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Papadopoulos NG, Bacharier LB, Jackson DJ, Deschildre A, Phipatanakul W, Szefler SJ, Gall R, Ledanois O, Jacob-Nara JA, Sacks H. Type 2 Inflammation and Asthma in Children: A Narrative Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2310-2324. [PMID: 38878861 DOI: 10.1016/j.jaip.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/22/2024]
Abstract
Increased understanding of the underlying pathophysiology has highlighted the heterogeneity of asthma and identified that most children with asthma have type 2 inflammation with elevated biomarkers, such as blood eosinophils and/or fractional exhaled nitric oxide. Although in the past most of these children may have been categorized as having allergic asthma, identifying the type 2 inflammatory phenotype provides a mechanism to explain both allergic and non-allergic triggers in pediatric patients with asthma. Most children achieve control with low to medium doses of inhaled corticosteroids. However, in a small but significant proportion of children, asthma remains uncontrolled despite maximum conventional treatment, with an increased risk of severe exacerbations. In this review, we focus on the role of type 2 inflammation and allergic processes in children with asthma, together with evidence of the efficacy of available treatment options for those who experience severe symptoms.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy and Clinical Immunology Unit, Second Pediatric Clinic, University of Athens, Athens, Greece; Lydia Becker Institute of Immunity and Inflammation, The University of Manchester, Manchester, United Kingdom.
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Antoine Deschildre
- University Lille, CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Department of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Stanley J Szefler
- Section of Pediatric Pulmonary and Sleep Medicine, Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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2
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Schepel IRM, Banzon TM, Phipatanakul W. Future of biologics in pediatric asthma: Optimizing response, early introduction, and equitable access to treatment. Ann Allergy Asthma Immunol 2024; 132:13-20. [PMID: 37652232 PMCID: PMC10842489 DOI: 10.1016/j.anai.2023.08.597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To evaluate the current evidence, its limitations, and future research directions for the use of biologics in pediatric asthma, with a particular focus on the potential use of biologics to prevent pediatric asthma and equity issues in access to biologic treatment and research participation. DATA SOURCES PubMed articles about the use of biologics in pediatric asthma were searched up to May 2023. STUDY SELECTIONS Recent (2019-2023) original research articles and reviews were prioritized. RESULTS Although there are now 5 U.S. Food and Drug Administration-approved biologics for use in pediatric asthma, there are important knowledge gaps that ongoing research seeks to address, which include (1) the long-term efficacy and safety of using biologics in children, (2) the comparative efficacy of different biologics, (3) multi-omics-based classification of asthma endotypes and phenotypes in children to find potential new therapeutic targets and enable identification and validation of new biomarkers that may predict and help monitor response to treatment, and (4) whether starting biologics in early childhood can modify the natural history of asthma and potentially prevent asthma development. SUMMARY To promote equitable access to biologics and optimize asthma outcomes, future research should recruit patients across the full spectrum of socioeconomic and racial/ethnic backgrounds. Large-scale national and international collaborations between asthma researchers and clinicians are also necessary to fully understand the role of biologics in pediatric asthma.
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Affiliation(s)
- Ianthe R M Schepel
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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3
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Sardon-Prado O, Diaz-Garcia C, Corcuera-Elosegui P, Korta-Murua J, Valverde-Molina J, Sanchez-Solis M. Severe Asthma and Biological Therapies: Now and the Future. J Clin Med 2023; 12:5846. [PMID: 37762787 PMCID: PMC10532431 DOI: 10.3390/jcm12185846] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Recognition of phenotypic variability in pediatric asthma allows for a more personalized therapeutic approach. Knowledge of the underlying pathophysiological and molecular mechanisms (endotypes) of corresponding biomarkers and new treatments enables this strategy to progress. Biologic therapies for children with severe asthma are becoming more relevant in this sense. The T2 phenotype is the most prevalent in childhood and adolescence, and non-T2 phenotypes are usually rare. This document aims to review the mechanism of action, efficacy, and potential predictive and monitoring biomarkers of biological drugs, focusing on the pediatric population. The drugs currently available are omalizumab, mepolizumab, benralizumab, dupilumab, and 1ezepelumab, with some differences in administrative approval prescription criteria between the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Previously, we described the characteristics of severe asthma in children and its diagnostic and therapeutic management.
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Affiliation(s)
- Olaia Sardon-Prado
- Division of Paediatric Respiratory Medicine, Donostia University Hospital, 20014 San Sebastián, Spain; (O.S.-P.); (P.C.-E.); (J.K.-M.)
- Department of Pediatrics, University of the Basque Country (UPV/EHU), 20014 Leioa, Spain
| | - Carolina Diaz-Garcia
- Paediatric Pulmonology and Allergy Unit, Santa Lucia General University Hospital, 30202 Cartagena, Spain;
| | - Paula Corcuera-Elosegui
- Division of Paediatric Respiratory Medicine, Donostia University Hospital, 20014 San Sebastián, Spain; (O.S.-P.); (P.C.-E.); (J.K.-M.)
| | - Javier Korta-Murua
- Division of Paediatric Respiratory Medicine, Donostia University Hospital, 20014 San Sebastián, Spain; (O.S.-P.); (P.C.-E.); (J.K.-M.)
| | - Jose Valverde-Molina
- Department of Paediatrics, Santa Lucía General University Hospital, 30202 Cartagena, Spain
- IMIB Biomedical Research Institute, 20120 Murcia, Spain;
| | - Manuel Sanchez-Solis
- IMIB Biomedical Research Institute, 20120 Murcia, Spain;
- Department of Pediatrics, University of Murcia, 20120 Murcia, Spain
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children’s Hospital, 20120 Murcia, Spain
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4
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Subasri M, Cressman C, Arje D, Schreyer L, Cooper E, Patel K, Ungar WJ, Barwick M, Denburg A, Hayeems RZ. Translating Precision Health for Pediatrics: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:897. [PMID: 37238445 PMCID: PMC10217253 DOI: 10.3390/children10050897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
Precision health aims to personalize treatment and prevention strategies based on individual genetic differences. While it has significantly improved healthcare for specific patient groups, broader translation faces challenges with evidence development, evidence appraisal, and implementation. These challenges are compounded in child health as existing methods fail to incorporate the physiology and socio-biology unique to childhood. This scoping review synthesizes the existing literature on evidence development, appraisal, prioritization, and implementation of precision child health. PubMed, Scopus, Web of Science, and Embase were searched. The included articles were related to pediatrics, precision health, and the translational pathway. Articles were excluded if they were too narrow in scope. In total, 74 articles identified challenges and solutions for putting pediatric precision health interventions into practice. The literature reinforced the unique attributes of children and their implications for study design and identified major themes for the value assessment of precision health interventions for children, including clinical benefit, cost-effectiveness, stakeholder values and preferences, and ethics and equity. Tackling these identified challenges will require developing international data networks and guidelines, re-thinking methods for value assessment, and broadening stakeholder support for the effective implementation of precision health within healthcare organizations. This research was funded by the SickKids Precision Child Health Catalyst Grant.
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Affiliation(s)
- Mathushan Subasri
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Celine Cressman
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Danielle Arje
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Leighton Schreyer
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Erin Cooper
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Komal Patel
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Wendy J. Ungar
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Avram Denburg
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Robin Z. Hayeems
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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5
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van den Berg S, Hashimoto S, Golebski K, Vijverberg SJH, Kapitein B. Severe acute asthma at the pediatric intensive care unit: can we link the clinical phenotypes to immunological endotypes? Expert Rev Respir Med 2021; 16:25-34. [PMID: 34709100 DOI: 10.1080/17476348.2021.1997597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The clinical phenotype of severe acute asthma at the pediatric intensive care unit (PICU) is highly heterogeneous. However, current treatment is still based on a 'one-size-fits-all approach'. AREAS COVERED We aim to give a comprehensive description of the clinical characteristics of pediatric patients with severe acute asthma admitted to the PICU and available immunological biomarkers, providing the first steps toward precision medicine for this patient population. A literature search was performed using PubMed for relevant studies on severe acute (pediatric) asthma. EXPERT OPINION Omics technologies should be used to investigate the relationship between cellular molecules and pathways, and their clinical phenotypes. Inflammatory phenotypes might guide bedside decisions regarding the use of corticosteroids, neutrophil modifiers and/or type of beta-agonist. A next step toward precision medicine should be inclusion of these patients in clinical trials on biologics.
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Affiliation(s)
- Sarah van den Berg
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Hashimoto
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Korneliusz Golebski
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berber Kapitein
- Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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6
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Golebski K, Dankelman LHM, Björkander S, Bønnelykke K, Brinkman P, Deschildre A, van Dijk YE, Fleming L, Grigg J, Hamelmann E, Hashimoto S, Kabesch M, Klevebro S, Maitland-van der Zee AH, Merid SK, Nieto A, Niggel J, Nilsson C, Potočnik U, Roberts G, Rusconi F, Saglani S, Valente E, van Drunen C, Wang G, Melén E, Vijverberg SJH. Expert meeting report: towards a joint European roadmap to address the unmet needs and priorities of paediatric asthma patients on biologic therapy. ERJ Open Res 2021; 7:00381-2021. [PMID: 34729368 PMCID: PMC8558470 DOI: 10.1183/23120541.00381-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023] Open
Abstract
A digital multidisciplinary European expert meeting took place on the 9 July 2020 to identify the unmet needs of paediatric severe asthma patients, and set the priorities for clinical and research activities ahead https://bit.ly/3CeLBHB.
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Affiliation(s)
- Korneliusz Golebski
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lente H M Dankelman
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sofia Björkander
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Paul Brinkman
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Yoni E van Dijk
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Louise Fleming
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
| | - Eckard Hamelmann
- Klinik für Kinder and Jugendmedizin Kinderzentrum, Bethel Evangelisches Krankenhaus, Allergy Center, Ruhr University Bochum, Bielefeld, Germany
| | - Simone Hashimoto
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael Kabesch
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Susanna Klevebro
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anke-Hilse Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Simon K Merid
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Nieto
- Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion Sanitaria La Fe, Valencia, Spain
| | - Jakob Niggel
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Caroline Nilsson
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Uroš Potočnik
- Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Graham Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - Franca Rusconi
- Epidemiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Sejal Saglani
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Elisangela Valente
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Cornelis van Drunen
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gang Wang
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Erik Melén
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,These authors contributed equally
| | - Susanne J H Vijverberg
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
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7
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Santos-Valente E, Buntrock-Döpke H, Abou Taam R, Arasi S, Bakirtas A, Lozano Blasco J, Bønnelykke K, Craiu M, Cutrera R, Deschildre A, Elnazir B, Fleming L, Frey U, Gappa M, Nieto García A, Skamstrup Hansen K, Hanssens L, Jahnz-Rozyk K, Jesenak M, Kerzel S, Kopp MV, Koppelman GH, Krivec U, MacLeod KA, Mäkelä M, Melén E, Mezei G, Moeller A, Moreira A, Pohunek P, Minić P, Rutjes NWP, Sammut P, Schwerk N, Szépfalusi Z, Turkalj M, Tzotcheva I, Ulmeanu A, Verhulst S, Xepapadaki P, Niggel J, Vijverberg S, Maitland-van der Zee AH, Potočnik U, Reinartz SM, van Drunen CM, Kabesch M. Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo. ERJ Open Res 2021; 7:00143-2021. [PMID: 34409097 PMCID: PMC8365152 DOI: 10.1183/23120541.00143-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/11/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident. This study reveals enormous differences in therapy with biologicals for childhood severe asthma across Europe, and demonstrates the urgent need for harmonisation in medication choice, definition of therapy success and how/when to discontinue treatmenthttps://bit.ly/3tnJMTY
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Affiliation(s)
- Elisangela Santos-Valente
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Heike Buntrock-Döpke
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.,Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany
| | - Rola Abou Taam
- Service de pneumologie pédiatrique, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Arzu Bakirtas
- Dept of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, Turkey
| | - Jaime Lozano Blasco
- Dept of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Klaus Bønnelykke
- Dept of Pediatrics, Herlev and Gentofte Hospital, University Hospital Copenhagen, Denmark
| | - Mihai Craiu
- Respiratory Dept, National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest, Romania
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Dept of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antoine Deschildre
- University of Lille, CHU Lille, Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght University Hospital, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | - Louise Fleming
- Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Monika Gappa
- Evangelisches Krankenhaus Düsseldorf, Children's Hospital, Düsseldorf, Germany
| | - Antonio Nieto García
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe and Health Research Institute La Fe, Valencia, Spain
| | | | - Laurence Hanssens
- Service de Pneumologie-Allergologie, Centre de reference de Mucoviscidose de l'ULB, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Karina Jahnz-Rozyk
- Dept of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Milos Jesenak
- Dept of Paediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia.,Dept of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia
| | - Sebastian Kerzel
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Matthias V Kopp
- University Children's Hospital Bern, Inselspital, University of Bern, Switzerland.,German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gerard H Koppelman
- Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Uros Krivec
- Dept of Paediatric Pulmology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Györgyi Mezei
- Allergy Unit, First Dept of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland
| | - Andre Moreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Petr Pohunek
- Pediatric Pulmonology, Pediatric Dept, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic
| | - Predrag Minić
- Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Niels W P Rutjes
- Dept of Paediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Sammut
- Dept of Paediatrics, Respiratory Medicine and Allergy, Mater Dei Hospital, Malta
| | - Nicolaus Schwerk
- Dept of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany
| | - Zsolt Szépfalusi
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mirjana Turkalj
- Srebrnjak Children's Hospital, Zagreb, and School of Medicine, University of Osijek "Josip Juraj Strossmayer", Osijek, and Catholic University of Croatia, Zagreb, Croatia
| | - Iren Tzotcheva
- Dept of Pediatrics, University Hospital for Emergency Medicine "N. I. Pirogov", Medical University, Sofia, Bulgaria
| | - Alexandru Ulmeanu
- "Grigore Alexandrescu" Emergency Hospital for Children, Bucharest, Romania
| | - Stijn Verhulst
- Dept of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paraskevi Xepapadaki
- Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Susanne Vijverberg
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anke H Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Uroš Potočnik
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia.,Centre for Human Molecular Genetics and Pharmacogenomics, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Susanne M Reinartz
- Dept of Otorhinolaryngology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Cornelis M van Drunen
- Dept of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael Kabesch
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.,Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany
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8
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A System Pharmacology Multi-Omics Approach toward Uncontrolled Pediatric Asthma. J Pers Med 2021; 11:jpm11060484. [PMID: 34071272 PMCID: PMC8227234 DOI: 10.3390/jpm11060484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 01/03/2023] Open
Abstract
There is a clinical need to identify children with poor asthma control as early as possible, to optimize treatment and/or to find therapeutic alternatives. Here, we present the “Systems Pharmacology Approach to Uncontrolled Pediatric Asthma” (SysPharmPediA) study, which aims to establish a pediatric cohort of moderate-to-severe uncontrolled and controlled patients with asthma, to investigate pathophysiological mechanisms underlying uncontrolled moderate-to-severe asthma in children on maintenance treatment, using a multi-omics systems medicine approach. In this multicenter observational case–control study, moderate-to-severe asthmatic children (age; 6–17 years) were included from four European countries (Netherlands, Germany, Spain, and Slovenia). Subjects were classified based on asthma control and number of exacerbations. Demographics, current and past patient/family history, and clinical characteristics were collected. In addition, systems-wide omics layers, including epi(genomics), transcriptomics, microbiome, proteomics, and metabolomics were evaluated from multiple samples. In all, 145 children were included in this cohort, 91 with uncontrolled (median age = 12 years, 43% females) and 54 with controlled asthma (median age = 11.7 years, 37% females). The two groups did not show statistically significant differences in age, sex, and body mass index z-score distribution. Comprehensive information and diverse noninvasive biosampling procedures for various omics analyses will provide the opportunity to delineate underlying pathophysiological mechanisms of moderate-to-severe uncontrolled pediatric asthma. This eventually might reveal novel biomarkers, which could potentially be used for noninvasive personalized diagnostics and/or treatment.
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9
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Ramphul M, Lo DKH, Gaillard EA. Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction. J Asthma Allergy 2021; 14:525-538. [PMID: 34045872 PMCID: PMC8144021 DOI: 10.2147/jaa.s265657] [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: 02/19/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including environmental, immunological and genetic factors. Severe asthma in children is associated with increased hospitalisation rates, a lower quality of life, increased healthcare costs and an increased mortality. In the era of new molecular biologics treatments, it is essential to improve deep phenotyping of children with severe asthma in order to deliver the most effective treatment to each individual child. In this review, we discuss the personalised approach to the assessment and management of severe asthma. We explore the indications and use of the currently licensed biologics, as well as the potential of other emerging treatments.
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Affiliation(s)
- Manisha Ramphul
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
| | - David K H Lo
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
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10
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Freeman AT, Staples KJ, Wilkinson TMA. Defining a role for exercise training in the management of asthma. Eur Respir Rev 2020; 29:29/156/190106. [PMID: 32620584 DOI: 10.1183/16000617.0106-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalence of asthma remains high worldwide, with increasing awareness of the morbidity and mortality from asthma in low-income countries. In the UK, despite the development of biological treatments, many patients remain suboptimally controlled, and mortality rates have been static for decades. Therefore, new approaches are needed to treat asthma that are scalable at minimal cost. Exercise immunology is an expanding field, and there is growing evidence that exercise can modulate inflammatory and immune processes in asthma. Whilst exercise is encouraged in current treatment guidelines, there are no specific recommendations as to the intensity, frequency or duration of exercise exposure. Despite national and international guidance to increase exercise, patients with asthma are less likely to engage in physical activity. This review explores the disease modifying benefit of exercise in asthma. We also review the domains in which exercise exerts positive clinical effects in asthma, including the effects of exercise on symptom scores, quality of life, psychosocial health, and in the obese asthma phenotype. Finally, we review the barriers to exercise in asthma, given the benefits it confers. A better understanding of the mechanisms through which exercise exerts its positive effects in asthma may provide more accurate prescription of exercise training programmes as part of broader asthma management, with the potential of identification of new drug targets.
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Affiliation(s)
- Anna T Freeman
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK .,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Karl J Staples
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
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11
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