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Pelaia C, Calabrese C, Terracciano R, de Blasio F, Vatrella A, Pelaia G. Omalizumab, the first available antibody for biological treatment of severe asthma: more than a decade of real-life effectiveness. Ther Adv Respir Dis 2018; 12:1753466618810192. [PMID: 30400762 PMCID: PMC6236630 DOI: 10.1177/1753466618810192] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
Omalizumab was the first, and for a long time the only available monoclonal antibody for the add-on treatment of severe allergic asthma. In particular, omalizumab selectively targets human immunoglobulin (Ig)E, forming small-size immune complexes that inhibit IgE binding to its high- and low-affinity receptors. Therefore, omalizumab effectively blunts the immune response in atopic asthmatic patients, thus significantly improving the control of asthma symptoms and successfully preventing disease exacerbations. These very positive effects of omalizumab make it possible to drastically decrease both referrals to the emergency room and hospitalizations for asthma exacerbations. Such important therapeutic actions of omalizumab have been documented by several randomized clinical trials, and especially by more than 10 years of real-life experience in daily clinical practice. Omalizumab can also interfere with airway remodelling by inhibiting the activation of IgE receptors located on structural cells such as bronchial epithelial cells and airway smooth muscle cells. Moreover, omalizumab is characterized by a very good safety and tolerability profile. Hence, omalizumab represents a valuable therapeutic option for the add-on biological treatment of severe allergic asthma.
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Affiliation(s)
- Corrado Pelaia
- Department of Medical and Surgical Sciences,
University ‘Magna Græcia’ of Catanzaro, Catanzaro, Italy
| | - Cecilia Calabrese
- Department of Cardio-Thoracic and Respiratory
Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Rosa Terracciano
- Department of Health Sciences, University ‘Magna
Græcia’ of Catanzaro, Catanzaro, Italy
| | - Francesco de Blasio
- Respiratory Medicine and Pulmonary
Rehabilitation Section, Clinic Center Private Hospital, Naples, Italy
- Department of Medicine and Health Sciences ‘V.
Tiberio’, University of Molise, Campobasso, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry,
University of Salerno, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences,
University ‘Magna Græcia’ of Catanzaro, Catanzaro, Italy; Campus
Universitario ‘Salvatore Venuta’, Viale Europa – Località Germaneto,
Catanzaro, 88100, Italy
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Borekci S, Aydin O, Hatemi G, Gemicioglu B. Development of eosinophilic granulomatosis with poliangiitis (Churg-Strauss syndrome) and brain tumor in a patient after more than 7 years of omalizumab use: A case report. Int J Immunopathol Pharmacol 2017; 28:134-7. [PMID: 25816417 DOI: 10.1177/0394632015572567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Omalizumab is a monoclonal anti-immunoglobulin E antibody used for the treatment of severe perennial allergic asthma. Previous reports have suggested that omalizumab treatment can be associated with the development of eosinophilic granulomatosis with poliangiitis (EGPA) (formerly known as Churg-Strauss syndrome) and an increased risk of malignancy. Long-term risks of omalizumab treatment are not very well defined. Here, we report the case of a 75-year-old woman with concurrent occurrence of EGPA and brain tumor after more than 7 years of omalizumab treatment. The possibility of EGPA should be borne in mind during long-term treatment with omalizumab. Despite the absence of definitive data, an association may also exist between the development of malignancy and omalizumab use.
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Affiliation(s)
- S Borekci
- Pulmonology Department, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - O Aydin
- Pathology Department, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - G Hatemi
- Rheumatology Department, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - B Gemicioglu
- Pulmonology Department, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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3
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Samitas K, Delimpoura V, Zervas E, Gaga M. Anti-IgE treatment, airway inflammation and remodelling in severe allergic asthma: current knowledge and future perspectives. Eur Respir Rev 2016; 24:594-601. [PMID: 26621973 DOI: 10.1183/16000617.00001715] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic inflammation and structural alterations in the airways, also known as remodelling. IgE is an important mediator of allergic reactions and has a central role in allergic asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating IgE in the development of airway remodelling. The use of monoclonal antibodies targeting IgE, such as omalizumab, has proven very effective in improving respiratory symptoms and quality of life, while reducing asthma exacerbations, emergency room visits and the use of systemic corticosteroids in allergic severe asthma. These effects are believed to be mainly mediated by omalizumab's inhibitory effect on the initiation and further propagation of the allergic inflammation cascade. However, there is evidence to suggest that anti-IgE treatment remains effective long after it has been discontinued. In part, these findings could be attributed to the possible ameliorating effects of anti-IgE treatment on airway remodelling. In this review, we discuss recent findings supporting the notion that anti-IgE treatment modulates the complex immune responses that manifest clinically as asthma and ameliorates airway remodelling changes often observed in allergic severe asthma phenotypes.
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Affiliation(s)
- Konstantinos Samitas
- 7th Respiratory Dept and Asthma Centre, Athens Chest Hospital "Sotiria", Athens, Greece Cellular Immunology Laboratory, Division of Cell Biology, Centre for Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Vasiliki Delimpoura
- 7th Respiratory Dept and Asthma Centre, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Eleftherios Zervas
- 7th Respiratory Dept and Asthma Centre, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Mina Gaga
- 7th Respiratory Dept and Asthma Centre, Athens Chest Hospital "Sotiria", Athens, Greece
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Yoshino S, Mizutani N. Intranasal exposure to monoclonal antibody Fab fragments to Japanese cedar pollen Cry j1 suppresses Japanese cedar pollen-induced allergic rhinitis. Br J Pharmacol 2016; 173:1629-38. [PMID: 26895546 PMCID: PMC4842921 DOI: 10.1111/bph.13463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 01/27/2016] [Accepted: 02/14/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Fab fragments (Fabs) of antibodies have the ability to bind to specific allergens but lack the Fc portion that exerts effector functions via binding to receptors including FcεR1 on mast cells. In the present study, we investigated whether intranasal administration of the effector function-lacking Fabs of a monoclonal antibody IgG1 (mAb, P1-8) to the major allergen Cry j1 of Japanese cedar pollen (JCP) suppressed JCP-induced allergic rhinitis in mice. EXPERIMENTAL APPROACH Balb/c mice sensitized with JCP on days 0 and 14 were challenged intranasally with the pollen on days 28, 29, 30 and 35. Fabs prepared by the digestion of P1-8 with papain were also administered intranasally 15 min before each JCP challenge. KEY RESULTS Intranasal administration of P1-8 Fabs was followed by marked suppression of sneezing and nasal rubbing in mice with JCP-induced allergic rhinitis. The suppression of these allergic symptoms by P1-8 Fabs was associated with decreases in mast cells and eosinophils and decreased hyperplasia of goblet cells in the nasal mucosa. CONCLUSIONS AND IMPLICATIONS These results demonstrated that intranasal exposure to P1-8 Fabs was effective in suppressing JCP-induced allergic rhinitis in mice, suggesting that allergen-specific mAb Fabs might be used as a tool to regulate allergic pollinosis.
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Affiliation(s)
- S Yoshino
- Department of Pharmacology, Kobe Pharmaceutical University, Kobe, Japan
| | - N Mizutani
- Department of Pharmacology, Kobe Pharmaceutical University, Kobe, Japan
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Vos W, Hajian B, De Backer J, Van Holsbeke C, Vinchurkar S, Claes R, Hufkens A, Parizel PM, Bedert L, De Backer W. Functional respiratory imaging to assess the interaction between systemic roflumilast and inhaled ICS/LABA/LAMA. Int J Chron Obstruct Pulmon Dis 2016; 11:263-71. [PMID: 26917956 PMCID: PMC4745845 DOI: 10.2147/copd.s93830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients with COPD show a significant reduction of the lobar hyperinflation at the functional residual capacity level in the patients who improved >120 mL in forced expiratory volume in 1 second (FEV1) after 6 months of treatment with roflumilast in addition to inhaled corticosteroids (ICSs)/long-acting beta-2 agonists (LABAs)/long-acting muscarinic antagonists (LAMAs). Methods Functional respiratory imaging was used to quantify lobar hyperinflation, blood vessel density, ventilation, aerosol deposition, and bronchodilation. To investigate the exact mode of action of roflumilast, correlations between lobar and global measures have been tested using a mixed-model approach with nested random factors and Pearson correlation, respectively. Results The reduction in lobar hyperinflation appears to be associated with a larger blood vessel density in the respective lobes (t=−2.154, P=0.040); lobes with a higher percentage of blood vessels reduce more in hyperinflation in the responder group. Subsequently, it can be observed that lobes that reduce in hyperinflation after treatment are better ventilated (t=−5.368, P<0.001). Functional respiratory imaging (FRI)-based aerosol deposition showed that enhanced ventilation leads to more peripheral particle deposition of ICS/LABA/LAMA in the better-ventilated areas (t=2.407, P=0.024). Finally, the study showed that areas receiving more particles have increased FRI-based bronchodilation (t=2.564, P=0.017), leading to an increase in FEV1 (R=0.348, P=0.029). Conclusion The study demonstrated that orally administered roflumilast supports the reduction of regional hyperinflation in areas previously undertreated by inhalation medication. The local reduction in hyperinflation induces a redistribution of ventilation and aerosol deposition, leading to enhanced efficacy of the concomitant ICS/LABA/LAMA therapy. FRI appears to be a sensitive tool to describe the mode of action of novel compounds in chronic obstructive pulmonary disease. Future studies need to confirm the enhanced sensitivity and the potential of FRI parameters to act as surrogates for clinically relevant, but more difficult to measure, end points such as exacerbations.
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Affiliation(s)
- Wim Vos
- FLUIDDA nv, Groeningenlei, Kontich, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Bita Hajian
- Department of Respiratory Medicine, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Jan De Backer
- FLUIDDA nv, Groeningenlei, Kontich, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Cedric Van Holsbeke
- FLUIDDA nv, Groeningenlei, Kontich, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Samir Vinchurkar
- FLUIDDA nv, Groeningenlei, Kontich, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Rita Claes
- Department of Respiratory Medicine, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Annemie Hufkens
- Department of Respiratory Medicine, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Lieven Bedert
- Department of Respiratory Medicine, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Wilfried De Backer
- Department of Respiratory Medicine, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
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Samitas K, Delimpoura V, Zervas E, Gaga M. Anti-IgE treatment, airway inflammation and remodelling in severe allergic asthma: current knowledge and future perspectives. Eur Respir Rev 2015. [DOI: 10.10.1183/16000617.00001715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic inflammation and structural alterations in the airways, also known as remodelling. IgE is an important mediator of allergic reactions and has a central role in allergic asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating IgE in the development of airway remodelling. The use of monoclonal antibodies targeting IgE, such as omalizumab, has proven very effective in improving respiratory symptoms and quality of life, while reducing asthma exacerbations, emergency room visits and the use of systemic corticosteroids in allergic severe asthma. These effects are believed to be mainly mediated by omalizumab's inhibitory effect on the initiation and further propagation of the allergic inflammation cascade. However, there is evidence to suggest that anti-IgE treatment remains effective long after it has been discontinued. In part, these findings could be attributed to the possible ameliorating effects of anti-IgE treatment on airway remodelling. In this review, we discuss recent findings supporting the notion that anti-IgE treatment modulates the complex immune responses that manifest clinically as asthma and ameliorates airway remodelling changes often observed in allergic severe asthma phenotypes.
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