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Patadia R, Casale TB, Fowler J, Patel S, Cardet JC. Advancements in biologic therapy in eosinophilic asthma. Expert Opin Biol Ther 2024; 24:251-261. [PMID: 38619468 DOI: 10.1080/14712598.2024.2342527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Asthma encompasses a spectrum of phenotypes often categorized into two groups- type 2 high (T2 high) and type 2 low (T2 low). T2 high includes atopic and eosinophilic presentations whereas T2 low is non-atopic, non-eosinophilic, and oft associated with neutrophilic inflammation. Eosinophilic asthma is often driven by IgE, IL-4, IL-5, and IL-13 and TSLP. This can lead to eosinophilic inflammatory response in the airways which in turn can be used as target for treatment. AREAS COVERED The article will focus on biologic therapy that is currently being used in eosinophilic asthma management in mainly the adult population including clinical trials and co-morbidities that can be treated using the same biologics. A review on asthma biologics for pediatric population has been reviewed elsewhere. EXPERT OPINION Biological therapy for asthma targeting the IgE, IL-4, IL-5, IL-13, and TSLP pathways are shown to have benefit for the treatment of eosinophilic asthma, as exemplified in real-world studies. When choosing the right biological agent factors such as phenotype, comorbidities, and cost-effectiveness of the biologic agent must be taken into consideration.
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Affiliation(s)
- Rini Patadia
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine, The James A. Haley Veterans' Affairs Hospital, Tampa, FL, USA
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine, The James A. Haley Veterans' Affairs Hospital, Tampa, FL, USA
| | - John Fowler
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Shiven Patel
- Department of Internal Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine, The James A. Haley Veterans' Affairs Hospital, Tampa, FL, USA
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Naharro-González S, Lorente-Sorolla C, Rodrigo-Muñoz JM, Valverde-Monge M, Pinillos-Robles EJ, Betancor D, Fernández-Nieto M, Sánchez-Mellado D, Gil-Martínez M, Santillán-Coello JM, Villacampa-Aubá JM, Mahillo-Fernandez I, Herrero-González A, Perez-González A, Rodríguez-Nieto MJ, del Pozo V. Moderate-High Blood Eosinophilia Is Associated with Increased Hospitalization and Other Asthma Comorbidities. Biomolecules 2024; 14:126. [PMID: 38254726 PMCID: PMC10813157 DOI: 10.3390/biom14010126] [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: 11/20/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Eosinophilia has traditionally been linked to eosinophilic asthma, for which it is the gold-standard prognostic biomarker. However, the association between eosinophilia and the presence of other diseases and comorbidities is yet unclear. (2) Methods: For this retrospective study, we reviewed the electronic medical records of 49,909 subjects with blood eosinophilia to gather data on the presence of asthma, COPD, sleep apnea, tuberculosis, dyslipidemia, hypertension, and other cardiovascular diseases and severe CRSwNP among these subjects. Demographic features including age, sex, and smoking habits were collected, as well as the number of hospitalizations and emergency department visits. T-tests, ANOVA, Fisher test, and logistic regression models were used. (3) Results: For all age groups studied, eosinophilia was significantly more prevalent among asthmatic subjects than nonasthmatics, especially in patients also presenting CRSwNP, hypertension, and dyslipidemia. The likelihood of developing asthma, COPD, and CRSwNP, and hospitalization, was increased when BEC was above 600 eosinophils/μL. The association between asthma, CRSwNP, and BEC was corroborated by multiple logistic regressions models. (4) Conclusions: We demonstrated the association of having over 600 blood eosinophils/μL with a higher number of hospitalizations and comorbidities (CRSwNP and COPD), which proves that BEC is a highly useful parameter to consider in subjects who present blood eosinophilia.
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Affiliation(s)
- Sara Naharro-González
- Immunoallergy Laboratory, Immunology Department, Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), 28040 Madrid, Spain; (S.N.-G.); (C.L.-S.); (J.M.R.-M.); (M.G.-M.)
| | - Clara Lorente-Sorolla
- Immunoallergy Laboratory, Immunology Department, Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), 28040 Madrid, Spain; (S.N.-G.); (C.L.-S.); (J.M.R.-M.); (M.G.-M.)
| | - José Manuel Rodrigo-Muñoz
- Immunoallergy Laboratory, Immunology Department, Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), 28040 Madrid, Spain; (S.N.-G.); (C.L.-S.); (J.M.R.-M.); (M.G.-M.)
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.V.-M.); (D.B.)
| | - Marcela Valverde-Monge
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.V.-M.); (D.B.)
- Allergy Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain;
| | - Erwin Javier Pinillos-Robles
- Pulmonology Unit, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (E.J.P.-R.); (D.S.-M.); (M.J.R.-N.)
| | - Diana Betancor
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.V.-M.); (D.B.)
- Allergy Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain;
| | - Mar Fernández-Nieto
- Allergy Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain;
| | - Diana Sánchez-Mellado
- Pulmonology Unit, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (E.J.P.-R.); (D.S.-M.); (M.J.R.-N.)
| | - Marta Gil-Martínez
- Immunoallergy Laboratory, Immunology Department, Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), 28040 Madrid, Spain; (S.N.-G.); (C.L.-S.); (J.M.R.-M.); (M.G.-M.)
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.V.-M.); (D.B.)
| | - Jessica Mireya Santillán-Coello
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (J.M.S.-C.); (J.M.V.-A.)
| | - José Miguel Villacampa-Aubá
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (J.M.S.-C.); (J.M.V.-A.)
| | | | - Antonio Herrero-González
- Data Analysis Department, I Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (A.H.-G.); (A.P.-G.)
| | - Alejandro Perez-González
- Data Analysis Department, I Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (A.H.-G.); (A.P.-G.)
| | - María Jesús Rodríguez-Nieto
- Pulmonology Unit, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (E.J.P.-R.); (D.S.-M.); (M.J.R.-N.)
- Villalba General University Hospital, 28400 Madrid, Spain
| | - Victoria del Pozo
- Immunoallergy Laboratory, Immunology Department, Fundación Jimenez Díaz Health Research Institute (IIS-FJD, UAM), 28040 Madrid, Spain; (S.N.-G.); (C.L.-S.); (J.M.R.-M.); (M.G.-M.)
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.V.-M.); (D.B.)
- Department of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain
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Al Meslamani AZ. Decoding treatment efficacy: uncovering response and failure dynamics to biologics in asthma. Expert Opin Biol Ther 2024; 24:25-29. [PMID: 38174421 DOI: 10.1080/14712598.2024.2302583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Asthma is a global health problem, with alarming prevalence and mortality rates. Biologic therapies, particularly monoclonal antibodies such as omalizumab, have emerged as promising alternatives, targeting specific immune pathways. This article assesses the efficacy of these biologics in asthma management and attempts to reveal factors associated with their response and failure dynamics. AREA COVERED This article explores the efficacy of biologics in asthma, biomarkers, and the relationship between asthma phenotypes (including eosinophilic and non-eosinophilic (neutrophilic) types) and biologic treatments; particularly their effectiveness for each subtype. EXPERT OPINION Personalized asthma management that incorporates molecular insights as well as individual variations is of outmost necessity. An emphasis is put on immunological profiling, understanding comorbidities and considering individual patient factors when managing asthma. Cutting-edge phenotyping tools including omic technologies play a crucial role in improving asthma management precision. Variability in patient responses to biologic treatments such as non-responders, partial responders and super responders poses a formidable challenge to effective asthma care management strategies.
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Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Quality of Care Center, Al Ain University, Abu Dhabi, United Arab Emirates
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Jesenak M, Vanecek V, Ondrusova M, Urdova V, Dostalova K, Hochmuth L. Real-world outcomes of mepolizumab treatment in severe eosinophilic asthma patients - retrospective cohort study in Slovakia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:272-280. [PMID: 37439266 DOI: 10.5507/bp.2023.029] [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: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023] Open
Abstract
AIMS Mepolizumab, a fully-humanized recombinant IgG1 kappa monoclonal antibody directed against IL-5, has shown improved asthma control and lung function in randomised controlled trials. The aim of this study was to evaluate real-world clinical experience in patients with severe eosinophilic asthma treated with mepolizumab in Slovakia. METHODS A retrospective, non-interventional study based on medical records of all adult asthma patients initiating mepolizumab between November 1, 2017 and January 31, 2019, completing 12 months of treatment. At baseline, general and clinical profile data were recorded 12 months prior to treatment. Primary and secondary endpoints described the results of mepolizumab use at 2, 6, and 12 months after the initiation and compared to baseline. Statistical testing of individual change (in each patient) in selected parameters was performed. RESULTS The cohort included 17 patients with particularly severe asthma at baseline, with frequent severe exacerbations (SE, median 5 [IQR 4-6]/patient/year), high blood eosinophil counts (median 0.6x109/L), frequent oral corticosteroid (OCS) dependence (82.35%), median dose 15 (IQR 7.5-20) mg/day, impaired lung function, and a spectrum of comorbidities. In a one-year follow-up, the data showed reductions in median SE (0 [IQR 0-1] patient/year, eosinophilia (median 0.175x109/L) and OCS maintenance dose (median 6.25 [IQR 2.5-20] mg/day), all statistically significant after 12 months on mepolizumab. Improved and stabilised lung functions throughout the cohort and a reduced incidence of nasal polyposis were observed. CONCLUSIONS The results provide clinical evidence of mepolizumab efficacy in a real sample of patients with severe asthma when administered in routine care settings in Slovakia.
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Affiliation(s)
- Milos Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - Vaclav Vanecek
- GlaxoSmithKline, Medical Department, Prague, Czech Republic
| | - Martina Ondrusova
- Pharm-In, Ltd, Bratislava, Slovakia
- Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Veronika Urdova
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
- Allergology and Immunology Clinic, Department of Internal Medicine, F. D. Roosevelt Hospital, Banska Bystrica, Slovakia
| | | | - Ludek Hochmuth
- Allergology and Immunology Clinic, Department of Internal Medicine, F. D. Roosevelt Hospital, Banska Bystrica, Slovakia
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Cheung TT, Mai TH, Chia YL, Yap DYH, Lee CH, Chen CCK, Huang Y, Jin Y, Johnston J, Werkström V, Yao Y, Ge X, Zheng W. Safety, Tolerability, and Pharmacokinetics of Benralizumab: A Phase 1, Randomized, Single-Blind Study of Healthy Chinese Participants. Drug Des Devel Ther 2023; 17:209-218. [PMID: 36726737 PMCID: PMC9885872 DOI: 10.2147/dddt.s392155] [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: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose Biological therapies targeting eosinophils have been shown to be effective in treating patients with severe eosinophilic asthma. Benralizumab (Fasenra®, AstraZeneca) is a humanized monoclonal antibody binding to the alpha subunit of the interleukin-5 receptor, which rapidly depletes eosinophils via antibody-dependent cellular cytotoxicity. The aim of this Phase 1 study was to assess the safety, tolerability, and pharmacokinetics of benralizumab in healthy Chinese individuals. Materials and Methods In this randomized, single-blind study (NCT03928262), healthy Chinese adult participants aged 18 to 45 years, weighing 50 to 100 kg, were randomized 1:1:1 to receive a single subcutaneous (SC) injection of benralizumab 10 mg, 30 mg, or 100 mg in the upper arms on Day 1. Safety was monitored throughout the study (up to Day 85), and blood samples were taken to determine serum benralizumab concentrations and for detection of anti-drug antibody. A non-compartmental analysis was conducted to estimate the pharmacokinetic parameters. Results Thirty-six healthy participants were enrolled, 12 in each dose group (mean [SD] age 26 [6] years). Following a single SC injection of benralizumab, 13 adverse events were reported by 10 participants (28%), with one mild injection-site reaction assessed as related. The mean serum benralizumab concentrations increased in a dose proportional manner, followed by exponential decreases. The mean terminal half-lives were 15.1 days for the 10 mg dose, 14.4 days for the 30 mg dose, and 15.4 days for the 100 mg dose. All doses resulted in near-complete depletion of eosinophils on Day 2, which was maintained throughout the study to Day 85. Conclusion A single SC injection of benralizumab was well tolerated by healthy Chinese participants, with no new or unexpected safety findings. The pharmacokinetics of benralizumab in Chinese participants was dose-proportional and consistent with those of non-Chinese participants observed in previous studies. Clinical Trial Registration NCT03928262 (https://clinicaltrials.gov/ct2/show/NCT03928262).
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Affiliation(s)
- Tommy Tsang Cheung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People’s Republic of China
| | - Tu H Mai
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Yen Lin Chia
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA,Correspondence: Yen Lin Chia, Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, 701 Gateway Blvd, South San Francisco, CA, 9408, USA, Tel +1 425 5272574, Email
| | - Desmond Y H Yap
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People’s Republic of China
| | - Chi-Ho Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People’s Republic of China
| | - Cecil Chi-Keung Chen
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Ying Huang
- Clinical Pharmacology, R&D China, AstraZeneca, Shanghai, People’s Republic of China
| | - Yuwen Jin
- Clinical Pharmacology, R&D China, AstraZeneca, Shanghai, People’s Republic of China
| | - James Johnston
- Late-stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Viktoria Werkström
- Late-Stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Yuhui Yao
- Respiratory & Immunology, R&D China, AstraZeneca, Shanghai, People’s Republic of China
| | - Xiaoyun Ge
- Clinical Safety, R&D China, AstraZeneca, Shanghai, People’s Republic of China
| | - Wenying Zheng
- Biometrics, R&D China, AstraZeneca, Shanghai, People’s Republic of China
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Kardas G, Panek M, Kuna P, Damiański P, Kupczyk M. Monoclonal antibodies in the management of asthma: Dead ends, current status and future perspectives. Front Immunol 2022; 13:983852. [PMID: 36561741 PMCID: PMC9763885 DOI: 10.3389/fimmu.2022.983852] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with moderate-to-severe asthma may now be treated using a variety of monoclonal antibodies that target key inflammatory cytokines involved in disease pathogenesis. Existing clinical data on anti-IgE, anti-IL-5 and other immunological pathways indicate these therapies to offer reduced exacerbation rates, improved lung function, greater asthma control and better quality of life. However, as several patients still do not achieve satisfactory clinical response with the antibodies available, many more biologics, aiming different immunological pathways, are under evaluation. This review summarizes recent data on existing and potential monoclonal antibodies in asthma. Recent advances have resulted in the registration of a new antibody targeting TSLP (tezepelumab), with others being under development. Some of the researched monoclonal antibodies (e.g. anti-IL-13 tralokinumab and lebrikizumab or anti-IL-17A secukinumab) have shown optimistic results in preliminary research; however, these have been discontinued in asthma clinical research. In addition, as available monoclonal antibody treatments have shown little benefit among patients with T2-low asthma, research continues in this area, with several antibodies in development. This article summarizes the available pre-clinical and clinical data on new and emerging drugs for treating severe asthma, discusses discontinued treatments and outlines future directions in this area.
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Tan LD, Nguyen N, Alismail A, Castro M. Management of Uncontrolled Asthma: A Framework for Novel and Legacy Biologic Treatments. J Asthma Allergy 2022; 15:875-883. [PMID: 35791394 PMCID: PMC9250774 DOI: 10.2147/jaa.s369836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Asthma continues to be a complex respiratory disease to control for many despite optimal standard inhaler therapy. The increased dependence on steroid-sparing biologic treatments in the 21st century has created a dilemma between identifying the patient’s intrinsic biomarkers and their “life markers.” With Tezepelumab being the most recent FDA-approved biologic for asthma, it is even more critical for asthma specialists to better understand and establish a framework to determine which biologic would work best for their patients. While cost and payor approvals limit access to certain asthma biologics, medical decisions on which biologic to select should be centered around shared decision-making, the rationale for biologic initiation, and critical biologic education to help achieve successful asthma control.
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Affiliation(s)
- Laren D Tan
- Department of Internal Medicine, School of Medicine, Loma Linda University Health, Loma Linda, CA, USA.,Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda, CA, USA
| | - Nolan Nguyen
- Department of Biological Sciences, University of California, San Diego, CA, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda, CA, USA
| | - Mario Castro
- Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
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Porpodis K, Tsiouprou I, Apostolopoulos A, Ntontsi P, Fouka E, Papakosta D, Vliagoftis H, Domvri K. Eosinophilic Asthma, Phenotypes-Endotypes and Current Biomarkers of Choice. J Pers Med 2022; 12:jpm12071093. [PMID: 35887589 PMCID: PMC9316404 DOI: 10.3390/jpm12071093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 12/16/2022] Open
Abstract
Asthma phenotyping and endotyping are constantly evolving. Currently, several biologic agents have been developed towards a personalized approach to asthma management. This review will focus on different eosinophilic phenotypes and Th2-associated endotypes with eosinophilic inflammation. Additionally, airway remodeling is analyzed as a key feature of asthmatic eosinophilic endotypes. In addition, evidence of biomarkers is examined with a predictive value to identify patients with severe, uncontrolled asthma who may benefit from new treatment options. Finally, there will be a discussion on the results from clinical trials regarding severe eosinophilic asthma and how the inhibition of the eosinophilic pathway by targeted treatments has led to the reduction of recurrent exacerbations.
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Affiliation(s)
- Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Ioanna Tsiouprou
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Apostolos Apostolopoulos
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 12462 Athens, Greece;
| | - Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Harissios Vliagoftis
- Department of Medicine, University of Alberta, 567 HMRC, Edmonton, AB T6G 2S2, Canada;
| | - Kalliopi Domvri
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2313307258
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Alsaffar RM, Alkholifi FK. Exploring the efficacy and contribution of Dupilumab in asthma management. Mol Immunol 2022; 146:9-17. [PMID: 35397375 DOI: 10.1016/j.molimm.2022.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/15/2023]
Abstract
IgG4 monoclonal antibody Dupilumab binds to the alpha chain (IL4R) of both types of the ligand-binding domains (IL4R/ IL13R1; equally IL4 and IL13 specific) of the IL-4 receptor. The current focus on precision medicine techniques to blocking pathways implicated in allergy disorders is crucial to the development of Dupilumab and broadening its therapeutic uses. Our review describes how the IL-4R complexes signaling pathway works, explores the probable mechanisms of Dupilumab activity and addresses its clinical usefulness and safety in asthma. The FDA (Food and Drug Administration) already licences it to treat Alzheimer's disease and moderate-to-severe asthma, and it has shown highly significant results in the management of chronic rhinosinusitis and Eosinophilic esophagitis (EoE). Previous investigations and clinical trials undertaken by various pharmaceutical firms are examined in this review article to assess the existing literature fully. The discovery of Dupilumab and the expanding range of therapeutic uses are pertinent to the current focus on precision medicine methods to blocking asthma-related pathways.
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Affiliation(s)
- Rana M Alsaffar
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia.
| | - Faisal K Alkholifi
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia
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AlShareef S, McDonald CF, Lee J. Clinical and Lung Function Outcomes After Anti-IgE or Anti-IL5 Therapy in Severe Asthma. J Asthma Allergy 2022; 15:209-217. [PMID: 35210787 PMCID: PMC8857973 DOI: 10.2147/jaa.s348137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although there have been indirect comparisons of the relative efficacy of mepolizumab (anti-IL-5) and benralizumab (anti-IL-5Rα) in severe asthma patients, long-term direct head-to-head comparisons are lacking. Here, we (i) examined the effect of mepolizumab, benralizumab, and omalizumab on symptom control and lung function parameters over time; and (ii) compared the efficacy of mepolizumab and benralizumab on symptom control and lung function outcomes. Methods This was a retrospective study of patients with severe asthma taking anti-IgE (omalizumab; n = 24), anti-IL5 (mepolizumab, n = 23), or anti-IL-Rα (benralizumab; n = 12) therapy. Data were extracted on (i) Asthma Control Questionnaire (ACQ-5) scores; (ii) forced expiratory volume over 1 second (FEV1); and (iii) peak expiratory flow rate (PEFR) at 4–6 months and 1 year and documented reductions in exacerbations. Clinical and lung function outcomes were compared between patients taking mepolizumab and benralizumab and over time. Results There were significant decreases in ACQ-5 scores (3.3 ± 0.93 to 1.7 ± 0.98 for mepolizumab, 3.5 ± 0.72 to 1.6 ±0.89 for benralizumab, and 3.5 ± 0.95 to 1.7 ± 1.1 for omalizumab; t-test, all p < 0.0001) but not increases in FEV1 and PEFR for all three agents after 4–6 months of therapy, which persisted but did not decrease further at one year. There were trends toward a greater percentage increase in FEV1 and PEFR from baseline and a decrease in the number of exacerbations in patients taking benralizumab than those taking mepolizumab. Conclusion Although limited by a small sample size, this real-world, head-to-head comparison of mepolizumab and benralizumab is consistent with comparative data on asthma biologicals and indirect comparisons showing no major difference in efficacy. The study also generates new testable hypotheses about the efficacy of asthma biologicals in different patient populations.
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Affiliation(s)
- Saad AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13317-4233, Saudi Arabia
- Correspondence: Saad AlShareef, Email
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Joy Lee
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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11
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Bergeron HC, Tripp RA. Immunopathology of RSV: An Updated Review. Viruses 2021; 13:2478. [PMID: 34960746 PMCID: PMC8703574 DOI: 10.3390/v13122478] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
RSV is a leading cause of respiratory tract disease in infants and the elderly. RSV has limited therapeutic interventions and no FDA-approved vaccine. Gaps in our understanding of virus-host interactions and immunity contribute to the lack of biological countermeasures. This review updates the current understanding of RSV immunity and immunopathology with a focus on interferon responses, animal modeling, and correlates of protection.
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Affiliation(s)
| | - Ralph A. Tripp
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA;
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12
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Li H, Zhang Q, Wang J, Gao S, Li C, Wang J, Zhang S, Lin J. Variability of Type 2 inflammatory markers guiding biologic therapy of severe asthma: A 5-year retrospective study from a single tertiary hospital. World Allergy Organ J 2021; 14:100547. [PMID: 34611471 PMCID: PMC8463912 DOI: 10.1016/j.waojou.2021.100547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
Background Currently, biotherapy is mainly administered to treat patients with severe asthma with the Type 2 (T2) inflammation phenotype. The variability of T2 inflammatory markers remains poorly understood. Objective We aimed to describe the individual distributions of different biomarkers at varying thresholds and their variation patterns in participants with severe asthma. Methods We retrospectively reviewed the data of participants who had completed 2 or more fraction of exhaled nitric oxide (FeNO) and peripheral blood eosinophil counts in our centre within 5 years. The individual distribution of biomarkers (blood or sputum eosinophils, FeNO, and serum total IgE) with repeated measurements at different thresholds was analysed. The varied patterns of biomarkers were analysed by cluster analysis. Results A total of 241 eligible participants were screened. Through long-term longitudinal multiple measurements, we found that approximately 50% of severe asthmatics had blood eosinophil levels fluctuating around the threshold defined by biological agents. FeNO persisted at levels >19.5 ppb or 25 ppb in more than half of patients; about 30% of participants crossed this threshold. In our centre, 47.4% of participants consistently exceeded sputum eosinophils >3%, and 47.4% of patients crossed this threshold. Approximately 66.7% of participants had more than 50% alterations of serum total IgE, and 98.1% of participants continued to have IgE levels greater than 30 IU/mL. We used cluster analysis to classify variability and levels of FeNO and blood eosinophils and identified 4 patient clusters. Cluster 1 can be summarised as T2 severe asthma with low blood eosinophil levels and stability. Cluster 2 can be summarised as asthma with continuous increase and small fluctuations in various T2 inflammatory markers. Cluster 3 can be summarised as a non/low-T2 inflammatory phenotype. Cluster 4 can be summarised as a stable, moderate T2 inflammatory phenotype. Conclusion We identified the distributions and variable patterns of the T2 inflammatory markers currently used to guide asthma biotherapy in clinical practice. The longitudinal comprehensive multiple assessments of T2 inflammatory markers provide support for initiating biologic therapy patients with severe asthma whose biomarker levels vary.
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Affiliation(s)
- Hongwen Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qing Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingru Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shengnan Gao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunxiao Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jianxin Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Shuhua Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jiangtao Lin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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13
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de Freitas Nakata KC, Marques LD, de Oliveira HC, Magalhães GCB, de Oliveira RG, Botelho C. Anti-interleukin-5 in the Management of Eosinophilic Asthma: A Review of Effectiveness, Safety, and Budgetary Impact From the Perspective of the Brazilian Health System. Value Health Reg Issues 2021; 26:169-181. [PMID: 34547665 DOI: 10.1016/j.vhri.2021.06.010] [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: 10/22/2020] [Revised: 03/30/2021] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of anti-interleukin-5 class therapy agents in the treatment of eosinophilic asthma and the financial impact of these drugs on the Brazilian and Mato Grosso public health systems. METHODS The literature review in important databases was guided by a structured research question including patient or population, intervention, comparator, outcome and type of study. The retrieved studies went through a screening, selection, data extraction, and methodological quality assessment process. A model with two scenarios, one with mepolizumab and the other with benralizumab, was created for budget impact analysis. RESULTS Evidence indicated that anti-interleukins-5 have an acceptable safety profile and can reduce exacerbation rates by up to 50% in the population with eosinophilic asthma; however, they showed no significant difference in quality of life. The adoption of these drugs in the Brazilian health system can impact the budget from R$ 40,379,731.50 to R$ 140,301,211.34 depending on the drug incorporated, considering a time horizon of 5 years. From the perspective of the state of Mato Grosso, the budget impact may reach, in the fifth year, an amount of R$ 1,301,210.58 and R$ 2,050.687.62 for the scenarios with mepolizumab and benralizumab, respectively. CONCLUSION Anti-interleukins-5 are promising treatments for eosinophilic asthma because they minimise exacerbations and are well tolerated and safe. The financial impact is large, implying that technology costs may be a barrier to accessing this treatment class.
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Affiliation(s)
| | - Luisa Daige Marques
- Núcleo de Avaliação de Tecnologias em Saúde - NATS/SES/MT, Cuiabá-MT, Brasil
| | - Helder Cássio de Oliveira
- Núcleo de Avaliação de Tecnologias em Saúde - NATS/SES/MT, Cuiabá-MT, Brasil; Coordenador do NATS-HUJM - Hospital Universitário Júlio Muller, Cuiabá-MT, Brasil
| | - Graciane Catarina Batista Magalhães
- Núcleo de Avaliação de Tecnologias em Saúde - NATS/SES/MT, Cuiabá-MT, Brasil; Centro Estadual de Referência em Média e Alta Complexidade - Cermac/SES MT, Cuiabá-MT, Brasil
| | - Ruberlei Godinho de Oliveira
- Hospital Universitário Júlio Muller - Programa de Pós-Graduação Mestrado em Ciências Aplicadas a Atenção Hospitalar, Cuiabá-MT, Brasil
| | - Clóvis Botelho
- Universidade Federal de Mato Grosso - UFMT/Universidade de Várzea Grande-MT, Cuiabá-MT, Brasil
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14
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Wardlaw AJ, Wharin S, Aung H, Shaffu S, Siddiqui S. The causes of a peripheral blood eosinophilia in a secondary care setting. Clin Exp Allergy 2021; 51:902-914. [PMID: 34080735 DOI: 10.1111/cea.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A peripheral blood eosinophilia of greater than 1.0 × 109 /L is relatively unusual and offers a clue to the underlying diagnosis. In 2003, we established a specialist service to diagnose unexplained eosinophilia. OBJECTIVE To describe the causes of an eosinophilia in our service and the diagnostic algorithm we developed. METHODS Subjects were referred by physician colleagues across a range of specialties and undertook standard investigations following a semi-structured protocol. Data were extracted from a bespoke database. RESULTS Three hundred and eighty two subjects were referred over a 17-year period. Average age was 54 years and 183 (48%) of subjects were female, with 21 of 25 (84%) females in the idiopathic eosinophilic pneumonia group (p < 0001), 22 of 30 (73%) females in the gastrointestinal disease group (p < .008), but 11 of 37 (30%) females in the eosinophilic granulomatosis with polyangiitis group (p < .04). A diagnosis was assigned after systematic evaluation using a pre-defined algorithm in 361 (94.5%) of cases. Fungal allergy (82 subjects: 21%), parasitic infection (61 subjects: 16%) and severe eosinophilic asthma (50 subjects: 13%) were the three commonest individual diagnoses. Hypereosinophilic syndrome (HES) disease including eosinophilic granulomatosis with polyangiitis (EGPA) accounted for 85 subjects (20%) of which seven subjects (2%) had myeloproliferative disease (M-HES). A high IgE was common, and 79 (91%) of subjects with complete data who had an IgE of ≥1000 IU/L had fungal allergy or parasite infection. The serum tryptase was raised in 44 of 302 (14.5%) of individuals across all diagnostic groups, though none had mastocytosis. CONCLUSION A diagnosis of an unexplained eosinophilia can usually be determined using as semi-structured algorithm. Parasitic infection and fungal allergy often with severe eosinophilic asthma were common causes, whereas HES, particularly myeloproliferative, disease was relatively rare.
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Affiliation(s)
- Andrew John Wardlaw
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah Wharin
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hnin Aung
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shireen Shaffu
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Salman Siddiqui
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
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15
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Karcz TP, Whitehead GS, Nakano K, Nakano H, Grimm SA, Williams JG, Deterding LJ, Jacobson KA, Cook DN. UDP-glucose and P2Y14 receptor amplify allergen-induced airway eosinophilia. J Clin Invest 2021; 131:140709. [PMID: 33792561 DOI: 10.1172/jci140709] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
Airway eosinophilia is a hallmark of allergic asthma and is associated with mucus production, airway hyperresponsiveness, and shortness of breath. Although glucocorticoids are widely used to treat asthma, their prolonged use is associated with several side effects. Furthermore, many individuals with eosinophilic asthma are resistant to glucocorticoid treatment, and they have an unmet need for novel therapies. Here, we show that UDP-glucose (UDP-G), a nucleotide sugar, is selectively released into the airways of allergen-sensitized mice upon their subsequent challenge with that same allergen. Mice lacking P2Y14R, the receptor for UDP-G, had decreased airway eosinophilia and airway hyperresponsiveness compared with wild-type mice in a protease-mediated model of asthma. P2Y14R was dispensable for allergic sensitization and for the production of type 2 cytokines in the lung after challenge. However, UDP-G increased chemokinesis in eosinophils and enhanced their response to the eosinophil chemoattractant, CCL24. In turn, eosinophils triggered the release of UDP-G into the airway, thereby amplifying eosinophilic recruitment. This positive feedback loop was sensitive to therapeutic intervention, as a small molecule antagonist of P2Y14R inhibited airway eosinophilia. These findings thus reveal a pathway that can be therapeutically targeted to treat asthma exacerbations and glucocorticoid-resistant forms of this disease.
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Affiliation(s)
| | | | | | | | | | - Jason G Williams
- Mass Spectrometry Research and Support Group, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina, USA
| | - Leesa J Deterding
- Mass Spectrometry Research and Support Group, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina, USA
| | - Kenneth A Jacobson
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
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16
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Reibman J, Tan L, Ambrose C, Chung Y, Desai P, Llanos JP, Moynihan M, Tkacz J. Clinical and economic burden of severe asthma among US patients treated with biologic therapies. Ann Allergy Asthma Immunol 2021; 127:318-325.e2. [PMID: 33775904 DOI: 10.1016/j.anai.2021.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with severe asthma may remain uncontrolled despite biologic therapy in addition to standard therapy, but this disease burden has not been quantified. OBJECTIVE To estimate the clinical and economic burden in a US national sample. METHODS Patients who have severe asthma with indicated biologic treatment (earliest use = index date) were selected from the MarketScan database between January 1, 2013, and June 30, 2018. Inclusion criteria were continuous enrollment for 12 months postindex with a minimum of 2 biologic fills, greater than or equal to 12 years of age, evidence of medium- to high-dose inhaled corticosteroids and long-acting β-agonist combination before the index, and absence of other respiratory diagnoses and malignancies. Disease exacerbations (used to classify asthma control), health care costs, and treatment characteristics were reported during the 12-month postindex period. RESULTS The sample included 3262 biologic patients; 88% with anti-immunoglobulin E therapy (omalizumab) and 12% non-anti-immunoglobulin E (reslizumab, mepolizumab, benralizumab). The mean age was 49 (±15) years; 64% were women. Prescriptions included inhaled corticosteroids and long-acting β-agonist (82%), systemic corticosteroids (76%), and leukotriene receptor antagonists (68%). Notably, 63% of patients presented greater than or equal to 1 asthma exacerbation (mean 1.3 per patient/year). Furthermore, 35% of patients were categorized as having controlled asthma, whereas 28% were suboptimally controlled and 29% were uncontrolled. Patients with uncontrolled disease had higher all-cause and asthma-related costs ($69,206 and $45,693, respectively) than patients with suboptimally controlled ($59,407 and $40,793, respectively) or controlled disease ($53,083 and $38,393, respectively). Furthermore, 62% of newly treated patients were persistent with their index biologic. CONCLUSION Biologic therapies are effective in reducing exacerbations, but a substantial proportion of patients with severe asthma treated with current biologics continue to experience uncontrolled disease, highlighting a remaining unmet need for patients with severe uncontrolled asthma.
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Affiliation(s)
- Joan Reibman
- Department of Medicine, NYU Langone Health, New York, New York.
| | - Laren Tan
- Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Chris Ambrose
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Yen Chung
- Payer Evidence, AstraZeneca, Gaithersburg, Maryland
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17
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de Graaff MB, Bendien SA, van de Bovenkamp HM. 'Like a fish on dry land': an explorative qualitative study into severe asthma and the impact of biologicals on patients' everyday life. J Asthma 2021; 59:980-988. [PMID: 33625306 DOI: 10.1080/02770903.2021.1888976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
RESULTS Findings show how our respondents experience a high burden of disease (breathlessness, fatigue, exacerbations, loss of family, friends and employment) and treatment (oral corticosteroids' side-effects, dependency, life-style changes). Treatment with biologicals is relatively new for respondents. They mention to be cautious in their embrace of biologicals and in expressing hope for the future. Respondents who react to treatment with biologicals experience relief of both the burden of disease and treatment. They aim to regain their social life and societal participation, a contrast to those for whom biologicals prove ineffective. Biologicals' burden of treatment is experienced as low and minor side-effects are mentioned by three respondents. Respondents appear relatively unconcerned about the lack of knowledge concerning the long-term effects of biologicals.Conclusions: Effective treatment with biologicals is generally experienced as a cautiously optimistic next step in a much longer and complex process of living with severe asthma. The practical lessons we draw point to managing patients' expectations and the need to pay attention to patients not eligible for treatment with biologicals.
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Affiliation(s)
- M B de Graaff
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - S A Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, the Netherlands
| | - H M van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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18
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Lee LY, Hew GSY, Mehta M, Shukla SD, Satija S, Khurana N, Anand K, Dureja H, Singh SK, Mishra V, Singh PK, Gulati M, Prasher P, Aljabali AAA, Tambuwala MM, Thangavelu L, Panneerselvam J, Gupta G, Zacconi FC, Shastri M, Jha NK, Xenaki D, MacLoughlin R, Oliver BG, Chellappan DK, Dua K. Targeting eosinophils in respiratory diseases: Biological axis, emerging therapeutics and treatment modalities. Life Sci 2021; 267:118973. [PMID: 33400932 DOI: 10.1016/j.lfs.2020.118973] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023]
Abstract
Eosinophils are bi-lobed, multi-functional innate immune cells with diverse cell surface receptors that regulate local immune and inflammatory responses. Several inflammatory and infectious diseases are triggered with their build up in the blood and tissues. The mobilization of eosinophils into the lungs is regulated by a cascade of processes guided by Th2 cytokine generating T-cells. Recruitment of eosinophils essentially leads to a characteristic immune response followed by airway hyperresponsiveness and remodeling, which are hallmarks of chronic respiratory diseases. By analysing the dynamic interactions of eosinophils with their extracellular environment, which also involve signaling molecules and tissues, various therapies have been invented and developed to target respiratory diseases. Having entered clinical testing, several eosinophil targeting therapeutic agents have shown much promise and have further bridged the gap between theory and practice. Moreover, researchers now have a clearer understanding of the roles and mechanisms of eosinophils. These factors have successfully assisted molecular biologists to block specific pathways in the growth, migration and activation of eosinophils. The primary purpose of this review is to provide an overview of the eosinophil biology with a special emphasis on potential pharmacotherapeutic targets. The review also summarizes promising eosinophil-targeting agents, along with their mechanisms and rationale for use, including those in developmental pipeline, in clinical trials, or approved for other respiratory disorders.
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Affiliation(s)
- Li-Yen Lee
- School of Pharmacy, International Medical University (IMU), Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Geena Suet Yin Hew
- School of Pharmacy, International Medical University (IMU), Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Meenu Mehta
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI), University of Newcastle, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Saurabh Satija
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Krishnan Anand
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences and National Health Laboratory Service, University of the Free State, Bloemfontein, South Africa
| | - Harish Dureja
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, Haryana 124001, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Vijay Mishra
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Pankaj Kumar Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Parteek Prasher
- Department of Chemistry, University of Petroleum & Energy Studies, Dehradun 248007, India
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, BT52 1SA, Northern Ireland, United Kingdom
| | - Lakshmi Thangavelu
- Department of Pharmacology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Jithendra Panneerselvam
- Department of Pharmaceutical Technology, International Medical University (IMU), Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Jaipur 302017, India
| | - Flavia C Zacconi
- Departamento de Química Orgánica, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile; Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Madhur Shastri
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart 7005, Australia
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Greater Noida 201310, India
| | - Dikaia Xenaki
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ronan MacLoughlin
- Aerogen, IDA Business Park, Dangan, H91 HE94 Galway, Ireland; School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40 Dublin, Ireland
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; School of Life Sciences, University of Technology Sydney, Sydney, New South Wales 2007, Australia.
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University (IMU), Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI), University of Newcastle, New Lambton Heights, Newcastle, NSW 2305, Australia; School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh 173229, India.
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19
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Receptors for pro-resolving mediators as a therapeutic tool for smooth muscle remodeling-associated disorders. Pharmacol Res 2020; 164:105340. [PMID: 33276103 DOI: 10.1016/j.phrs.2020.105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/16/2022]
Abstract
Respiratory airway, blood vessel and intestinal wall remodeling, in which smooth muscle remodeling plays a major role, is a key pathological event underlying the development of several associated diseases, including asthma, cardiovascular disorders (e.g., atherosclerosis, hypertension, and aneurism formation), and inflammatory bowel disease. However, the mechanisms underlying these remodeling processes remain poorly understood. We hypothesize that the creation of chronic inflammation-mediated networks that support and exacerbate the airway, as well as vascular and intestinal wall remodeling, is a crucial pathogenic mechanism governing the development of the associated diseases. The failed inflammation resolution might be one of the causal pathogenic mechanisms. Hence, it is reasonable to assume that applying specialized, pro-resolving mediators (SPMs), acting via cognate G-protein coupled receptors (GPCRs), could potentially be an effective pathway for treating these disorders. However, several obstacles, such as poor understanding of the SPM/receptor signaling pathways, SMP rapid inactivation as well as their complex and costly synthesis, limit their translational potential. In this connection, stable, small-molecule SPM mimetics and receptor agonists have emerged as new, potentially suitable drugs. It has been recently shown in preclinical studies that they can effectively attenuate the manifestations of asthma, atherosclerosis and Crohn's disease. Remarkably, some biased SPM receptor agonists, which cause a signaling response in the desired inflammation pro-resolving direction, revealed similar beneficial effects. These encouraging observations suggest that SPM mimetics and receptor agonists can be applied as a novel approach for the treatment of various chronic inflammation conditions, including airway, vascular and intestinal wall remodeling-associated disorders.
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Ookawara T, Aihara R, Morimoto A, Iwashita N, Kurata K, Takagi Y, Miyasaka A, Kushiro M, Miyake S, Fukuyama T. Acute and subacute oral toxicity of deoxynivalenol exposure in a Dermatophagoides farinae induced murine asthma model. Toxicol Sci 2020; 179:229-240. [PMID: 33170220 DOI: 10.1093/toxsci/kfaa168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Previously, researchers have demonstrated that mycotoxin deoxynivalenol significantly enhances immunocyte activation. However, the interaction between deoxynivalenol exposure and immune disorders remains unclear. In this study, we aimed to investigate whether acute and subacute oral exposure to deoxynivalenol exacerbates the development of respiratory allergy using a mite allergen (Dermatophagoides farina, Derf)-induced mouse model of asthma. The direct relationship between deoxynivalenol exposure and asthma development was examined following acute oral deoxynivalenol administration (0, 0.1, or 0.3 mg/kg body weight), immediately before the final mite allergen challenge. Simultaneously, the influence of subacute oral exposure via low dose deoxynivalenol contaminated wheat (0.33 ppm) was evaluated using the same settings. To detect the pro-inflammatory effects of deoxynivalenol exposure, we examined the total and Derf-specific serum IgE levels, histology, number of immunocytes, and cytokine and chemokine secretion. Acute oral deoxynivalenol significantly enhanced the inflammatory responses, including cellular infiltration into bronchoalveolar lavage fluid, infiltration of immunocytes and cytokine production in local lymph nodes, and cytokine levels in lung tissues. Corresponding pro-inflammatory responses were observed in a mouse group exposed to subacute oral deoxynivalenol. In vivo results were validated by in vitro experiments using the human bronchial epithelial (BEAS-2B) and human eosinophilic leukemia (EOL-1) cell lines. Following exposure to deoxynivalenol, the secretion of interleukin (IL)-1β, IL-6, IL-8, and/or tumor necrosis factor (TNF)-α in BEAS-2B cells, as well as EoL-1 cells, increased significantly. Our findings indicate that deoxynivalenol exposure is significantly involved in the pro-inflammatory response observed in respiratory allergy.
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Affiliation(s)
- Toa Ookawara
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Ryota Aihara
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Ai Morimoto
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Naoki Iwashita
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan.,Bioalchemis, 3-28-61 Honshuku-cho, Fuchu-shi, Tokyo, Japan
| | - Keigo Kurata
- Institute of Tokyo Environmental Allergy, ITEA Inc, 1-2-5, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yoshiichi Takagi
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan.,Japan SLC, Inc, 85 Ohara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Atsushi Miyasaka
- Kyushu Okinawa Agricultural Research Center, National Agriculture and Food Research Organization (NARO), Suya 2421, Koshi, Kumamoto, Japan
| | - Masayo Kushiro
- Food Research Institute, National Agriculture and Food Research Organization (NARO), 2-1-12 Kannondai, Tsukuba, Ibaraki, Japan
| | - Shiro Miyake
- Laboratory of Food and Hygiene, School of Food and Life Science, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Tomoki Fukuyama
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
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21
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Beliefs and preferences regarding biological treatments for severe asthma. World Allergy Organ J 2020; 13:100441. [PMID: 32774661 PMCID: PMC7396819 DOI: 10.1016/j.waojou.2020.100441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022] Open
Abstract
Background Severe asthma is a serious condition with a significant burden on patients' morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore the beliefs and practices in the use of biological therapies in severe asthma, hypothesizing that differences will occur depending on the prescribers’ specialty and experience. Methods We conducted an online survey composed of 35 questions in English. The survey was circulated via the INterasma Scientific Network (INESNET) platform as well as through social media. Responses from allergists and pulmonologists, both those with experience of prescribing omalizumab with (OMA/IL5) and without (OMA) experience with anti-IL5 drugs, were compared. Results Two hundred eighty-five (285) valid questionnaires from 37 countries were analyzed. Seventy-on percent (71%) of respondents prescribed biologics instead of oral glucocorticoids and believed that their side effects are inferior to those of Prednisone 5 mg daily. Agreement with ATS/ERS guidelines for identifying severe asthma patients was less than 50%. Specifically, significant differences were found comparing responses between allergists and pulmonologists (Chi-square test, p < 0.05) and between OMA/IL5 and OMA groups (p < 0.05). Conclusions Uncertainties and inconsistencies regarding the use of biological medications have been shown. The accuracy of prescribers to correctly identify asthma severity, according to guidelines criteria, is quite poor. Although a substantial majority of prescribers believe that biological drugs are safer than low dose long-term treatment with oral steroids, and that they must be used instead of oral steroids, every effort should be made to further increase awareness. Efficacy as disease modifiers, biomarkers for selecting responsive patients, timing for outcomes evaluation, and checks need to be addressed by further research. Practices and beliefs regarding the use of asthma biologics differ between the prescriber's specialty and experience; however, the latter seems more significant in determining beliefs and behavior. Tailored educational measures are needed to ensure research results are better integrated in daily practice.
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Albertson TE, Pugashetti JV, Chau-Etchepare F, Chenoweth JA, Murin S. Pharmacotherapeutic management of asthma in the elderly patient. Expert Opin Pharmacother 2020; 21:1991-2010. [PMID: 32686969 DOI: 10.1080/14656566.2020.1795131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Asthma is a heterogeneous syndrome with variable phenotypes. Reversible airway obstruction and airway hyper-responsiveness often with an atopic or eosinophilic component is common in the elderly asthmatic. Asthma chronic obstructive pulmonary disease overlap syndrome (ACOS), a combination of atopy-mediated airway hyper-responsiveness and a history of smoking or other environmental noxious exposures, can lead to some fixed airway obstruction and is also common in elderly patients. Little specific data exist for the treating the elderly asthmatic, thus requiring the clinician to extrapolate from general adult data and asthma treatment guidelines. AREAS COVERED A stepwise approach to pharmacotherapy of the elderly patient with asthma and ACOS is offered and the literature supporting the use of each class of drugs reviewed. EXPERT OPINION Inhaled, long-acting bronchodilators in combination with inhaled corticosteroids represent the backbone of treatment for the elderly patient with asthma or ACOS . Beyond these medications used as direct bronchodilators and topical anti-inflammatory agents, a stepwise approach to escalation of therapy includes multiple options such as oral leukotriene receptor antagonist or 5-lipoxygense inhibitor therapy, oral phosphodiesterase inhibitors, systemic corticosteroids, oral macrolide antibiotics and if evidence of eosinophilic/atopic component disease exists then modifying monoclonal antibody therapies.
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Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Emergency Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Janelle V Pugashetti
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Florence Chau-Etchepare
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - James A Chenoweth
- Department of Emergency Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Susan Murin
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
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Tajima H, Tajiki-Nishino R, Watanabe Y, Kurata K, Fukuyama T. Activation of aryl hydrocarbon receptor by benzo[a]pyrene increases interleukin 33 expression and eosinophil infiltration in a mouse model of allergic airway inflammation. J Appl Toxicol 2020; 40:1545-1553. [PMID: 32557721 DOI: 10.1002/jat.4017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
Abstract
We recently demonstrated that benzo[a]pyrene (BaP), the aryl hydrocarbon receptor (AhR) ligand, directly contributes to aggravation of cutaneous allergy in a mouse model of allergic dermatitis. The present study aimed to determine whether BaP-induced AhR activation results in development of airway inflammation. Initially, the potential for a direct relationship between BaP-induced AhR activation and airway inflammation was investigated in vivo, using a mouse model of type 2 helper T cell (Th2) hapten toluene-2,4-diisocyanate (TDI)-induced airway inflammation. Mice were orally administered BaP at 48, 24, and 4 h before the final allergen challenge. Oral administration of BaP showed a significant increase in lung inflammation and eosinophil infiltration. While expression of Th2 cytokines such as interleukin 4 (IL-4) and IL-13 was not affected by exposure to BaP, AhR activation significantly increased IL-33 expression. To confirm the in vivo results, in vitro experiments were performed using the human eosinophilic leukemia cell line (EOL-1), human bronchial epithelial cell line (BEAS-2B), and human lung adenocarcinoma epithelial cell line (A549). Results indicated that pre-treatment with BaP increased expression of IL-8 in house dust mite-activated EOL-1, BEAS-2B, and A549 cells. In addition, IL-33 levels in BEAS-2B cells were significantly increased after BaP exposure. Our findings indicated that BaP-induced AhR activation is involved in the pro-inflammatory response in respiratory allergy, and that this effect may be mediated by increased IL-33 expression and eosinophil infiltration.
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Affiliation(s)
- Hitoshi Tajima
- Toxicology Division, Institute of Environmental Toxicology, Ibaraki, Japan
| | | | - Yuko Watanabe
- Toxicology Division, Institute of Environmental Toxicology, Ibaraki, Japan
| | - Keigo Kurata
- Institute of Tokyo Environmental Allergy, ITEA Inc., Tokyo, Japan
| | - Tomoki Fukuyama
- Toxicology Division, Institute of Environmental Toxicology, Ibaraki, Japan.,Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, Sagamihara-shi, Kanagawa, Japan
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Kardas G, Kuna P, Panek M. Biological Therapies of Severe Asthma and Their Possible Effects on Airway Remodeling. Front Immunol 2020; 11:1134. [PMID: 32625205 PMCID: PMC7314989 DOI: 10.3389/fimmu.2020.01134] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma is a chronic and heterogenic respiratory tract disorder with a high global prevalence. The underlying chronic inflammatory process and airway remodeling (AR) contribute to the symptomatology of the disease. The most severely ill asthma patients may now be treated using a variety of monoclonal antibodies aiming key inflammatory cytokines involved in asthma pathogenesis. Although clinical data shows much beneficial effects of biological therapies in terms of reduction of exacerbation rates, improvement of lung functions, asthma control and patients' quality of life, little is known on the effects of these monoclonal antibodies on AR—a key clinical trait of long-term asthma management. In this review, the authors summarize the data on the proven effects of monoclonal antibodies in asthma on AR. To date, in terms of reversing AR, the mostly studied was omalizumab. However, some studies also addressed this clinical issue in context of other severe asthma biological therapies (mepolizumab, benralizumab, tralokinumab). Still, data on effects of particular biological therapies on AR in severe asthma are incomplete and require further studies. According to the American Thoracic Society research recommendations, future research shall focus on AR in asthma and improve drugs targeting AR, including the available and future monoclonal antibodies.
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Affiliation(s)
- Grzegorz Kardas
- Clinic of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Łódz, Poland
| | - Piotr Kuna
- Clinic of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Łódz, Poland
| | - Michał Panek
- Clinic of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Łódz, Poland
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Biologic Therapeutics and Their Role in Allergic Disease of the Unified Airway. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Bagnasco D, Massolo A, Bonavia M, Brussino L, Bucca C, Caminati M, Canonica GW, Caruso C, D’Amato M, De Ferrari L, Guida G, Heffler E, Lombardi C, Menzella F, Milanese M, Paoletti G, Riccio AM, Rolla G, Senna G, Testino E, Passalacqua G. The importance of being not significant: Blood eosinophils and clinical responses do not correlate in severe asthma patients treated with mepolizumab in real life. Allergy 2020; 75:1460-1463. [PMID: 31773742 DOI: 10.1111/all.14135] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | | | | | - Luisa Brussino
- Allergy and Immunology AO Mauriziano Hospital University of Turin Turin Italy
| | - Caterina Bucca
- Azienda Ospedale‐Università Città della Salute e della Scienza, S.C. Pneumologia University of Turin Turin Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit Verona University and General Hospital University of Verona Verona Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | | | - Maria D’Amato
- Department of Pneumology Monaldi Hospital Federico II University Naples Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Giuseppe Guida
- Department of Medical Sciences University of Turin Turin Italy
| | - Enrico Heffler
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases Fondazione Poliambulanza Brescia Italy
| | - Francesco Menzella
- Pneumology Unit Arcispedale Santa Maria Nuova Azienda Ospedaliera di Reggio Emilia Italy
| | - Manlio Milanese
- Division of Pneumology S.Corona Hospital Pietra Ligure Italy
| | - Giovanni Paoletti
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Giovanni Rolla
- Allergy and Immunology AO Mauriziano Hospital University of Turin Turin Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit Verona University and General Hospital University of Verona Verona Italy
| | - Elisa Testino
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
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Albertson TE, Chenoweth JA, Pearson SJ, Murin S. The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Expert Opin Pharmacother 2020; 21:213-231. [PMID: 31955671 DOI: 10.1080/14656566.2019.1701656] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a disease phenotype that shares T helper lymphocyte cell Th1/neutrophilic/non-Type-2 Inflammation pathways thought to be key in COPD and Th2/eosinophilic/Type-2 inflammatory pathways of asthma. The pharmacology of treating ACOS is challenging in severe circumstances.Areas covered: This review evaluates the stepwise treatment of ACOS using pharmacological treatments used in both COPD and asthma. The most common medications involve the same inhalers used to treat COPD and asthma patients. Advanced stepwise therapies for ACOS patients are based on patient characteristics and biomarkers. Very few clinical trials exist that focus specifically on ACOS patients.Expert opinion: After inhalers, advanced therapies including phosphodiesterase inhibitors, macrolides, N-acetylcysteine and statin therapy for those ACOS patients with a COPD appearance and exacerbations are available. In atopic ACOS patients with exacerbations, advanced asthma therapies (leukotriene receptor antagonists and synthesis blocking agents.) are used. ACOS patients with elevated blood eosinophil/IgE levels are considered for immunotherapy or therapeutic monoclonal antibodies blocking specific Th2/Type-2 interleukins or IgE. Symptom control, stabilization/improvement in pulmonary function and reduced exacerbations are the metrics of success. More pharmacological trials of ACOS patients are needed to better understand which patients benefit from specific treatments.Abbreviations: 5-LOi: 5-lipoxygenase inhibitor; ACOS: asthma - COPD overlap syndrome; B2AR: Beta2 adrenergic receptors; cAMP: cyclic adenosine monophosphate; cGMP: cyclic guanosine monophosphate; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CRS : chronic rhinosinusitis; cys-LT: cysteinyl leukotrienes; DPI: dry powder inhaler; EMA: European Medicines Agency; FDA: US Food and Drug Administration; FDC: fixed-dose combination; FeNO: exhaled nitric oxide; FEV1: forced expiratory volume in one second; FVC: forced vital capacity; GM-CSF: granulocyte-macrophage colony-stimulating factor; ICS : inhaled corticosteroids; IL: interleukin; ILC2: Type 2 innate lymphoid cells; IP3: Inositol triphosphate; IRR: incidence rate ratio; KOLD: Korean Obstructive Lung Disease; LABA: long-acting B2 adrenergic receptor agonist; LAMA: long-acting muscarinic receptor antagonist; LRA: leukotriene receptor antagonist; LT: leukotrienes; MDI: metered-dose inhalers; MN: M-subtype muscarinic receptors; MRA: muscarinic receptor antagonist; NAC: N-acetylcysteine; NEB: nebulization; OR: odds ratio; PDE: phosphodiesterase; PEFR: peak expiratory flow rate; PGD2: prostaglandin D2; PRN: as needed; RR: risk ratio; SABA: short-acting B2 adrenergic receptor agonist; SAMA: short-acting muscarinic receptor antagonist; SDMI: spring-driven mist inhaler; Th1: T helper cell 1 lymphocyte; Th2: T helper cell 2 lymphocytes; TNF-α: tumor necrosis factor alpha; US : United States.
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Affiliation(s)
- Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - James A Chenoweth
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - Skyler J Pearson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - Susan Murin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
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Jackson K, Bahna SL. Hypersensitivity and adverse reactions to biologics for asthma and allergic diseases. Expert Rev Clin Immunol 2020; 16:311-319. [PMID: 31994421 DOI: 10.1080/1744666x.2020.1724089] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The development of new biologic agents has provided definite therapeutic advances but, like with any new medications, safety remains a concern.Areas covered: Using PubMed, we reviewed the literature on the adverse effects (AE) to five biologics approved for asthma and/or allergic diseases: one anti-IgE (omalizumab), three anti-IL5 (mepolizumab, reslizumab, benralizumab), and one anti-IL4 (dupilumab).Expert opinion: Biologic agents approved for asthma and allergic diseases are generally safe. Most common AE are benign and tolerated, though long-term safety is lacking for most of them. A slightly increased risk of anaphylaxis to omalizumab and reslizumab required the inclusion of a black box warning, informing the patient, the need for post-injection observation period, and the provision of epinephrine autoinjectors for self-administration when needed. Hypersensitivity reactions, mainly urticaria and very rarely serum sickness have occurred.
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Affiliation(s)
- Kim Jackson
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Sami L Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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30
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Pelaia C, Busceti MT, Vatrella A, Rago GF, Crimi C, Terracciano R, Pelaia G. Real-life rapidity of benralizumab effects in patients with severe allergic eosinophilic asthma: Assessment of blood eosinophils, symptom control, lung function and oral corticosteroid intake after the first drug dose. Pulm Pharmacol Ther 2019; 58:101830. [PMID: 31344472 DOI: 10.1016/j.pupt.2019.101830] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022]
Abstract
Benralizumab is a humanized monoclonal antibody which binds to the α subunit of the interleukin-5 (IL-5) receptor and to the FcγRIIIa receptor expressed by natural killer cells, thus suppressing the pro-eosinophil actions of IL-5 and triggering eosinophil apoptosis via the very effective mechanism of antibody-dependent cell-mediated cytotoxicity (ADCC). Because of its recent approval and introduction in clinical practice for the add-on biological therapy of severe eosinophilic asthma, real-life investigations are still lacking. In this regard, our present real-life study refers to 13 patients with severe allergic eosinophilic asthma, currently under treatment with benralizumab at the Respiratory Unit of "Magna Græcia" University Hospital located in Catanzaro, Italy. Already 4 weeks after the first subcutaneous injection of benralizumab at the dosage of 30 mg, blood eosinophil count rapidly dropped down from 814.7 ± 292.3 cells/μL to 51.3 ± 97.5 cells/μL (p < 0.0001). This relevant hematologic change was associated with quick and significant increases in asthma control test (ACT) score (from 15.31 ± 2.78 to 21.15 ± 3.58; p < 0.0001), pre-bronchodilator forced expiratory volume in 1 s (FEV1) (from 1441 ± 757.9 mL to 1887 ± 837.3 mL; p < 0.001), and morning peak expiratory flow (PEF) (from 4.21 ± 2.20 to 5.33 ± 1.99 L/sec; p < 0.01). Furthermore, the marked improvement in global health status experienced by our patients allowed them to progressively lower and then completely interrupt, within 4 weeks, their daily intake of oral corticosteroids (OCS), which thereby fell from 15.58 ± 8.30 to 0 mg (p < 0.0001) of prednisone. Therefore, such preliminary results suggest that in patients with severe allergic eosinophilic asthma benralizumab can exert, within a real-life context, a very rapid and effective therapeutic action, already detectable 4 weeks after the first drug administration.
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Affiliation(s)
- Corrado Pelaia
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Maria Teresa Busceti
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Francesco Rago
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosa Terracciano
- Department of Health Science, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
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Kim JE, Jung K, Kim JA, Kim SH, Park HS, Kim YS. Engineering of anti-human interleukin-4 receptor alpha antibodies with potent antagonistic activity. Sci Rep 2019; 9:7772. [PMID: 31123339 PMCID: PMC6533264 DOI: 10.1038/s41598-019-44253-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/13/2019] [Indexed: 01/10/2023] Open
Abstract
Development of antagonistic antibody (Ab) against interleukin-4 receptor alpha (IL-4Rα) subunit of IL-4/IL-13 receptors is a promising therapeutic strategy for T helper 2 (TH2)-mediated allergic diseases such as asthma and atopic dermatitis. Here we isolated anti-human IL-4Rα antagonistic Abs from a large yeast surface-displayed human Ab library and further engineered their complementarity-determining regions to improve the affinity using yeast display technology, finally generating a candidate Ab, 4R34.1.19. When reformatted as human IgG1 form, 4R34.1.19 specifically bound to IL-4Rα with a high affinity (KD ≈ 178 pM) and effectively blocked IL-4- and IL-13-dependent signaling in a reporter cell system at a comparable level to that of the clinically approved anti-IL-4Rα dupilumab Ab analogue. Epitope mapping by alanine scanning mutagenesis revealed that 4R34.1.19 mainly bound to IL-4 binding sites on IL-4Rα with different epitopes from those of dupilumab analogue. Further, 4R34.1.19 efficiently inhibited IL-4-dependent proliferation of T cells among human peripheral blood mononuclear cells and suppressed the differentiation of naïve CD4+ T cells from healthy donors and asthmatic patients into TH2 cells, the activities of which were comparable to those of dupilumab analogue. Our work demonstrates that both affinity and epitope are critical factors for the efficacy of anti-IL-4Rα antagonistic Abs.
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Affiliation(s)
- Jung-Eun Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Keunok Jung
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Jeong-Ah Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Yong-Sung Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea.
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea.
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Morjaria JB, Emma R, Fuochi V, Polosa R, Caruso M. An evaluation of mepolizumab for the treatment of severe asthma. Expert Opin Biol Ther 2019; 19:491-500. [PMID: 31009582 DOI: 10.1080/14712598.2019.1610382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Asthma is considered one of the most common chronic conditions globally, characterized by variable airflow obstruction and symptoms. Severe asthma is diagnosed when asthma control requires high-intensity therapy or continues to remain uncontrolled despite treatment. Eosinophilic inflammation is known to be perpetuated by the activity of IL-5 in a proportion of severe asthma subjects, and targeting IL-5 may offer a therapeutic option. Areas covered: In this review, we discuss the role and pathogenesis of IL-5 and eosinophils in asthma and rationale of antagonizing IL-5 in severe eosinophilic asthma. Mepolizumab is the first of three anti-IL-5 biologics licensed in 2015 for use in this subgroup of patients. We discuss clinical and real-life studies leading up to its approval and post-marketing outcomes in terms of efficacy and safety to-date, as well as its pros and cons. Expert opinion: IL-5 antagonism has paved the way for an additional personalized therapeutic opportunity for use in severe asthma with eosinophilic inflammation, though there is limited evidence on the long-term implications of suppressing/depleting eosinophils and the duration for which they should be administered.
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Affiliation(s)
- Jaymin B Morjaria
- a Department of Respiratory Medicine , Royal Brompton & Harefield Hospital Foundation Trust, Harefield Hospital , Harefield , UK.,b Honorary Senior Clinical Lecturer, Respiratory Medicine , Imperial College , London , UK
| | - Rosalia Emma
- c Department of Clinical and Experimental Medicine , University of Catania , Catania (CT) , Italy
| | - Virginia Fuochi
- d Department of Biomedical and Biotechnological Sciences , University of Catania, Catania (CT) , Italy
| | - Riccardo Polosa
- c Department of Clinical and Experimental Medicine , University of Catania , Catania (CT) , Italy
| | - Massimo Caruso
- c Department of Clinical and Experimental Medicine , University of Catania , Catania (CT) , Italy.,d Department of Biomedical and Biotechnological Sciences , University of Catania, Catania (CT) , Italy
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Pelaia C, Busceti MT, Solinas S, Terracciano R, Pelaia G. Real-life evaluation of the clinical, functional, and hematological effects of mepolizumab in patients with severe eosinophilic asthma: Results of a single-centre observational study. Pulm Pharmacol Ther 2018; 53:1-5. [PMID: 30217438 DOI: 10.1016/j.pupt.2018.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Mepolizumab is a humanized monoclonal antibody which targets interleukin-5 (IL-5) and is nowadays available in many countries for add-on biological therapy of severe eosinophilic asthma. Although the approval of mepolizumab use in clinical practice has been made possible by several successful pre-marketing controlled trials, so far only a very few studies have been performed in a real-life setting. Within such a context, our present observational investigation refers to 14 patients with refractory eosinophilic asthma, currently treated with mepolizumab at the Respiratory Unit of "Magna Græcia" University Hospital located in Catanzaro, Italy, whose anti-IL-5 treatment began between June 2017 and January 2018. These patients experienced a significant increase in asthma control test (ACT) score, that was evaluated at baseline (13.64 ± 3.00), as well as after 4 weeks (18.86 ± 3.15; p < 0.0001) and 24 weeks (20.07 ± 1.94; p < 0.0001) of add-on therapy with mepolizumab. This relevant improvement in symptom control was paralleled by a dramatic fall of blood eosinophil numbers, counted at baseline (647.1 ± 274.7 cells/μl), and at the 4th (147.8 ± 66.5 cells/μl; p < 0.0001) and 24th week (98.6 ± 40.3 cells/μl; p < 0.0001) after starting add-on treatment with mepolizumab. These changes were associated with significant and stable increases in FEV1, which was recorded at baseline (1389 ± 454.3 mL), as well as after 4 weeks (1711 ± 482.3 mL; p < 0.001) and 24 weeks (1701 ± 456.0 mL; p < 0.01). Moreover, in comparison to the 6 months preceding the beginning of treatment with mepolizumab, after 24 weeks of anti-IL-5 therapy significant decreases were detected with regard to exacerbation numbers (from 3.64 ± 1.86 to 1.0 ± 0.78; p < 0.001) and oral intake of prednisone (from 24.11 ± 10.36 mg/day to 1.78 ± 3.82 mg/day). Therefore, these preliminary data referring to our single-centre observational study corroborate, in a real-life environment, the efficacy of mepolizumab for treatment of patients with exacerbation-prone, corticosteroid-refractory, severe eosinophilic asthma.
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Affiliation(s)
- Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Maria Teresa Busceti
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Sabina Solinas
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Rosa Terracciano
- Department of Health Science, University "Magna Græcia" of Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy.
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