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Pfaar O, De BLAY F, Canonica GW, Casale TB, Gevaert P, Hellings PW, Kowal K, Passalacqua G, Tortajada-Girbés M, Vidal C, Worm M, Bahbah F, Demoly P. Clinical benefits with 300 IR HDM SLIT tablet in Europeans with house dust mite allergic rhinitis: Post hoc analysis of a large phase 3 trial. World Allergy Organ J 2024; 17:100849. [PMID: 38225952 PMCID: PMC10788274 DOI: 10.1016/j.waojou.2023.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/11/2023] [Indexed: 01/17/2024] Open
Abstract
Background House dust mite (HDM)-induced allergic rhinitis (AR) is a major cause of allergic respiratory disease. The efficacy and safety of the 300 IR HDM sublingual immunotherapy (SLIT) tablet in patients with moderate-to-severe HDM-AR was confirmed in a large, international, phase 3 randomized controlled trials (RCTs). Here, we analyzed the results in the European population. Methods Data from 91 European centers that participated in the international, double-blind, RCT (EudraCT 2014-004223-46, NCT02443805) with the 300 IR HDM SLIT tablet versus placebo over 12 months were analyzed post hoc. The treatment effect in European adults and adolescents was notably assessed through the European Academy of Allergy and Clinical Immunology (EAACI)-recommended combined symptom and medication score (CSMS0-6, pre-defined endpoint) and the total combined rhinitis score (TCRS0-24, post hoc endpoint, also balanced) during the primary evaluation period (4 weeks at the end of treatment period) using analysis of covariance (ANCOVA). Results There were 818 patients who comprised the modified full analysis set in Europe. Over the primary period, the differences in CSMS0-6 and TCRS0-24 between the 300 IR and placebo groups were statistically significant (p < 0.0001): -0.32 (95%CI [-0.46; -0.17]) and -1.28 (95%CI [-1.63; -0.94]), respectively, with relative differences of -20.9% and -21.2%. All post hoc and the rhinoconjunctivitis quality of life endpoints were significantly improved with 300 IR versus placebo. The 300 IR HDM tablet was generally well tolerated. Conclusion This RCT sub-analysis confirmed the 300 IR HDM SLIT tablet is an effective and safe treatment for European adults and adolescents with HDM-AR with clinically meaningful benefits from the patients' perspective. Trial registration NCT02443805. Registered on April 29, 2015./EudraCT 2014-004223-46. Registered on September 16, 2015.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, D-35043 Marburg, Germany
| | - Frédéric De BLAY
- Chest Diseases Department, Federation of Translational Medicine EA 3072, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Personalized Medicine Asthma & Allergy Unit-IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Thomas B. Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, FL 33612, USA
| | - Philippe Gevaert
- Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University, 9000 Ghent, Belgium
| | - Peter W. Hellings
- Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University, 9000 Ghent, Belgium
- Otorhinolaryngology Department, Otorhinolaryngologist, Head and Neck Surgery, University Hospital of Leuven, University of Leuven, 3000 Leuven, Belgium
| | - Krzysztof Kowal
- Department of Experimental Allergology and Immunology, Medical University of Bialystok, Sklodowskiej-Curie 24, 15-369 Bialystok, Poland
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Carmen Vidal
- Allergy Department and Faculty of Medicine, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación de Santiago (IDIS) and University of Santiago, 15706 Santiago de Compostela, Spain
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | | | - Pascal Demoly
- University Hospital of Montpellier and IDESP, UMR UA11, University of Montpellier - INSERM, Montpellier, France
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Zeng Z, Li S, Ye Y, Ling Y, Gong Y, Zi X, Yang J, McElwee KJ, Zhang X. Allergen desensitization reduces the severity of relapsed alopecia areata in dust-mite allergic patients. Exp Dermatol 2023. [PMID: 37114716 DOI: 10.1111/exd.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Atopy may be a facilitating factor in some alopecia areata (AA) patients with early disease onset and more severe/extensive AA. The underlying immune mechanisms are unknown, but allergen responses may support a pro-inflammatory environment that indirectly promotes AA. To investigate the long-term effect of allergen immunotherapy (AIT) against house dust mite (HDM) allergy on disease severity and prognosis for AA patients. An observational comparative effectiveness study was conducted on 69 AA patients with HDM allergy. 34 patients received conventional/traditional AA treatment (TrAA) plus AIT (AIT-TrAA), and 35 patients received TrAA alone. Serum total immunoglobulin E (tIgE), HDM specific IgE (sIgE), HDM specific IgG4 (sIgG4) and cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, IL-33, IFNγ) were quantified in these patients, together with 58 non-allergic AA patients and 40 healthy controls. At the end of the 3-year desensitization course, the AIT-TrAA group presented with lower SALT scores than the TrAA group, especially in non-alopecia totalis/universalis (AT/U) patients and pre-adolescent AT/U patients (age ≤ 14). In patients with elevated tIgE levels before AIT, a decrease in tIgE was correlated to reduced extent of AA on completion of the AIT course. After desensitization, elevation of IL-5 and decrease of IL-33 were observed in HDM allergic-AA patients. Desensitization to HDM in allergic AA patients reduces the severity of relapse-related hair loss over the 3-year AIT treatment course, possibly via opposing Th2 dominance. This adjunctive treatment may help reduce disease severity and curtail the disease process in allergic patients with AA.
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Affiliation(s)
- Zixun Zeng
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, P.R. China
| | - Shuifeng Li
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yanting Ye
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yunxia Ling
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yugang Gong
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Xue Zi
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Jian Yang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Kevin J McElwee
- Centre for Skin Sciences, University of Bradford, Bradford, UK
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xingqi Zhang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
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Bastos F, Pinto AC, Nunes A, Simões S. Oromucosal products - Market landscape and innovative technologies: A review. J Control Release 2022; 348:305-320. [PMID: 35660635 DOI: 10.1016/j.jconrel.2022.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
Abstract
Strategies that rely on oral mucosal administration have increased in the last decade and oromucosal products are paving the way to overcome specific challenges, namely improving drug bioavailability when compared with the conventional oral route, due to a reduction of the hepatic first-pass metabolism and pre-systemic degradation. Overall, the advantages of these products make oromucosal route of administration attractive for the development of value-added medicines, which can address more properly the unmet medical needs of specific patients. Generally, such products have an easy and convenient administration since they do not require water for ingestion, which may be particularly relevant for geriatric and pediatric groups, or non-cooperative patients. Usually, the development of these products aims to provide a faster onset of action, critical for acute or emergency treatments. Although oriented to achieve better therapeutic outcomes, today's drug development is primarily focused on patient-centered care, meaning that patients' specific characteristics/needs are an important driving force behind product-development efforts. In accordance, pharmaceutical innovation can rely not only on new drug substances but also on re-formulation of already approved ones or alternative routes of administration, enhancing patient convenience, treatment efficacy and/or safety. Throughout this review, the oromucosal drug products, approved in the last decade, and a retrospective analysis of their critical quality attributes and specifications will be described. Furthermore, trends and opportunities of the latest technologies in this field, as well as the number of ongoing clinical studies, will be presented and discussed.
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Affiliation(s)
- Francisca Bastos
- Bluepharma - Indústria Farmacêutica S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Ana Catarina Pinto
- Bluepharma - Indústria Farmacêutica S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal
| | - António Nunes
- Bluepharma - Indústria Farmacêutica S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal.
| | - Sérgio Simões
- Bluepharma - Indústria Farmacêutica S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; CNC - Center for Neurosciences and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Faculty of Medicine (Polo 1), Rua Larga, 3004-504 Coimbra, Portugal
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Reiber R, Wolf H, Futschik T, Schwab JA, Hölscher U, Schnitker J, Wüstenberg E. Safety and tolerability of the standardized quality house dust mite sublingual immunotherapy tablet in real life: A noninterventional, open-label study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3221-3223.e5. [PMID: 33839345 DOI: 10.1016/j.jaip.2021.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rainer Reiber
- Specialist for Otorhinolaryngology, Allergist, Schorndorf, Germany
| | - Hendrik Wolf
- Clinical Development, ALK-Abelló Arzneimittel GmbH, Hamburg, Germany.
| | - Thomas Futschik
- Specialist for Otorhinolaryngology, Allergist, Dresden, Germany
| | | | - Uwe Hölscher
- Specialist for Otorhinolaryngology, Allergist, Munich, Germany
| | - Jörg Schnitker
- Institut für Angewandte Statistik GmbH, Bielefeld, Germany
| | - Eike Wüstenberg
- Medical Department, ALK-Abelló Arzneimittel GmbH, Hamburg, Germany; Clinic for Otorhinolaryngology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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Incorvaia C, Makri E, Ridolo E, Pellicelli I, Panella L. Advances in allergen immunotherapy as a treatment of asthma. Expert Rev Respir Med 2019; 13:1161-1167. [PMID: 31581868 DOI: 10.1080/17476348.2019.1676153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Specific immunotherapy is the only treatment acting on causes and not only on symptoms of respiratory allergy. It was first introduced as subcutaneous immunotherapy (SCIT) with the aim to induce immunological tolerance to the administered allergen(s). In the 1980s, sublingual immunotherapy (SLIT) was developed, mainly to improve the safety, which was a critical issue at that time.Areas covered: This article reviews the available literature, including a large number of randomized controlled trials, meta-analyses, and real-life studies as well, on the outcomes of SCIT and SLIT concerning the treatment critical issues of the two routes, that are efficacy, safety, cost-effectiveness, and compliance to treatment.Expert opinion: SCIT and SLIT are similarly effective in treating patients with respiratory allergy, providing, based on the induction of typical changes in the immunologic response, an early control of symptoms that steadily increases during the treatment and, once reached the recommended duration of 3 years, continues to work after stopping. This outcome is the major factor influencing the economic advantage of SCIT and SLIT over drug treatment.
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Affiliation(s)
| | - Eleni Makri
- Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy
| | - Erminia Ridolo
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Irene Pellicelli
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Lorenzo Panella
- Department of Rehabilitation and Functional Recovery, ASST Pini/CTO, Milan, Italy
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[Role of non pharmacological Interventions for asthma]. Presse Med 2019; 48:282-292. [PMID: 30871852 DOI: 10.1016/j.lpm.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Smoking cessation remains a major issue for asthmatic smokers. Respiratory rehabilitation and respiratory physiotherapy have shown a benefit in controlling symptoms, preventing exacerbations and improving the quality of life. The control of the environment is crucial and must be approached in a global way. Management of obesity and psychological disorders should be systematically proposed. Allergen immunotherapy may be discussed in allergic persistent asthma to house dust mites. Certain dietary interventions or alternative medicines have not proved their worth.
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Luna-Pech JA. House Dust Mite Tablets Now Officially Accepted as Treatment in GINA: What Is the Evidence and What’s Next? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wang YT, Liu HC, Chen HC, Lee YC, Tsai TC, Chen HL, Fan HC, Chen CM. Oral immunotherapy with the ingestion of house dust mite extract in a murine model of allergic asthma. Allergy Asthma Clin Immunol 2018; 14:43. [PMID: 30356799 PMCID: PMC6190578 DOI: 10.1186/s13223-018-0269-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022] Open
Abstract
Background Allergen-specific immunotherapy (ASIT) has the potential to modify allergic diseases, and it is also considered a potential therapy for allergic asthma. House dust mite (HDM) allergens, a common source of airborne allergen in human diseases, have been developed as an immunotherapy for patients with allergic asthma via the subcutaneous and sublingual routes. Oral immunotherapy with repeated allergen ingestion is emerging as another potential modality of ASIT. The aim of this study was to evaluate the therapeutic efficacy of the oral ingestion of HDM extracts in a murine model of allergic asthma. Methods BABL/c mice were sensitized twice by intraperitoneal injection of HDM extracts and Al(OH)3 on day 1 and day 8. Then, the mice received challenge to induce airway inflammation by intratracheal instillation of HDM extracts on days 29–31. The treatment group received immunotherapy with oral HDM extracts ingestion before the challenge. All the mice were sacrificed on day 32 for bronchoalveolar inflammatory cytokines, mediastinal lymph node T cells, lung histology, and serum HDM-specific immunoglobulins analyses. Results Upon HDM sensitization and following challenge, a robust Th2 cell response and eosinophilic airway inflammation were observed in mice of the positive control group. The mice treated with HDM extracts ingestion had decreased eosinophilic airway inflammation, suppressed HDM-specific Th2 cell responses in the mediastinal lymph nodes, and attenuated serum HDM-specific IgE levels. Conclusions Oral immunotherapy with HDM extracts ingestion was demonstrated to have a partial therapeutic effect in the murine model of allergic asthma. This study may serve as the basis for the further development of oral immunotherapy with HDM extracts in allergic asthma.
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Affiliation(s)
- Yao-Tung Wang
- 1Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,2School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsu-Chung Liu
- 2School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,3Division of Chest Medicine, Department of Internal Medicine, Cheng Ching Hospital, Taichung, Taiwan.,4Department of Life Sciences, College of Life Sciences, National Chung Hsing University, No. 250, Kuo-Kuang Road, Taichung, 402 Taiwan
| | - Hui-Chen Chen
- 5Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yen-Ching Lee
- 4Department of Life Sciences, College of Life Sciences, National Chung Hsing University, No. 250, Kuo-Kuang Road, Taichung, 402 Taiwan
| | - Tung-Chou Tsai
- 4Department of Life Sciences, College of Life Sciences, National Chung Hsing University, No. 250, Kuo-Kuang Road, Taichung, 402 Taiwan
| | - Hsiao-Ling Chen
- Department of Bioresources, Da-Yeh University, Changhwa, Taiwan
| | - Hueng-Chuen Fan
- 7Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuchi, Taichung, 435 Taiwan.,8Department of Medical Research, Tungs' Taichung Metroharbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuchi, Taichung, 435 Taiwan.,Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chuan-Mu Chen
- 4Department of Life Sciences, College of Life Sciences, National Chung Hsing University, No. 250, Kuo-Kuang Road, Taichung, 402 Taiwan.,10The iEGG and Animal Biotechnology Center, National Chung Hsing University, Taichung, Taiwan.,11Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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9
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Bush RK. Dust Mite Tablet Immunotherapy: How Does It Compare and Where Does It Fit? CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Ricketti PA, Alandijani S, Lin CH, Casale TB. Investigational new drugs for allergic rhinitis. Expert Opin Investig Drugs 2017; 26:279-292. [DOI: 10.1080/13543784.2017.1290079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Peter A. Ricketti
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Sultan Alandijani
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Chen Hsing Lin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Thomas B. Casale
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
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