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Gonzalez-Uribe V, Romero-Tapia SJ, Castro-Rodriguez JA. Asthma Phenotypes in the Era of Personalized Medicine. J Clin Med 2023; 12:6207. [PMID: 37834850 PMCID: PMC10573947 DOI: 10.3390/jcm12196207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Asthma is a widespread disease affecting approximately 300-million people globally. This condition leads to significant morbidity, mortality, and economic strain worldwide. Recent clinical and laboratory research advancements have illuminated the immunological factors contributing to asthma. As of now, asthma is understood to be a heterogeneous disease. Personalized medicine involves categorizing asthma by its endotypes, linking observable characteristics to specific immunological mechanisms. Identifying these endotypic mechanisms is paramount in accurately profiling patients and tailoring therapeutic approaches using innovative biological agents targeting distinct immune pathways. This article presents a synopsis of the key immunological mechanisms implicated in the pathogenesis and manifestation of the disease's phenotypic traits and individualized treatments for severe asthma subtypes.
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Affiliation(s)
- Victor Gonzalez-Uribe
- Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, Ciudad de Mexico 06720, Mexico;
- Facultad Mexicana de Medicina, Universidad La Salle México, Ciudad de Mexico 14000, Mexico
| | - Sergio J. Romero-Tapia
- Health Sciences Academic Division (DACS), Universidad Juárez Autónoma de Tabasco, Villahermosa 86040, Mexico;
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
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2
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Vivarelli E, Matucci A, Parronchi P, Liotta F, Cosmi L, Rossi O, Cavigli E, Alessandra V. Primary antibody deficiencies represent an underestimated comorbidity in asthma patients: efficacy of immunoglobulin replacement therapy in asthma control. J Asthma 2022; 60:1227-1236. [PMID: 36282045 DOI: 10.1080/02770903.2022.2140435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Primary antibody deficiencies (PAD) are an underestimated comorbidity in asthma and its treatment could improve disease control. METHODS a retrospective cohort of asthmatics, affected by IgG subclass deficiency or unclassified antibody deficiency and treated with low-dose intravenous immunoglobulin replacement therapy (IRT) was recruited. Demographic and clinical data, chest CT scan, blood eosinophils, atopy, chronic oral corticosteroid (OCS) therapy were evaluated at baseline. Asthma exacerbations, lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI) and asthma-related hospitalizations were assessed after one and two years of IRT. RESULTS 57 moderate-to-severe asthmatics were enrolled, mostly affected by T2 low asthma (39/57, 68.4%). After one year, IRT was effective in improving, irrespective of bronchiectasis, atopy, eosinophils and PAD type: 1) trough IgG (826.9 ± 221.3 vs 942.2 ± 195.1 mg/dl; p < 0.0001) and IgG subclasses (IgG1 355.4 ± 88.4 vs 466.7 ± 122.3, p < 0.0001; IgG2 300.1 ± 130.1 vs 347.6 ± 117.3, p < 0.0005) serum levels. 2) asthma exacerbations (6.4 ± 4.1 vs 2.4 ± 1.9, p < 0.0001), LRTI (4.3 ± 3.9 vs 1.3 ± 1.5, p < 0.0001) and hospitalization rate (0.26 ± 0.7 vs 0.05 ± 0.2, p < 0.01). These results persisted after 2 years of therapy. Estimated mean cumulative OCS exposure was reduced by 4500 mg over the 2-year period. CONCLUSIONS low-dose IRT is effective in improving asthma control and lessening OCS burden in asthmatics affected by PAD.
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Affiliation(s)
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
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3
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Pirola F, Pace GM, Giombi F, Heffler E, Paoletti G, Nappi E, Sanità W, Giulietti G, Giunta G, Ferreli F, Mercante G, Spriano G, Canonica GW, Malvezzi L. Outcomes of Non-Mucosa Sparing Endoscopic Sinus Surgery (Partial Reboot) in Refractory Chronic Rhinosinusitis with Nasal Polyposis: An Academic Hospital Experience. Laryngoscope 2022. [PMID: 36200712 DOI: 10.1002/lary.30422] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The reboot approach could be an effective treatment option to lower recurrence rates (RRs) in recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). The purpose of this study was to investigate RR, recurrence-free survival (RFS), quality of life (QoL) improvement, and oral corticosteroid (OCS) intake in pluri-operated CRSwNP patients treated with partial reboot surgery. METHODS A consecutive sample of patients with recalcitrant CRSwNP, ineligible for monoclonal antibodies, underwent partial reboot surgery. The 22-item SinoNasal Outcome Test (SNOT-22), Visual Analogue Scales (VAS) scores, OCS intake, and endoscopic Nasal Polyp Score (NPS) were collected pre and postoperatively. The main outcomes were RR and RFS, and comparison of disease-free time with previous endoscopic surgeries. RESULTS Thirty pluri-operated patients were enrolled. Before the reboot, all had experienced disease recurrence at a mean recurrence time of 8.08 ± 2.83 months after surgery. After reboot, 7 (23.3%) had recurrence at a mean time of 16.67 ± 3.07 months (p = 0.02); none needed additional revision surgery till time of data collection. RR at 12, 18, and 24 months follow-up resulted significantly lower for reboot than other previous surgeries (p = 0.010, p = 0.002, p = 0.016, respectively); RFS difference resulted significant (log-rank test = 4.16; p = 0.04). Differences between pre-and post-operative total and single-items scores of SNOT-22 were significant (p = 0.001), as well as VAS scores (p = 0.001). Before the reboot, 21 patients (70%) took ≥2 OCS courses per year; at the latest follow-up visit, none had taken any course of OCS after reboot. CONCLUSIONS The reboot approach showed lower RR, longer RFS, improved QoL, and zeroing of OCS uptake. Larger samples and longer follow-up studies are needed to assess long-term efficacy and safety of this procedure. LEVEL OF EVIDENCE Level 4. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 2022. Laryngoscope, 2022.
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Affiliation(s)
- Francesca Pirola
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gian Marco Pace
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Giombi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuele Nappi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - William Sanità
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gaia Giulietti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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4
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Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:31/164/210278. [PMID: 35675922 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
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Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy .,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
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5
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Zhang J, Lu CW, Chen CB, Wang CW, Chen WT, Cheng B, Ji C, Chung WH. Evaluation of Combination Therapy With Etanercept and Systemic Corticosteroids for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Multicenter Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1295-1304.e6. [PMID: 35131514 DOI: 10.1016/j.jaip.2022.01.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) are fatal severe cutaneous adverse reactions, without consensus on the medical treatment. The use of systemic corticosteroids or intravenous immunoglobulin (IVIG) remains debatable. Tumor necrosis factor-alpha inhibitors are potentially effective. OBJECTIVE To evaluate the effectiveness and safety of combination therapy using etanercept combined with corticosteroids or IVIG combined with corticosteroids versus corticosteroid monotherapy for patients with SJS-TEN. METHODS We retrospectively enrolled SJS-TEN patients from Taiwan and the Chinese mainland, during 2014 to 2019. Patients enrolled were treated with corticosteroid monotherapy, or combinations with IVIG or etanercept. We analyzed the clinical characteristics, skin healing time, mortality, and adverse events among these treatment groups. RESULTS Among the 242 patients (187 with SJS or SJS-TEN overlapping and 55 with TEN), patients who received combination therapy with etanercept and corticosteroids had lower actual mortality than those with corticosteroid monotherapy and those with IVIG combined with corticosteroids, respectively (0% vs 6.63% and 4.76%). There was a tendency of reducing standardized (observed/predicted) mortality rate (SMR) based on the Score of Toxic Epidermal Necrolysis in etanercept combined with corticosteroids compared with corticosteroid monotherapy and IVIG combined with corticosteroids therapy (SMR [95% CI] 0 [1.80-3.59], 0.71 [0.83-2.64], 0.30 [0.68-6.22]; P = .006). Etanercept combined with corticosteroids showed a reduced skin healing time (12.0 [8.5-14.0], median days [interquartile range]), compared with corticosteroid monotherapy (13.0 [10.0-18.0]) and IVIG combined with corticosteroids therapy (13.5 [10.0-19.5]); P = .004 and P = .012, respectively). Etanercept combined with corticosteroids also showed a lower incidence of adverse event with gastrointestinal hemorrhage than corticosteroid monotherapy, especially in patients with TEN (P = .001). CONCLUSIONS The tumor necrosis factor-alpha inhibitors and corticosteroids combination therapy was effective and safer than corticosteroid monotherapy for SJS-TEN, and may be considered as an alternative therapy for SJS-TEN patients who responded poorly to conventional corticosteroid therapy.
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Affiliation(s)
- Jing Zhang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chun-Wei Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Ti Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bo Cheng
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chao Ji
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan.
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6
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Bagnasco D, Paggiaro P, Latorre M, Folli C, Testino E, Bassi A, Milanese M, Heffler E, Manfredi A, Riccio AM, De Ferrari L, Blasi F, Canevari RF, Canonica GW, Passalacqua G. Severe asthma: One disease and multiple definitions. World Allergy Organ J 2021; 14:100606. [PMID: 34871335 PMCID: PMC8609160 DOI: 10.1016/j.waojou.2021.100606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.,Pulmonary Unit, Nuovo Ospedale Apuano, Massa, Italy
| | - Chiara Folli
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Elisa Testino
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Arianna Bassi
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Milan, Rozzano, Italy
| | - Andrea Manfredi
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Francesco Blasi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Milano, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Rikki Frank Canevari
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Milan, Rozzano, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Italy
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7
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Lombardi C, Asero R, Bagnasco D, Blasi F, Bonini M, Bussi M, Canevari RF, Canonica GW, Castelnuovo P, Cecchi L, Cosmi L, Gelardi M, Heffler E, Indinnimeo L, Landi M, Licari A, Liotta F, Macchi A, Malvezzi L, Marseglia G, Micheletto C, Musarra A, Peroni D, Piacentini G, Poletti V, Richeldi L, Santoni A, Schiappoli M, Senna G, Vaghi A, Villani A, Passalacqua G. ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments. World Allergy Organ J 2021; 14:100592. [PMID: 34786034 PMCID: PMC8573187 DOI: 10.1016/j.waojou.2021.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022] Open
Abstract
In the recent years, it was recognized that type-2 inflammation links many forms of nasal polyposis with severe asthma. Thus, some biological drugs developed for severe asthma appeared to exert an effect on nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies for severe asthma were assessed also in polyposis, with promising results. Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT, allergists), it was felt that an educational and informative document was needed to better identify the indications of biologicals in nasal polyposis. We collected the main Italian Scientific Societies, and prepared (under the Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all Societies, to provide a provisional statement for the future use of monoclonal antibodies as a medical treatment for polyposis. It is the first nationwide endorsed document on this aspect. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.
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Affiliation(s)
- Carlo Lombardi
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
| | - Matteo Bonini
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mario Bussi
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
| | - Rikki F. Canevari
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Castelnuovo
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
| | - Lorenzo Cecchi
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Matteo Gelardi
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luciana Indinnimeo
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
| | - Massimo Landi
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Alberto Macchi
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | | | - Antonino Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
| | - Diego Peroni
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
| | - Giorgio Piacentini
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
| | | | - Luca Richeldi
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Angela Santoni
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | | | - Alberto Villani
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - ARIA Italia
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
- UOC Pneumologia, Azienda Ospedaliera Universitaria, Verona, Italy
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
- Dipartimento Toracico Azienda USL ROMAGNA (I), Italy
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
- ASST Rodhense Pneumologia, Italy
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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8
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Breathing freely is possible! How to help patients with bronchial asthma and polyposis rhinosinusitis? TERAPEVT ARKH 2021; 93:991-998. [DOI: 10.26442/00403660.2021.08.201050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 11/22/2022]
Abstract
On June 2325, under the auspices of the Year of Science and Technology in Russia, the 17th International Interdisciplinary Congress of Allergology and Rhinosinusitis was held in Moscow. The 17th International Interdisciplinary Congress of Allergology and Immunology, where the results of current research, approaches to therapy and prevention of diseases based on modern clinical guidelines were presented. The event included a symposium "Breathe freely it is possible! How to help patients with bronchial asthma and polyposis rhinosinusitis?" with the participation of leading Russian specialists.
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9
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Paggiaro P, Barbaglia S, Centanni S, Croce D, Desideri E, Giustini S, Micheletto C, Musarra A, Scichilone N, Trama U, Zedda MT, Canonica GW. Overcoming Barriers to the Effective Management of Severe Asthma in Italy. J Asthma Allergy 2021; 14:481-491. [PMID: 34007186 PMCID: PMC8121981 DOI: 10.2147/jaa.s293380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction People with severe asthma (SA) often have poor disease control and quality of life, and are at high risk of exacerbations, lung function decline and asthma-related death. The present expert opinion article aimed to identify unmet needs in the management of SA in Italy, and propose possible solutions to address these needs. Methods At five multidisciplinary events in Italy, attendees identified factors that interfered with the effective management of SA and suggested how these barriers could be overcome. A core group of 12 Italian experts (pulmonologists, general practitioners, allergists, payers and patients) identified the main issues and proposed possible solutions based on the results from the meetings and relevant articles from the literature. Results and Conclusions We reviewed the gap between real-world practice and guidelines, oral corticosteroid overuse, SA-related mortality, and barriers to effective SA treatment. Common themes were lack of awareness about SA among both patients and clinicians, and lack of networking/information exchange between those involved in the treatment of SA. Participants agreed on the need to implement patient education and create multidisciplinary groups of specialists to improve SA management through multidisciplinary educational initiatives, meetings with local experts, development of a flow chart for referral/connection with local experts and specialized centers. Clinical instruments that might help specialists improve SA management included referral networks, integrated care pathways, phenotyping and treatment algorithms, exacerbation tracking, and examination of electronic medical records for patients with uncontrolled asthma. The following actions need to be implemented in Italy: i) maximize the use of advanced therapies, eg, biologics; ii) increase/improve education for physicians and patients; iii) improve multidisciplinary communication and care coordination; iv) introduce regional and local protocols for SA diagnosis and treatment; and v) change the structure of healthcare services to reduce specialist waiting times and facilitate access to biologic therapies.
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Affiliation(s)
- Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Simona Barbaglia
- Associazione Nazionale Pazienti "Respiriamo Insieme", Padova, Italy
| | - Stefano Centanni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | | | - Saffi Giustini
- Italian General Practitioners' Association "SIMG", Florence, Italy.,Local Health Unit of Montale, Pistoia, Italy
| | - Claudio Micheletto
- Cardio-Thoracic Department, Respiratory Unit, Integrated University Hospital, Verona, Italy
| | - Antonino Musarra
- Allergy Unit, National Healthcare System, Reggio Calabria, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Ugo Trama
- Dirigente UOD 06 Politica del Farmaco e Dispositivi, Naples, Italy
| | - Maria Teresa Zedda
- Italian General Practitioners' Association "SIMG", Florence, Italy.,General Practice, Cagliari, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University and Research Hospital-IRCCS, Milan, Italy
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10
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Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma. Sci Rep 2021; 11:5453. [PMID: 33750842 PMCID: PMC7943587 DOI: 10.1038/s41598-021-84895-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/12/2021] [Indexed: 11/09/2022] Open
Abstract
Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics, but not optimally controlled by omalizumab. We retrospectively enrolled uncontrolled severe asthmatic patients who switched from OMA to MEP during the last two years. Information included blood eosinophil count, asthma control test (ACT), spirometry, serum IgE, fractional exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-MEP 12-month standardized total cost per patient was calculated. 33 patients were enrolled: five males, mean age 57 years, disease onset 24 years. At OMA discontinuation, 88% were OCS-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to MEP improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03–0.14), OCS-dependent patients (OR = 0.02, 95% CI 0.005–0.08), and number of lost working days (Δ = − 7.9, 95% CI − 11.2 to − 4.6). Pulmonary function improved, serum IgE, FeNO and eosinophils decreased. Mean annual costs were €12,239 for OMA and €12,639 for MEP (Δ = €400, 95% CI − 1588–2389); the increment due to drug therapy (+ €1,581) was almost offset by savings regarding all other cost items (− €1,181). Patients with severe eosinophilic asthma, not controlled by OMA, experienced comprehensive benefits by switching to MEP with only slight increases in economic costs.
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11
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Bagnasco D, Povero M, Pradelli L, Brussino L, Rolla G, Caminati M, Menzella F, Heffler E, Canonica GW, Paggiaro P, Senna G, Milanese M, Lombardi C, Bucca C, Manfredi A, Canevari RF, Passalacqua G. Economic impact of mepolizumab in uncontrolled severe eosinophilic asthma, in real life. World Allergy Organ J 2021; 14:100509. [PMID: 33598095 PMCID: PMC7846931 DOI: 10.1016/j.waojou.2021.100509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS) which worsen patients' health and increase healthcare spending. Aim of this study was to assess the clinical and economic effect of adding mepolizumab (MEP) for the treatment of these patients. METHODS Patients >18 years old, referred to 8 asthma clinics, starting MEP between May 2017 and December 2018, were enrolled and followed-up for 12 months. Information in the 12 months before mepolizumab were collected retrospectively. The evaluation parameters included: OCS use, number of exacerbations/hospitalizations, concomitant therapies, comorbidity, and annual number of working days lost due to the disease. The primary objective was to compare the annual total cost per patient pre- and post-MEP. Secondary outcomes included rates of exacerbations and number of OCS-dependent patients. RESULTS 106 patients were enrolled in the study: 46 male, median age 58 years. Mean annual cost pre- and post-MEP (cost of biologic excluded) was €3996 and €1,527, respectively. Total savings due to MEP resulted in €2469 (95%CI 1945-2993), 62% due to exacerbations reduction and 33% due to productivity increase. Such savings could fund about 22% of the total cost of MEP for one year. The introduction of MEP induced a clinical benefit by reducing both OCS-dependent patients (OR = 0.12, 95%CI 0.06-0.23) and exacerbation rate (RR = 0.19, 95%CI 0.15-0.24). CONCLUSIONS Patients with severe eosinophilic asthma experienced a clinical benefit in asthma control adding MEP to standard therapy. Biologic therapy can be, partially, funded by the savings produced by patients' improvement.
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Key Words
- ACT, Asthma Control Test
- Anti IL-5
- CI, Confidence Intervals
- COPD, chronic obstructive pulmonary disease
- Comorbidities
- FeNO, fractional nitric oxide
- GERD, gastroesophageal reflux disease
- ICS, inhaled corticosteroids
- IQR, interquartile range
- LABA, long acting beta 2 agonist
- LAMA, long acting muscarinic antagonist
- LOS, Length of stay
- MEP, Mepolizumab
- Mepolizumab
- OCS
- OCS, Oral Corticosteroids
- OR, Odds Ratio
- Pharmacoeconomics
- RCTs, Randomized Controlled Trials
- RR, Rate Ratio
- SD, Standard Deviation
- Severe asthma
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
| | | | | | - Luisa Brussino
- Mauriziano Hospital of Torino, Department of Medical Science, University of Torino, Italy
| | - Giovanni Rolla
- Mauriziano Hospital of Torino, Department of Medical Science, University of Torino, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Menzella
- Azienda USL di Reggio Emilia-IRCSS, Santa Maria Nuova Hospital- Pneumology Unit, Reggio Emilia, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center – IRCCS – Rozzano (Milan), Italy
- Department of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center – IRCCS – Rozzano (Milan), Italy
- Department of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Caterina Bucca
- Azienda Ospedale-Università Città della Salute e della Scienza, S.C. Pneumologia, Dept. of Medical Sciences University of Turin, Turin
| | - Andrea Manfredi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
| | - Rikki Frank Canevari
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
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12
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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13
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Castagnoli R, Licari A, Brambilla I, Tosca M, Ciprandi G, Marseglia GL. An update on the role of chronic rhinosinusitis with nasal polyps as a co-morbidity in severe asthma. Expert Rev Respir Med 2020; 14:1197-1205. [PMID: 32875924 DOI: 10.1080/17476348.2020.1812388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis and asthma are heterogeneous diseases with complex pathogenesis. The presence of chronic rhinosinusitis with nasal polyps has been associated with increased asthma exacerbation frequency and may represent a predictor of future exacerbations in severe asthma. AREAS COVERED This review provides the clinician with an overview of the prevalence and clinical impact of the chronic rhinosinusitis with nasal polyps in severe asthma and summarizes recommended therapeutic approaches, including innovative biologic therapies. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed and ClinicalTrials.gov databases, using terms 'chronic rhinosinusitis with nasal polyps' AND 'asthma' OR 'severe asthma.' The literature review was performed for publication years 2010-2020, restricting the articles to humans and English language publications. EXPERT OPINION Biological therapies have opened new perspectives in the treatment of upper and lower airway allergic diseases. Care pathways in severe asthma are almost consolidated, while they still rely on phenotypic rather than endotypic features in chronic rhinosinusitis with nasal polyps. Unveiling the correlation between clinical phenotypes and molecular endotypes will allow better stratification of patients with chronic rhinosinusitis with nasal polyps to identify candidates who benefit most from biological therapy.
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Affiliation(s)
- Riccardo Castagnoli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia, Italy
| | - Ilaria Brambilla
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia, Italy
| | - Mariangela Tosca
- Pediatric Allergy Center, Istituto Giannina Gaslini , Genoa, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia, Italy
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14
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Scichilone N, Barnes PJ, Battaglia S, Benfante A, Brown R, Canonica GW, Caramori G, Cazzola M, Centanni S, Cianferoni A, Corsico A, De Carlo G, Di Marco F, Gaga M, Hawrylowicz C, Heffler E, Matera MG, Matucci A, Paggiaro P, Papi A, Popov T, Rogliani P, Santus P, Solidoro P, Togias A, Boulet LP. The Hidden Burden of Severe Asthma: From Patient Perspective to New Opportunities for Clinicians. J Clin Med 2020; 9:jcm9082397. [PMID: 32727032 PMCID: PMC7463666 DOI: 10.3390/jcm9082397] [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: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Severe asthma is an important topic in respiratory diseases, due to its high impact on morbidity and mortality as well as on health-care resources. The many challenges that still exist in the management of the most difficult-to-treat forms of the disease, and the acknowledgement of the existence of unexplored areas in the pathophysiological mechanisms and the therapeutic targets represent an opportunity to gather experts in the field with the immediate goals to summarize current understanding about the natural history of severe asthma and to identify gaps in knowledge and research opportunities, with the aim to contribute to improved medical care and health outcomes. This article is a consensus document from the “International Course on Severe Asthma” that took place in Palermo, Italy, on May 10–11, 2019. Emerging topics in severe asthma were addressed and discussed among experts, with special focus on patient’s needs and research opportunities, with the aim to highlight the unanswered questions in the diagnostic process and therapeutic approach.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
- Correspondence: ; Tel.: +39-091-655-2146
| | - Peter John Barnes
- Airway Disease Section, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Robert Brown
- Department of Anesthesiology and Critical Care Medicine, Medicine, Department of Medicine, Division of Pulmonary Medicine, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Giorgio Walter Canonica
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Gaetano Caramori
- Respiratory Medicine Unit, Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging (BIOMORF), University of Messina, 98122 Messina, Italy;
| | - Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Antonella Cianferoni
- Pediatrics Department, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics – University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe De Carlo
- The European Federation of Allergy and Airways Diseases Patients Associations (EFA), 1000 Brussels, Belgium;
| | - Fabiano Di Marco
- Respiratory Unit, ASST - Papa Giovanni XXIII Hospital, Bergamo, University of Milan, 24127 Milan, Italy;
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Asthma Cen, Athens Chest Hospital, 11527 Athens, Greece;
| | - Catherine Hawrylowicz
- Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Enrico Heffler
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50139 Florence, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Todor Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, 1431 Sofia, Bulgaria;
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Paolo Solidoro
- Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy;
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20814, USA;
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15
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Fu Z, Xu Y, Cai C. Efficacy and safety of omalizumab in children with moderate-to-severe asthma: a meta-analysis. J Asthma 2020; 58:1350-1358. [PMID: 32602383 DOI: 10.1080/02770903.2020.1789875] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of omalizumab in children with moderate-to-severe asthma.Data sources: We systematically searched MEDLINE, EMBASE, and Cochrane for randomized controlled trials (RCTs ) (inception to January 2020).Study selections: All RCTs which were conducted in childhood and adolescence with asthma and compared the efficacy or safety of omalizumab were adopted. RESULTS Three studies with four publications including 1380 pediatric patients met our criteria. For children with moderate-to-severe asthma, omalizumab decreased asthma exacerbations rate (OR 0.51, 95% CI: 0.44-0.58, p < 0.001) compared with placebo with no evidence of heterogeneity. Omalizumab reduced the rate of asthma exacerbations 0.58) with treatment period ≥30 weeks (p for heterogeneity = 0.03). Omalizumab treated patients had an excellent or good response rate of treatment effectiveness assessed by physicians (2.75, 2.45-3.09) and a bigger reduction in the dosage of inhaled corticosteroid (ICS) at the end of follow-up. For children with severe asthma, omalizumab also reduced the likelihood of asthma exacerbations and increased the odd of treatment effectiveness rated as excellent or good. Patients receiving omalizumab had a lower incidence of severe adverse events (0.36, 0.22-0.57). CONCLUSIONS These findings suggested that omalizumab had beneficial effects on moderate-to-severe asthma in children. Patients may benefit more from long-term use of omalizumab. In addition, omalizumab reduces the rate of serious adverse events requiring hospitalizations.
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Affiliation(s)
- Zhuo Fu
- Tianjin Medical University, Tianjin, PR China.,Respiratory Department, Tianjin Children's Hospital, Tianjin, PR China
| | - Yongsheng Xu
- Respiratory Department, Tianjin Children's Hospital, Tianjin, PR China
| | - Chunquan Cai
- Department of Neurosurgery, Tianjin Institute of Pediatrics, Tianjin Children's Hospital, Tianjin, PR China
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16
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Bagnasco D, Brussino L, Bonavia M, Calzolari E, Caminati M, Caruso C, D'Amato M, De Ferrari L, Di Marco F, Imeri G, Di Bona D, Gilardenghi A, Guida G, Lombardi C, Milanese M, Nicolini A, Riccio AM, Rolla G, Santus P, Senna G, Passalacqua G. Efficacy of Benralizumab in severe asthma in real life and focus on nasal polyposis. Respir Med 2020; 171:106080. [PMID: 32917354 DOI: 10.1016/j.rmed.2020.106080] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Severe asthma occurs in 5-10% of asthmatic patients, with nasal polyposis as one of the most frequent comorbidity. Benralizumab was recently marketed, thus we could analyse its effects in real-life in severe asthma, and compare the effects of the drug in patients with and without polyposis. METHODS Patients with severe asthma, receiving Benralizumab were enrolled in Italian asthma centres. The efficacy criteria for asthma (exacerbation rate, oral corticosteroid intake, hospitalizations, pulmonary function, exhaled nitric oxide) were evaluated at baseline and after 24 weeks of treatment. Patients were then sub-analysed according to the presence/absence of nasal polyposis. RESULTS Fifty-nine patients with severe uncontrolled asthma (21 males, age range 32-78) and treated with benralizumab for at least 24 weeks has been evaluated, showing significant improvements in asthma-related outcomes, except for pulmonary function and exhaled nitric oxide. This included a reduction in the sino-nasal outcome-22 score versus baseline of 13.7 points (p = .0037) in the 34 patients with nasal polyposis. Anosmia disappeared in 31% patients (p = .0034). When comparing the groups with and without nasal polyposis, a similar reduction of exacerbations was seen, with a greater reduction of the steroid dependence in patients with polyposis (-72% vs -53%; p < .0001), whereas lung function was significantly more improved (12% vs 34%, p = .0064) without polyposis patients. CONCLUSIONS Benralizumab, after 6 months of treatment, confirmed its efficacy in severe asthma, and also in nasal polyposis, which is the most frequent comorbidity. The efficacy of Benralizumab in reducing steroid dependence was even higher in patients with polyposis.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy.
| | - Luisa Brussino
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Marco Bonavia
- Pneumology Unit, Ospedale La Colletta, Arenzano, Italy
| | - Elisa Calzolari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - Maria D'Amato
- Department of Pneumology, AO "Dei Colli" Federico II University, Naples, Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianluca Imeri
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Andrea Gilardenghi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce e Carle, Cuneo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giovanni Rolla
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Division of Respiratory Diseases, Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Via G.B. Grassi, 74-20157, Milano, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
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17
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Malipiero G, Heffler E, Pelaia C, Puggioni F, Racca F, Ferri S, Spinello L, Merigo M, Lamacchia D, Cataldo G, Sansonna M, Canonica GW, Paoletti G. Allergy clinics in times of the SARS-CoV-2 pandemic: an integrated model. Clin Transl Allergy 2020; 10:23. [PMID: 32566128 PMCID: PMC7299638 DOI: 10.1186/s13601-020-00333-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Almost the entire World is experiencing the Coronavirus-Disease-2019 (COVID-19) pandemic, responsible, at the end of May 2020, of more than five million people infected worldwide and about 350,000 deaths. In this context, a deep reorganization of allergy clinics, in order to ensure proper diagnosis and care despite of social distancing measures expose, is needed. MAIN TEXT The reorganization of allergy clinics should include programmed checks for severe and poorly controlled patients, application of digital medicine service for mild-to-moderate disease in well-controlled ones, postponement of non urgent diagnostic work-ups and domiciliation of therapies, whenever possible. As far as therapies, allergen immunotherapy (AIT) should not be stopped and sublingual immunotherapy (SLIT) fits perfectly for this purpose, since a drug home-delivery service can be activated for the entire pandemic duration. Moreover, biologic agents for severe asthma, chronic spontaneous urticaria and atopic dermatitis should be particularly encouraged to achieve best control possible of severe disease in times of COVID-19 and, whenever possible, home-delivery and self-administration should be the preferred choice. CONCLUSION During COVID-19 pandemic, allergists have the responsibility of balancing individual patients' needs with public health issues, and innovative tools, such as telemedicine and digital medicine services, can be helpful to reduce the risk of viral spreading while delivering up-to-date personalized care.
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Affiliation(s)
- Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University “Magna Grecia” of Catanzaro, Catanzaro, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Lina Spinello
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Morena Merigo
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Melissa Sansonna
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
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18
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Bagnasco D, Brussino L, Caruso C, Paoletti G, Heffler E, Guida G, Calzolari E, Nicola S, De Ferrari L, Passalacqua G, Canonica GW. Do the current guidelines for asthma pharmacotherapy encourage over-treatment? Expert Opin Pharmacother 2020; 21:1283-1286. [PMID: 32401551 DOI: 10.1080/14656566.2020.1759551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa, Italy
| | - Luisa Brussino
- Mauriziano Hospital, Department of Medical Science, University of Turin , Turin, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS , Rome, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce E Carle , Cuneo, Italy
| | - Elisa Calzolari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa, Italy
| | - Stefania Nicola
- Mauriziano Hospital, Department of Medical Science, University of Turin , Turin, Italy
| | - Laura De Ferrari
- 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
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
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19
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Canonica GW, Malvezzi L, Blasi F, Paggiaro P, Mantero M, Senna G, Heffler E. Chronic rhinosinusitis with nasal polyps impact in severe asthma patients: Evidences from the Severe Asthma Network Italy (SANI) registry. Respir Med 2020; 166:105947. [PMID: 32250875 DOI: 10.1016/j.rmed.2020.105947] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical and laboratory features of patients enrolled in the Severe Asthma Network in Italy (SANI) registry, a web-based observatory collecting demographic, clinical, functional and inflammatory data of patients with severe asthma were evaluated, with a special emphasis to chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS For each eligible patients the following information has been collected: demographic data, clinical features, asthma control in the previous month according to the GINA (Global INitiative for Asthma) Guidelines and standardized questionnaires, concomitant regular and on demand treatments and inflammatory markers. RESULTS 695 patients with severe asthma enrolled in 66 SANI centers were analyzed. The prevalence of chronic rhinosinusitis with nasal polyposis was 40.6%. Atopic dermatitis and bronchiectasis was significantly more frequent in patients with CRSwNP than in subjects without nasal polyposis; similarly, FeNO values are significantly higher in subject with CRSwNP than in patients without nasal polyposis. Finally, patients with CRSwNP had a significantly higher number of asthma exacerbations per year, more days on oral corticosteroids and were more likely to be OCS long term users. CONCLUSION OCS sparing is needed in patients with severe asthma, mainly in subjects with CRSwNP, adopting adequate strategies such as a better adherence to the treatment with inhaled therapy according to the GINA recommendations, the use of biologic agents and a multidisciplinary approach of the patient.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Luca Malvezzi
- Otolaryngology, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Mantero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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20
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Bagnasco D, Passalacqua G, Caminati M, Heffler E, Menzella F, De Ferrari L, Riccio AM, Folli C, Canonica GW. Evolving phenotypes to endotypes: is precision medicine achievable in asthma? Expert Rev Respir Med 2020; 14:163-172. [PMID: 31899999 DOI: 10.1080/17476348.2020.1703675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: The development of biologic molecules led to a drastic change in the therapeutic approach to asthma. With the prospect of acting on different pathophysiological mechanisms of the disease, the idea of precision medicine was developed, in which a single molecule is able to modify a specific triggering mechanism. Thus, it seemed limiting to stop at the distinction of patients phenotypes and the concept of endotypes became more relevant in the therapeutic approach.Areas covered: This review deepened the topic of precision medicine through the transition from phenotyping to endotyping. We performed a review of the literature, preferring articles quoted in Medline and published in journals with an impact factor. Results showed that it is fundamental to take into consideration the role of biomarkers and the related therapies currently available for precision medicine.Expert opinion: The possible overlap of patients in different phenotypes requires a more precise classification, which considers endotypization. With the development of biological drugs able to modify and modulate some pathophysiological mechanisms of the disease, the theoretical concept of endotyping becomes practical, allowing the clinician to choose the specific mechanism to 'attack' in order to control the disease.
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Affiliation(s)
- Diego Bagnasco
- 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
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova- IRCCS, Reggio Emilia, Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Chiara Folli
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS, Milan, Italy
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Rhyou HI, Nam YH. Efficacy of Allergen Immunotherapy for Allergic Asthma in Real World Practice. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:99-109. [PMID: 31743967 PMCID: PMC6875479 DOI: 10.4168/aair.2020.12.1.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 12/30/2022]
Abstract
Purpose Allergen immunotherapy (AIT) induces immunological tolerance, and there is increasing evidence of the clinical efficacy of AIT in the treatment of allergic asthma. However, the optimal parameters for asthma control in clinical trials are still unclear. We investigated the efficacy of AIT with respect to changes in the inhaled corticosteroid (ICS) dose in patients with allergic asthma. Methods A total of 117 adults with allergic asthma who had used ICS for more than 1 year in a single tertiary hospital in Korea were included in this retrospective study. We compared the clinical parameters and outcomes between the AIT group (ICS with AIT, n = 48) and the non-AIT group (ICS without AIT, n = 69) by applying an inverse probability of treatment weighting method. The patients in the AIT group had received subcutaneous AIT monthly as a maintenance treatment for more than 1 year. The changes in the ICS dose from baseline were evaluated in the 2 groups for 3 years. Results The proportion of responders who discontinued or decreased in the ICS dose with achieving control status of asthma was significantly higher in the AIT group than in the non-AIT group throughout the study period (at 6 months, 52.1% vs. 24.6%; at 1 year, 70.8% vs. 34.7%; at 2 years, 89.5% vs. 35.6%; at 3 years, 96.3% vs. 51.2%). Treatment responses did not differ significantly by type of allergen (single- or multi-allergens or 3 different products) used throughout the study period. Conclusions Irrespective of the type of allergen, long-term maintenance AIT helps to spare ICS dose and achieve better control in patients with allergic asthma in real-world clinical practice.
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Affiliation(s)
- Hyo In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Young Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
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22
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Bagnasco D, Menzella F, Caminati M, Caruso C, Guida G, Bonavia M, Riccio A, Milanese M, Manfredi A, Senna G, Passalacqua G. Efficacy of mepolizumab in patients with previous omalizumab treatment failure: Real-life observation. Allergy 2019; 74:2539-2541. [PMID: 31166605 DOI: 10.1111/all.13937] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit Arcispedale Santa Maria Nuova‐ IRCCS, Azienda USL di Reggio Emilia Reggio Emilia Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit Verona University and General Hospital Verona Italy
| | - Cristiano Caruso
- Allergy Unit Fondazione Policlinico A. Gemelli, IRCSS Rome Italy
| | - Giuseppe Guida
- Department of Medical Sciences University of Torino Turin Italy
| | | | - Annamaria Riccio
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Manlio Milanese
- Division of Pneumology S.Corona Hospital Pietra Ligure Italy
| | - Andrea Manfredi
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit Verona University and General Hospital Verona Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
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23
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Bagnasco D, Caminati M, Menzella F, Milanese M, Rolla G, Lombardi C, Bucca C, Heffler E, Paoletti G, Testino E, Manfredi A, Caruso C, Guida G, Senna G, Bonavia M, Riccio AM, Canonica GW, Passalacqua G. One year of mepolizumab. Efficacy and safety in real-life in Italy. Pulm Pharmacol Ther 2019; 58:101836. [PMID: 31473366 DOI: 10.1016/j.pupt.2019.101836] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Severe asthma is a disease with a heavy socio-economic burden and a relevant impact on the life of patients. Mepolizumab (MEP) was recently introduced in practice. The previous data were favourable as efficacy and safety are concerned. Nowadays, we can report the clinical data after more than one year of use of MEP in the real-life setting. OBJECTIVE To evaluate the efficacy and safety of MEP in a real life framework, mainly concerning asthma exacerbations, steroid dependence, effects on respiratory function and adverse events. METHODS This retrospective analysis was performed on 138 patients, treated with MEP for at least 12 months, and referred to eleven severe asthma clinics in Italy. All patients met the criteria for severe uncontrolled asthma according to ATS/ERS guidelines and prescribing MEP conditions according to the Italian Drug Agency (AIFA). RESULTS We could observe 138 patients (78 female, age 58 ± 10 years). The average age of onset of asthma was 34 ± 16 years. The blood eosinophil count decreased from 822 ± 491/μL at baseline to 117 ± 96/μL (p < .0001) after 12 months of therapy. Exacerbations decreased from 3.8/year to 0.7/year (-81%; p < .0001). Steroid-dependent patients before MEP (80%) with a daily dose of 10.1 ± 9.4 mg prednisone decrease at 28% after 12 months with a mean of 2.0 ± 4.2 mg/day (p < .0001). The occurrence of adverse events was overall low. CONCLUSIONS & CLINICAL RELEVANCE In this real-life setting, MEP confirmed its efficacy and safety profile, already shown in clinical trials. This was apparent concerning exacerbation rate, systemic steroids intake and safety.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Menzella
- Azienda USL di Reggio Emilia-IRCSS, Santa Maria Nuova Hospital- Pneumology Unit, Reggio Emilia, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Rolla
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Caterina Bucca
- Azienda Ospedale-Università Città della Salute e della Scienza, S.C. Pneumologia, Turin, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Elisa Testino
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Andrea Manfredi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce e Carle, Cuneo, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | | | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy.
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24
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Asthma from immune pathogenesis to precision medicine. Semin Immunol 2019; 46:101294. [PMID: 31387788 DOI: 10.1016/j.smim.2019.101294] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
Asthma is characterized by multiple immunological mechanisms (endotypes) determining variable clinical presentations (phenotypes). The identification of endotypic mechanisms is crucial to better characterize patients and to identify tailored therapeutic approaches with novel biological agents targeting specific immunological pathways. This review focused on summarizing the major immunological mechanisms involved in the pathogenesis of asthma, as well as on discussing the emergence of phenotypic features of the disease. Novel biological agents and other drugs targeting specific endotypes are discussed, as their use represent a precision medicine approach to the disease that is nowadays mandatory particularly for treating more severe patients.
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Menzella F, Latorre M, Ruggiero P, Bagnasco D, Heffler E. Reduction of oral corticosteroids in patients with severe eosinophilic asthma treated with Benralizumab: could it represent a marker of treatment efficacy? Expert Opin Biol Ther 2019; 19:601-606. [PMID: 31033373 DOI: 10.1080/14712598.2019.1613367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Subjects with severe Th2-high endotype usually respond to oral corticosteroids (OCS). However, they often require high dosages with incremental side effects and health-care costs. The advent of biological therapies provides an effective strategy to improve asthma control, as well as reduce OCS use. Various molecules have been developed, each targeting different pathways. We analyzed the two anti-IL-5 strategies, benralizumab and mepolizumab, based on pivotal trials (RCTs), mechanisms of action and their possible role on the steroid-sparing effect. Areas covered: This review analyzes the data from the benralizumab and mepolizumab RCTs, focusing on the advantages of each drug on clinical efficacy and the steroid-sparing effect. Expert opinion: Benralizumab may represent a promising therapeutic option in the treatment of eosinophilic asthma, due to its mechanism of action, which rapidly allows a reduction in the eosinophils' number, and a greater steroid-sparing effect.
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Affiliation(s)
- Francesco Menzella
- a Department of Medical Specialties, Pneumology Unit , Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS , Reggio Emilia , Italy
| | - Manuela Latorre
- b Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Patrizia Ruggiero
- a Department of Medical Specialties, Pneumology Unit , Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS , Reggio Emilia , Italy
| | - Diego Bagnasco
- c Allergy & Respiratory Diseases, DIMI Department of Internal Medicine , University of Genoa, IRCCS AOU San Martino-IST , Genoa , Italy
| | - Enrico Heffler
- d Personalized Medicine, Asthma and Allergy , Humanitas Research Hospital , Rozzano , Italy
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Canonica GW, Colombo GL, Bruno GM, Di Matteo S, Martinotti C, Blasi F, Bucca C, Crimi N, Paggiaro P, Pelaia G, Passalaqua G, Senna G, Heffler E. Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12:100007. [PMID: 30937132 PMCID: PMC6439414 DOI: 10.1016/j.waojou.2018.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. METHODS The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. RESULTS Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. CONCLUSIONS Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Lorenzo Colombo
- Drug Science Department, Pavia University, Italy
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Giacomo Matteo Bruno
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Sergio Di Matteo
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Chiara Martinotti
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS “Cà Granda – Ospedale Maggiore Policlinico”, Milan, Italy
| | - Caterina Bucca
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Molinette “Città della Salute e della Scienza”, Department of Medical Sciences, University of Torino, Italy
| | - Nunzio Crimi
- Allergy and Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit – University Magna Graecia of Catanzaro, Italy
| | - Giovanni Passalaqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI) – University of Genoa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Heffler E, Brussino L, Del Giacco S, Paoletti G, Minciullo PL, Varricchi G, Scadding G, Malvezzi L, De Virgilio A, Spriano G, Puggioni F, Fornero M, Rolla G, Canonica GW. New drugs in early-stage clinical trials for allergic rhinitis. Expert Opin Investig Drugs 2019; 28:267-273. [PMID: 30676119 DOI: 10.1080/13543784.2019.1571581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is the most common allergic disease, and it has a relevant impact on the quality of life of the patient. Treatment of AR includes a combination of strategies of proven efficacy and effectiveness; however, a relevant proportion of patients remain uncontrolled. AREAS COVERED This review article summarizes emerging therapeutic approaches to AR; these approaches include nasal sprays, oral drugs, alternative allergen immunotherapy administration routes, and biologic agents. EXPERT OPINION The agents discussed require further clinical trials to prove their efficacy in the treatment of AR. Some of these agents, in particular, allergen immunotherapies and biologics, have the potential to form crucial precision medicine approaches to AR. Those that prove their efficacy in clinical trials must also be evaluated from a pharmacoeconomic perspective, possibly in real-life studies; this will define which therapeutic strategies achieve the most convenient and cost-effective ratio, thus yielding a novel opportunity for the most severe and previously treatment-resistant allergic patients.
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Affiliation(s)
- Enrico Heffler
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Luisa Brussino
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Stefano Del Giacco
- d Department of Medical Sciences 'M. Aresu,' Allergy and Clinical Immunology Unit , University of Cagliari , Cagliari , Italy
| | - Giovanni Paoletti
- b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Paola Lucia Minciullo
- e Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology , University Hospital 'G. Martino' , Messina , Italy
| | - Gilda Varricchi
- f Department of Translational Medical Sciences and Center for Basic and Clinical Immunology , University of Napoli Federico II , Napoli , Italy
| | - Guy Scadding
- g Allergy and Clinical Immunology, Division of Respiratory Science , National Heart and Lung Institute, Imperial College, Royal Brompton Hospital , London , UK
| | - Luca Malvezzi
- h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Armando De Virgilio
- h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Giuseppe Spriano
- b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy.,h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Francesca Puggioni
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Monica Fornero
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Giovanni Rolla
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Giorgio Walter Canonica
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
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