with a high PPV. Further studies are needed for external validation of these criteria.
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Affiliation(s)
- Yuto Hamada
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | | | | | - Kisako Nagayama
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yasuhiro Tomita
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
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Solomon Y, Woldu B, Mesfin N, Enawgaw B. Selected hematological abnormalities and their associated factors among asthmatic patients in Northwest Ethiopia: a cross-sectional study. BMC Pulm Med 2022; 22:228. [PMID: 35698065 PMCID: PMC9190135 DOI: 10.1186/s12890-022-02020-z] [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: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Asthma is a chronic inflammatory disease that affects the lungs. Variation in whole blood cell lines is caused by the progression and severity of asthma. Common hematological abnormalities encountered during asthma include eosinophilia, neutrophilia, leukocytosis, and increased erythrocyte sedimentation rate. The main aim of this study was to assess the selected hematological abnormalities and their associated factors among asthmatic patients in Northwest Ethiopia from March to May 2021. Methodology A hospital-based cross-sectional study was conducted on a total of 320 asthmatic patients in Northwest Ethiopia. A simple random sampling technique was employed to select study participants. A pre-tested structured questionnaire and a checklist were used to collect data. Blood samples were collected from asthmatic patients for complete blood count and erythrocyte sedimentation rate determination. Hematological profiles were analyzed by Unicel DxH 800 (Beckman Coulter, Ireland). The erythrocyte sedimentation rate was determined by using the Westergren method. The data were entered into EpiData version 3.0.4 and analyzed with a statistical package for social science version 20 software. The bi-variable and multi-variable binary logistic regression models were used to assess the factors associated with hematological abnormalities. A p value of less than 0.05 in the multivariable logistic regression analysis was considered statistically significant. Results The overall prevalence of neutrophilia, eosinophilia, thrombocytopenia, leukocytosis, and basophilia was 35.3%, 20%, 11.9%, 10.3%, and 4.1%, respectively. Neutrophilia was associated with a lack of physical activity (AOR = 3.25; 95% CI 1.43–7.37) and a history of taking non-asthmatic drugs within the previous three months (AOR = 2.63; 95% CI 1.22–5.65). Being admitted to the emergency department (AOR = 0.27; 95% CI 0.11–5.67) was found to be associated with eosinophilia. In addition, being admitted to the emergency department (AOR = 5.44; 95%CI: 2.6–11.3) was associated with thrombocytopenia. Conclusion The current study demonstrated the predominant prevalence of neutrophilia, followed by eosinophilia, among asthma patients. Therefore, hematological abnormalities should be taken into account for proper monitoring and management of asthmatic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02020-z.
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Affiliation(s)
- Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mesfin
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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Chung Y, Katial R, Mu F, Cook EE, Young J, Yang D, Betts KA, Carstens DD. Real-world effectiveness of benralizumab: Results from the ZEPHYR 1 Study. Ann Allergy Asthma Immunol 2022; 128:669-676.e6. [PMID: 35247595 DOI: 10.1016/j.anai.2022.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Real-world evidence characterizing the clinical outcomes and economic impact on patients with severe eosinophilic asthma treated with benralizumab is limited. OBJECTIVE To characterize patients with severe asthma treated with benralizumab and assess its clinical and economic impact in the United States. METHODS A pre-post benralizumab comparison was performed using a large US insurance claims database between November 2016 and November 2019. The primary cohort included patients with asthma aged 12 years or more with 2 or more records of benralizumab. Secondary cohorts included persistent users (6 or more records of benralizumab), patients switching to benralizumab from mepolizumab or omalizumab, and stratified by Medicaid vs non-Medicaid. Exacerbations, concomitant medications, and exacerbation-related health care resource utilization (HCRU) and costs were compared in the 12-month periods pre- and post-benralizumab initiation (index). RESULTS Of the 204 patients in the primary cohort, mean age at index was 45.3 years and 68.6% were of female sex. The patients experienced a significant 55% reduction in rates of exacerbations post-benralizumab initiation (3.25 pre-index vs 1.47 post-index per person-year; P < .001), and 41% of the patients had no exacerbations post-benralizumab initiation. The proportion of oral corticosteroid-dependent patients decreased from 82% to 50% (P < .001). Reductions in HCRU were 42%, 46%, and 57% for asthma exacerbation-related inpatient hospitalizations, emergency department, and outpatient visits, respectively (all P < .001). Exacerbation-related costs decreased by $6439 ($13,559 vs $7120; P < .001). Similar results for all outcomes were observed for the persistent cohort, switch cohorts, and Medicaid vs non-Medicaid cohorts. CONCLUSION Patients with severe asthma treated with benralizumab experienced clinical and economic benefits in the real world, as demonstrated by the reduction in exacerbations and HCRU.
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Affiliation(s)
| | | | - Fan Mu
- Analysis Group, Inc., Boston, Massachusetts.
| | | | | | - Danni Yang
- Analysis Group, Inc., Boston, Massachusetts
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9
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Al-Jahdali H, Wali S, Albanna AS, Allehebi R, Al-Matar H, Fattouh M, Beekman M. Prevalence of eosinophilic, atopic, and overlap phenotypes among patients with severe asthma in Saudi Arabia: a cross-sectional study. BMC Pulm Med 2022; 22:67. [PMID: 35177038 PMCID: PMC8855582 DOI: 10.1186/s12890-022-01856-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background Eosinophilia is a significant factor in asthma severity; however, the prevalence of severe eosinophilic asthma in Saudi Arabia is largely unknown. We aimed to determine the prevalence of the eosinophilic (defined in this study as ≥ 300 cells/mm3 in blood), atopic (atopic phenotype 1, defined in this study as > 100 IU/mL total serum IgE; atopic phenotype 2, defined in this study as > 150 IU/mL), and overlap phenotypes among patients with severe asthma in Saudi Arabia.
Methods A cross-sectional study was conducted in centers specialized in severe asthma management. Patients aged ≥ 12 years with severe asthma were enrolled. Study patients responded to the Global Initiative for Asthma 2018 assessment of asthma control questionnaire and provided study investigators with current information related to the study objectives. Additional medical record data and a blood sample for total serum IgE and complete blood count were collected. Results A total of 101 patients were enrolled; 83% were female and the mean (standard deviation) age was 48.7 (13.2) years. Forty-five (45%) patients had the eosinophilic phenotype, 50 (50%) had atopic phenotype 1, and 25 (25%) had phenotypic overlap (eosinophilic and atopic 1). Forty-one (41%) patients had atopic phenotype 2 and 23 (23%) had phenotypic overlap (eosinophilic and atopic 2). Asthma control and oral corticosteroid use patterns were similar and there were no significant differences in number of asthma exacerbations across phenotypes. Conclusions In Saudi Arabia, 45% of patients with severe asthma had the eosinophilic phenotype, which is most likely an underestimation as no clinical features of eosinophilia were taken into account in the definition of eosinophilia. Approximately half of them had phenotypic overlap with the atopic phenotype. Trial registration NCT03931954; ClinicalTrials.gov, April 30, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01856-9.
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Affiliation(s)
- Hamdan Al-Jahdali
- Department of Medicine - Pulmonary Division, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Siraj Wali
- Department of Medicine - Pulmonary Division, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr S Albanna
- Department of Medicine - Pulmonary Division, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Riyad Allehebi
- Department of Medicine - Pulmonary Division, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hussein Al-Matar
- Department of Medicine, Imam Abdulrahman Al Faisal Hospital, Dammam, Saudi Arabia
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10
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Czira A, Turner M, Martin A, Hinds D, Birch H, Gardiner F, Zhang S. A systematic literature review of burden of illness in adults with uncontrolled moderate/severe asthma. Respir Med 2021; 191:106670. [PMID: 34883444 DOI: 10.1016/j.rmed.2021.106670] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited published data on the burden of moderate/severe uncontrolled asthma. METHODS We conducted a systematic literature review to better understand the impact of moderate-to-severe asthma in the US, the UK, Germany, France, Italy, Spain, Canada, Japan, and Australia in terms of prevalence, clinical measures, health-related quality of life (HRQoL) and economic burden, for patients whose asthma is uncontrolled despite inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. RESULTS The prevalence of uncontrolled asthma among patients with moderate/severe disease varied but was as high as 100% in some subgroups. Patients with uncontrolled asthma generally had poor lung function (mean/median pre-bronchodilator forced expiratory volume in 1 second [FEV1]: 1.69-2.45 L; mean/median pre-bronchodilator percent predicted FEV1: 57.2-79.7). There was also a substantial but variable exacerbation burden associated with uncontrolled asthma, with the annualised rate of exacerbations ranging from 1.30 to 7.30 when considering various patient subgroups. Furthermore, the annualised rate of severe exacerbations ranged from 1.66 to 3.60. The HRQoL burden measured using disease-specific and generic instruments consistently demonstrated substantial impairment of HRQoL for those with uncontrolled asthma; Asthma Quality of Life Questionnaire scores ranged from 3.00 to 5.20, whilst EurQol-5 Dimensions index scores ranged from 0.53 to 0.59. Direct, indirect and total costs together with consumption of other healthcare resources associated with managing uncontrolled asthma were also substantial in the population studied; no caregiver burden was identified. CONCLUSIONS Our findings suggest that significant unmet needs exist for patients with uncontrolled asthma despite the availability of ICS/LABA therapy. Novel treatments are needed to help reduce the burden to patients, healthcare systems and society.
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Affiliation(s)
| | - Monica Turner
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - Amber Martin
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - David Hinds
- GSK, R&D Global Medical, Collegeville, PA, United States.
| | - Helen Birch
- GSK, R&D Global Medical, Brentford, Middlesex, UK.
| | | | - Shiyuan Zhang
- GSK, R&D Global Medical, Collegeville, PA, United States.
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11
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Kayser MZ, Drick N, Milger K, Fuge J, Kneidinger N, Korn S, Buhl R, Behr J, Welte T, Suhling H. Real-World Multicenter Experience with Mepolizumab and Benralizumab in the Treatment of Uncontrolled Severe Eosinophilic Asthma Over 12 Months. J Asthma Allergy 2021; 14:863-871. [PMID: 34285513 PMCID: PMC8285237 DOI: 10.2147/jaa.s319572] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Treatment of severe eosinophilic asthma (SEA) has been revolutionized by the development of monoclonal antibodies targeting underlying immunological pathways of eosinophilic asthma. Two of the most frequently used antibodies in clinical practice are mepolizumab, targeting interleukin (IL) 5 and benralizumab, targeting the IL5 receptor alpha. The comparative treatment efficacy of these antibodies remains unclear, particularly regarding long-term outcomes. Patients and Methods In this multicenter, retrospective study, we included 123 patients treated with mepolizumab and 64 patients treated with benralizumab for 12 months at one of three study sites in Germany. Data were collected at baseline and after 6 and 12 months of therapy. Endpoints were changes in pulmonary function (PF), exacerbation rate, oral corticosteroid (OCS) use and dose, asthma control test (ACT) score and fractional exhaled nitric oxide (FeNO) levels. Results Both mepolizumab and benralizumab led to significant improvements in PF with an increase in median forced expiratory volume (FEV1) after 12 months from 59% to 74% for mepolizumab and 63% to 72% for benralizumab. Treatment also led to significant improvements in ACT scores after 12 months (mepolizumab: 13 [interquartile range (IQR) 9-17] to 19 [IQR 15-23]; benralizumab: 12 [IQR 9-16] to 22 [IQR 16-25]) as well as a reduction of mean OCS dose (mepolizumab 8 mg [IQR 5-12.5 mg] median prednisolone equivalent at baseline to 5 mg [IQR 3-7.5 mg]; benralizumab 7.5 mg [IQR 5-15 mg] to 5 mg [IQR 2-10 mg]). The exacerbation rates were reduced significantly, irrespective of the treatment. Overall, changes were similar after 6 and 12 months of therapy. Conclusion Both mepolizumab and benralizumab are highly effective in the long-term treatment of SEA, with no clinically relevant differences in outcomes after 12 months of therapy. In both groups, improvements were similar after 6 and 12 months of therapy, underlining the feasibility of early treatment evaluation.
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Affiliation(s)
- Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU, Munich, Germany.,Comprehensive Pneumology Center-Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU, Munich, Germany.,Comprehensive Pneumology Center-Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stephanie Korn
- Clinical Research Centre for Respiratory Medicine, Mainz, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU, Munich, Germany.,Comprehensive Pneumology Center-Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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12
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Mallah N, Rodriguez-Segade S, Gonzalez-Barcala FJ, Takkouche B. Blood eosinophil count as predictor of asthma exacerbation. A meta-analysis. Pediatr Allergy Immunol 2021; 32:465-478. [PMID: 33135257 DOI: 10.1111/pai.13403] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence about the association of high blood eosinophil count with asthma exacerbation is inconsistent and unclear. The objective of this meta-analysis was to determine whether elevated blood eosinophil count predicts asthma exacerbation. METHODS We searched MEDLINE, EMBASE, and additional databases, without any language restriction. We also checked the reference lists of the included studies and of relevant systematic reviews. The main outcome was the occurrence of asthma exacerbation. We calculated global pooled odds ratios (ORs) and their 95% confidence intervals (CIs) and performed predefined subgroup analyses. We appraised the quality of the studies using Newcastle-Ottawa Scale, examined the heterogeneity between studies, assessed publication bias, and carried out sensitivity analyses. RESULTS Among 1567 retrieved publications, 23 observational studies comprising 155,772 participants met the inclusion criteria. High blood eosinophil count was associated with higher odds of asthma exacerbation [OR: 1.31 (95% CI: 1.16, 1.49)], specifically with asthma-related outpatient visits [OR: 1.46 (95% CI: 1.25, 1.70)] and emergency department visits [OR: 1.63 (95% CI: 1.29, 2.07)]. A significant association was observed starting from an eosinophils' cutoff value of 200 cells/μl. The association was observed for cohort studies [OR: 1.30 (95%CI: 1.13, 1.49)], North American studies [OR: 1.43 (95%CI: 1.31, 1.57)], Asian populations [OR: 1.67 (95%CI: 1.34, 2.08)], children [OR: 1.38 (95%CI: 1.22, 1.56)], and studies that adjusted for inhaled corticosteroids therapy [OR: 1.42 (95%CI: 1.28, 1.56)]. CONCLUSIONS Blood eosinophil counts ≥ 200 cells/µL are associated with asthma exacerbation. Blood eosinophil count is a modifiable factor that could be addressed in asthma management strategies.
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Affiliation(s)
- Narmeen Mallah
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Carlos III Health Research Institute, Madrid, Spain
| | - Santiago Rodriguez-Segade
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - Francisco-Javier Gonzalez-Barcala
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela (CHUS), Santiago de Compostela, Spain.,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Spanish Biomedical Research Networking Centre (CIBER-ES), Carlos III Health Research Institute, Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Carlos III Health Research Institute, Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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13
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Chan R, RuiWen Kuo C, Lipworth B. Pragmatic Clinical Perspective on Biologics for Severe Refractory Type 2 Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3363-3370. [PMID: 32673880 DOI: 10.1016/j.jaip.2020.06.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 06/28/2020] [Indexed: 12/18/2022]
Abstract
Patients with severe refractory asthma present a challenging clinical conundrum for practicing clinicians. Biologics that target key mediators in the type 2 inflammation cascade, including IL-4, IL-5, IL-13, and IgE, can be effective strategies for these patients. However, with various biologics available, choosing the optimal one for a particular patient becomes a nuanced decision. We propose a pragmatic algorithm that identifies the optimal biologic class for patients who have specific type 2 disease endotypes. Patients with eosinophilic endotypes fare well with anti-IL-5(rα) medications, comprising mepolizumab, benralizumab, and reslizumab because they have been shown to reduce exacerbations in severe eosinophilic asthma by approximately 50%. In patients with fractional exhaled nitric oxide-high endotypes, anti-IL-4rα such as dupilumab is deemed to be most effective and has demonstrated a 47% reduction in asthma exacerbations. For patients with severe uncontrolled allergic asthma, anti-IgE (omalizumab) is effective and has been shown to confer a 25% reduction in asthma exacerbations. Type 2 comorbidities including chronic rhinosinusitis with nasal polyps, atopic dermatitis, chronic idiopathic urticaria, and eosinophilic esophagitis are important to bear in mind before the prescription of biologics. Further head-to-head studies are indicated to compare biologics in patients with mixed endotypes according to peripheral blood eosinophils, fractional exhaled nitric oxide, and allergic status. The evidence strongly supports endotype-driven prescribing of biologics to achieve clinically relevant outcomes in severe refractory asthma and related comorbidities.
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Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom.
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Sato K, Ishii T, Kaise T. Burden of Asthma in Elderly Japanese Patients: Using Hospital-Based Administrative Claims Data. Pulm Ther 2020; 6:247-260. [PMID: 32504384 PMCID: PMC7672137 DOI: 10.1007/s41030-020-00121-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Data are lacking on severe asthma burden in elderly people in Japan. We assessed the prevalence and clinical/economic burden of severe asthma and asthma-related hospitalizations in elderly and younger Japanese patients. METHODS This retrospective study analyzed outpatient claims data and inpatient hospital discharge records among patients aged ≥ 15 years with asthma (defined as ≥ 2 prescriptions of inhaled corticosteroids [ICS] or ICS/long-acting beta-agonists [LABA]) between 1 July 2014 and 30 June 2017. We analyzed the outpatient visit assessment population with severe asthma (≥ 240-day prescription of high-dose ICS and ≥ 90-day prescription of ≥ 1 additional controllers) and the asthma-related hospitalization population (≥ 1 hospital admission[S] with a primary diagnosis of asthma/status asthmaticus and use of systemic corticosteroids) over a 1-year observation period before the date of each patient's latest asthma prescription or asthma-related hospitalization within the study period. The primary outcome was the proportion of elderly (≥ 65 years) and younger (15-39 and 40-64 years) patients among the outpatient visit assessment population. Secondary outcomes included outpatient and inpatient characteristics, asthma-related healthcare resource utilization, and asthma-associated costs, by age group. RESULTS Of the outpatient visit assessment population (n = 35,742), 4211 had severe asthma, with the prevalence of 8.2%, 12.8%, and 12.4% for the 15-39, 40-64, and ≥ 65 years age groups, respectively. Elderly versus younger outpatients with severe asthma had higher cumulative oral corticosteroid doses. Among both outpatient visit assessment population and hospitalization assessment population, elderly versus younger outpatients with severe asthma or asthma-related hospitalizations had more comorbidities, required more biological, hematological, immunological, and microbiological tests, and incurred higher asthma-associated costs. CONCLUSIONS In addition to reaffirming the higher prevalence of severe asthma in Japanese patients ≥ 40 years versus those < 40 years of age, our results demonstrated higher clinical and economic burden in elderly versus younger patients.
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Affiliation(s)
- Keiko Sato
- Value Evidence Outcomes, Japan Development Division, GSK K.K., Tokyo, Japan.
| | - Takeo Ishii
- Japan Respiratory Medical Affairs, Development and Medical Affairs, GSK K.K., Tokyo, Japan
| | - Toshihiko Kaise
- Value Evidence Outcomes, Japan Development Division, GSK K.K., Tokyo, Japan
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15
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Factors affecting the hospitalization of female patients with asthma. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.616836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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