1
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Alves S, Rufo JC, Crispim J. Economic evaluation of biological treatments in patients with severe asthma: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:733-747. [PMID: 37265078 DOI: 10.1080/14737167.2023.2221435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Asthma is a highly prevalent disease, one of the chronic diseases with the highest economic costs; thus, it imposes a high economic burden on society, the healthcare system, patients, and third-party payers. Contrary to this study, until now, systematic reviews of economic evaluations (EEs) of treatments for severe asthma have not been exclusively focused on biological treatments, and have included a small number of studies and only model-based EEs. METHODS This study systematically reviews EEs of biological therapies for severe asthma published until December 2022 using PRISMA guidelines. The review analyzes the cost-effectiveness of biologicals in comparison to SOC, or SOC plus OCS. The quality of the EEs is assessed using Consensus on Health Economics Checklist extended (CHEC-extended). RESULTS Thirty-nine studies were eligible: 15 based on a Markov model, and 19 trial-based; eight adopting societal and NHS perspectives, and seven the payer's perspective. The reviewed EEs addressed cost-effectiveness, cost-utility, and incremental costs and outcomes comparison. Their findings were mainly expressed through ICER-incremental cost-effectiveness ratio (24 studies: 13 concluded that biological were cost-effective) and cost comparison analysis (14 studies: 6 concluded that biological were cost-effective), and were sensitive to a wide variety of factors (e.g. medication cost, treatment response, time horizon, utility benefits, mortality, exacerbation rate, discount rate, etc.). CONCLUSIONS There has been some ambiguity concerning the EE of biological therapies due to variation in choice of study design and contradictory results. Nevertheless, it can be concluded that biological treatments improve health outcomes, in many contexts at a high cost.
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Affiliation(s)
- Sara Alves
- Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Unidade de Epidemiologia, Instituto de Saúde Pública, Porto, Portugal
- Serviço E Laboratório de Imunologia Básica E Clínica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - José Crispim
- NIPE, Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
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2
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Hanania NA, Niven R, Chanez P, Antoine D, Pfister P, Garcia Conde L, Jaumont X. Long-term effectiveness and safety of omalizumab in pediatric and adult patients with moderate-to-severe inadequately controlled allergic asthma. World Allergy Organ J 2022; 15:100695. [PMID: 36254180 PMCID: PMC9519799 DOI: 10.1016/j.waojou.2022.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
- Corresponding author. Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030 USA
| | - Robert Niven
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Pascal Chanez
- Clinique des Bronches, de l'Allergie et du Sommeil, Department of Respiratory Diseases, APHM, Aix-Marseille University, France
| | - Deschildre Antoine
- CHU Lille, Université Nord de France, unité de pneumologie et allergologie pédiatriques, Hôpital Jeanne de Flandre, 59000 Lille, France
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Menzella F, Fontana M, Contoli M, Ruggiero P, Galeone C, Capobelli S, Simonazzi A, Catellani C, Scelfo C, Castagnetti C, Livrieri F, Facciolongo N. Efficacy and Safety of Omalizumab Treatment Over a 16-Year Follow-Up: When a Clinical Trial Meets Real-Life. J Asthma Allergy 2022; 15:505-515. [PMID: 35495876 PMCID: PMC9039243 DOI: 10.2147/jaa.s363398] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Treatment of severe asthma has made great strides thanks to rapid progress in understanding immune response and inflammatory pathways. This led to the advent of the first biologic for severe allergic asthma (SAA), omalizumab. Although the long-term efficacy and safety of omalizumab has been confirmed, increasingly longer follow-up data can further reinforce this evidence and potentially provide new ones, for example on any loss of efficacy or the appearance of unexpected side effects. This study reports omalizumab treatment-related outcomes after 16 years of follow-up. Patients and Methods In this real-life retrospective study, an extension of a previous 9-year follow-up study on patients initially recruited in a clinical trial, we enrolled 8 adult patients with SAA followed-up from November 2005 to December 2021. Study subjects were selected based on omalizumab eligibility criteria. Results Exacerbation rate significantly decreased from 3.6 ± 2.1 events in year before index date to 0.1 ± 0.4 after 32 weeks of treatment (p < 0.0001). Mean annual number of mild-to-moderate exacerbations at 16 years was 0.88 compared with 1.8 in the year before the index date and 1.1 at 32 weeks. No hospitalizations were documented during the 16-year follow-up compared to 0.3 hospitalizations/patient in the year before the index date. Respiratory function also progressively and significantly improved. Regarding patient-reported outcomes (PROs), The AQLQ and ACT significantly improved from baseline throughout the follow-up, particularly up to 9 years of follow-up. During the study, an overall reduction in doses of asthma medications was observed, with a significant OCS-sparing effect. Conclusion Our study, the longest clinical follow-up on patients treated with anti-IgE, confirms and amplifies the results of the studies carried out so far, as they are maintained over a very long interval of time without drops in efficacy without any type of side effect.
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Affiliation(s)
- Francesco Menzella
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Fontana
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Contoli
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Patrizia Ruggiero
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carla Galeone
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Capobelli
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Simonazzi
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Catellani
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Scelfo
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudia Castagnetti
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Livrieri
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Arcispedale Santa Maria Nuova, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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4
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Omalizumab: An Optimal Choice for Patients with Severe Allergic Asthma. J Pers Med 2022; 12:jpm12020165. [PMID: 35207654 PMCID: PMC8878072 DOI: 10.3390/jpm12020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/28/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Omalizumab is the first monoclonal antibody that was globally approved as a personalized treatment option for patients with moderate-to-severe allergic asthma. This review summarizes the knowledge of almost two decades of use of omalizumab to answer some important everyday clinical practice questions, concerning its efficacy and safety and its association with other asthma-related and drug-related parameters. Evidence suggests that omalizumab improves asthma control and reduces the incidence and frequency of exacerbations in patients with severe allergic asthma. Omalizumab is also effective in those patients in reducing corticosteroid use and healthcare utilization, while it also seems to improve lung function. Several biomarkers have been recognized in predicting its efficacy in its target group of patients, while the optimal duration for evaluating its efficacy is between 16 and 32 weeks.
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5
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Bousquet J, Humbert M, Gibson PG, Kostikas K, Jaumont X, Pfister P, Nissen F. Real-World Effectiveness of Omalizumab in Severe Allergic Asthma: A Meta-Analysis of Observational Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2702-2714. [PMID: 33486142 DOI: 10.1016/j.jaip.2021.01.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessment of clinical outcomes in the real-world corroborates findings from randomized controlled trials (RCTs). OBJECTIVE This meta-analysis evaluated real-world data of omalizumab on treatment response, lung function, exacerbations, oral corticosteroid (OCS) use, patient-reported outcomes (PROs), health care resource utilization (HCRU), and school/work absenteeism at 4, 6, and 12 months after treatment. METHODS Observational studies in patients with severe allergic asthma (≥6 years) treated with omalizumab for ≥16 weeks, published from January 2005 to October 2018, were retrieved from PubMed, Embase, and Cochrane. A random-effects model was used to assess heterogeneity. RESULTS In total, 86 publications were included. Global evaluation of treatment effectiveness (GETE) was good/excellent in 77% patients at 16 weeks (risk difference: 0.77; 95% confidence interval [CI]: 0.70-0.84; I2 = 96%) and in 82% patients at 12 months (0.82, 0.73-0.91; 97%). The mean improvement in forced expiratory volume in 1 second was 160, 220, and 250 mL at 16 weeks, 6 months, and 12 months, respectively. There was a decrease in Asthma Control Questionnaire score at 16 weeks (-1.14), 6 months (-1.56), and 12 months (-1.13) after omalizumab therapy. Omalizumab significantly reduced annualized rate of severe exacerbations (risk ratio [RR]: 0.41, 95% CI: 0.30-0.56; I2 = 96%), proportion of patients receiving OCS (RR: 0.59, 95% CI: 0.47-0.75; I2 = 96%), and number of unscheduled physician visits (mean difference: -2.34, 95% CI: -3.54 to -1.13; I2 = 98%) at 12 months versus baseline. CONCLUSION The consistent improvements in GETE, lung function, and PROs, and reductions in asthma exacerbations, OCS use, and HCRU with add-on omalizumab in real-life confirm and complement the efficacy data of RCTs.
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Affiliation(s)
- Jean Bousquet
- Contre les Maladies Chroniques pour un VIeillissement Actif (MACVIA) en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; Centre Hospitalier Universitaire de Montpellier, Montpellier, France; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany.
| | - Marc Humbert
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Peter G Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia; Priority Research Centre for Asthma and Respiratory Disease, the University of Newcastle, Newcastle, NSW, Australia
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
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6
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Menzella F, Galeone C, Ghidoni G, Ruggiero P, D'Amato M, Fontana M, Facciolongo N. The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review. Multidiscip Respir Med 2021; 16:787. [PMID: 34557301 PMCID: PMC8404525 DOI: 10.4081/mrm.2021.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.
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Affiliation(s)
- Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Carla Galeone
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Giulia Ghidoni
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Patrizia Ruggiero
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Maria D'Amato
- Department of Pneumology, AO "Dei Colli", University of Naples Federico II, Naples, Italy
| | - Matteo Fontana
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Nicola Facciolongo
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
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7
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Azzano P, Dufresne É, Poder T, Bégin P. Economic considerations on the usage of biologics in the allergy clinic. Allergy 2021; 76:191-209. [PMID: 32656802 DOI: 10.1111/all.14494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022]
Abstract
The advent of biologic therapies has transformed care for severe atopic disorders but their high cost poses new challenges with regard to long-term sustainability and fair allocation of resources. This article covers the basic concepts of cost-utility analyses and reviews the available literature on cost utility of biologic drugs in atopic disorders. When used within their limits as part of a multi-dimensional assessment, economic analyses can be extremely useful to guide decision-making and prioritization of care. Despite the good quality of most cost-utility analyses conducted for the use of biologics in asthma and other atopic diseases, their conclusions regarding cost-effectiveness are extremely variable. This is mainly due to the use of inconsistent estimates of health utility benefit with therapy. Development of reliable and validated instruments to measure disutility in atopic disorders and measure of indirect costs in atopic disease are identified as a priority for future research.
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Affiliation(s)
- Pauline Azzano
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
| | - Élise Dufresne
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
| | - Thomas Poder
- Department of Management, Evaluation and Health Policy School of Public Health University of Montreal Montreal QC Canada
- Research Center of the Institut Universitaire en Santé Mentale de Montréal Montreal QC Canada
| | - Philippe Bégin
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
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8
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Agache I, Rocha C, Beltran J, Song Y, Posso M, Solà I, Alonso‐Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park H, Pérez de Llano L, Quirce S, Sastre J, Shamji M, Schwarze J, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma: A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020; 75:1043-1057. [PMID: 32064642 DOI: 10.1111/all.14235] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 01/01/2023]
Abstract
Allergic asthma is a frequent asthma phenotype. Both IgE and type 2 cytokines are increased, with some degree of overlap with other phenotypes. Systematic reviews assessed the efficacy and safety of benralizumab, dupilumab and omalizumab (alphabetical order) vs standard of care for patients with uncontrolled severe allergic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. All three biologicals reduced with high certainty the annualized asthma exacerbation rate: benralizumab incidence rate ratios (IRR) 0.63 (95% CI 0.50 - 0.81); dupilumab IRR 0.58 (95%CI 0.47 - 0.73); and omalizumab IRR 0.56 (95%CI 0.42 - 0.73). Benralizumab and dupilumab improved asthma control with high certainty and omalizumab with moderate certainty; however, none reached the minimal important difference (MID). Both benralizumab and omalizumab improved QoL with high certainty, but only omalizumab reached the MID. Omalizumab enabled ICS dose reduction with high certainty. Benralizumab and omalizumab showed an increase in drug-related adverse events (AEs) with low to moderate certainty. All three biologicals had moderate certainty for an ICER/QALY value above the willingness to pay threshold. There was high certainty that in children 6-12 years old omalizumab decreased the annualized exacerbation rate [IRR 0.57 (95%CI 0.45-0.72)], improved QoL [relative risk 1.43 (95%CI 1.12 -1.83)], reduced ICS [mean difference (MD) -0.45 (95% CI -0.58 to -0.32)] and rescue medication use [ MD -0.41 (95%CI -0.66 to -0.15)].
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9
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Colombo GL, Di Matteo S, Martinotti C, Oselin M, Valentino MC, Bruno GM, Pitotti C, Menzella F. Omalizumab and long-term quality of life outcomes in patients with moderate-to-severe allergic asthma: a systematic review. Ther Adv Respir Dis 2019; 13:1753466619841350. [PMID: 31035904 PMCID: PMC6492364 DOI: 10.1177/1753466619841350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Asthma is a highly prevalent chronic inflammatory airways disease, with a
considerable impact on quality of life (QoL). To express the effects of
asthma on patients’ subjective experience, patient-reported outcomes (PROs)
represent an important instrument. The asthma QoL questionnaire (AQLQ) is
one of the main PROs among these. Materials and methods: To identify long-term asthma-related QoL outcomes associated with omalizumab
therapy in patients with moderate-to-severe asthma, we developed a
systematic review according to the PRISMA guidelines. Published real-world
effectiveness studies of adults or adolescents (12 years or older) with
moderate-to-severe allergic asthma treated with omalizumab for at least 48
weeks were reviewed. Sources used were Medline
(PubMed), the Cochrane Library and
Google Scholar up to February 2018. In addition, a
cross-referencing search was conducted to complete the revision. Results: A total of 255 potential papers were identified in the first search through
the database. After full-text viewing, eight articles were finally included
in the review. We summarized the results according to the study design,
patient baseline characteristics and effectiveness outcomes assessed by AQLQ
score results: variation from baseline to the end of study. Results
confirmed the long-term benefits of omalizumab as an add-on therapy in
patients with uncontrolled moderate-to-severe allergic asthma. Since there
is a lot of evidence on omalizumab effectiveness, we aimed to focus on how a
therapy can change patient’s QoL in a long time period. Data showed
long-term effects of omalizumab treatment on subjective (PROs) and objective
(lung function, corticosteroid use, hospitalizations, asthma exacerbation)
effectiveness measures. Conclusion: Studies included in our review were observational trials that, due to their
design, present a potential risk of selection bias in the patients included.
Beyond this limit, the evaluation of QoL using the AQLQ showed a clear
increase over time, following both 48 weeks and 9 years of observation,
where QoL improvements still were significant over baseline values.
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Affiliation(s)
- Giorgio Lorenzo Colombo
- Department of Drug Sciences, University of Pavia, Via G. Previati 74 20149 Milano c/o S.A.V.E., Pavia, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Martina Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | | | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova- IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
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MacDonald KM, Kavati A, Ortiz B, Alhossan A, Lee CS, Abraham I. Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018. Expert Rev Clin Immunol 2019; 15:553-569. [PMID: 30763137 DOI: 10.1080/1744666x.2019.1574571] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Omalizumab is a recombinant monoclonal anti-IgE antibody approved in the US as add-on treatment in moderate-to-severe allergic asthma (in severe allergic asthma [SAA] in Europe). A 2016 review of 24 real-world effectiveness studies in SAA published between 2008-2015 concluded that omalizumab was associated with significant improvements in objective and subjective outcomes with benefits extending beyond 2 years. Several new real-world studies have been published since, bringing the total to 42 studies. Areas covered: This systematic review of 42 studies published since 2008 updates and extends the 2016 review on the real-word evidence on omalizumab in SAA. It offers greater granularity as to time windows within which outcomes are reported and includes studies extending well beyond 4 years post omalizumab initiation. Expert commentary: This review firmly establishes the short-term effectiveness of omalizumab in adolescent and adult patients with SAA at 1 year, and provides strong evidence of long-term effectiveness up to 4 years and emergent evidence of effectiveness beyond 4 years. In the aggregate, these 42 studies underscore the long-term effectiveness of omalizumab in terms of: reducing exacerbations and symptoms, achieving asthma control, improving lung function, enhancing quality of life, decreasing emergency department visits and hospitalizations, and promoting concomitant medication-sparing.
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Affiliation(s)
| | - Abhishek Kavati
- b Health Economics & Outcomes Research , Novartis , East Hanover , NJ , USA
| | - Benjamin Ortiz
- c Clinical Development & Medical Affairs , Novartis , East Hanover , NJ , USA
| | | | - Christopher S Lee
- a Division of Research , Matrix45 , Tucson , AZ , USA.,e Boston College , Connell School of Nursing , Boston , MA , USA
| | - Ivo Abraham
- a Division of Research , Matrix45 , Tucson , AZ , USA.,f Center for Health Outcomes and Pharmacoeconomic Research , University of Arizona , Tucson , AZ , USA.,g Department of Pharmacy Practice and Science, College of Pharmacy , University of Arizona , Tucson , AZ , USA.,h Department of Family and Community Medicine , College of Medicine - Tucson, University of Arizona , Tucson , AZ , USA
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11
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Menzella F, Bertolini F, Biava M, Galeone C, Scelfo C, Caminati M. Severe refractory asthma: current treatment options and ongoing research. Drugs Context 2018; 7:212561. [PMID: 30534175 PMCID: PMC6284776 DOI: 10.7573/dic.212561] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with severe asthma have a greater risk of asthma-related symptoms, morbidities, and exacerbations. Moreover, healthcare costs of patients with severe refractory asthma are at least 80% higher than those with stable asthma, mainly because of a higher use of healthcare resources and chronic side effects of oral corticosteroids (OCS). The advent of new promising biologicals provides a unique therapeutic option that could achieve asthma control without OCS. However, the increasing number of available molecules poses a new challenge: the identification and selection of the most appropriate treatment. Thanks to a better understanding of the basic mechanisms of the disease and the use of predictive biomarkers, especially regarding the Th2-high endotype, it is now easier than before to tailor therapy and guide clinicians toward the most suitable therapeutic choice, thus reducing the number of uncontrolled patients and therapeutic failures. In this review, we will discuss the different biological options available for the treatment of severe refractory asthma, their mechanism of action, and the overlapping aspects of their usage in clinical practice. The availability of new molecules, specific for different molecular targets, is a key topic, especially when considering that the same targets are sometimes part of the same phenotype. The aim of this review is to help clarify these doubts, which may facilitate the clinical decision-making process and the achievement of the best possible outcomes.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Francesca Bertolini
- Department of Bio and Health Informatics, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark
| | - Mirella Biava
- National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Carla Galeone
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Chiara Scelfo
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Piazzale L.A. Scuro, 37134 Verona, Italy
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12
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McQueen RB, Sheehan DN, Whittington MD, van Boven JFM, Campbell JD. Cost-Effectiveness of Biological Asthma Treatments: A Systematic Review and Recommendations for Future Economic Evaluations. PHARMACOECONOMICS 2018; 36:957-971. [PMID: 29736895 DOI: 10.1007/s40273-018-0658-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Recently developed asthma biological therapies have been shown to provide relief for severe asthma patients not controlled by inhaled treatment. Given the relatively high costs of biological therapies, cost-effectiveness analyses (CEAs) may be required as a prerequisite for coverage and reimbursement. OBJECTIVE We aimed to systematically review published literature on the economic impact of biological asthma therapies and to identify key drivers that impact cost-effectiveness in order to provide recommendations for future economic evaluations. METHODS We conducted a systematic literature search in PubMed and Google Scholar. We included studies that assessed the cost-effectiveness of asthma biologics and were published in English between 2000 and 2018. The Quality of Health Economic Studies (QHES) instrument was used to evaluate quality. RESULTS Twenty asthma biological CEAs were identified. Nineteen studies analyzed the cost-effectiveness of omalizumab, and one study analyzed mepolizumab. Ten studies concluded that omalizumab was cost-effective in base-case scenarios, four studies concluded omalizumab was not cost-effective, and the remaining studies concluded omalizumab or mepolizumab was cost-effective only when targeted to specific severe subgroups or given considerable price discounts. Key drivers of cost-effectiveness included day-to-day health-related quality of life (HRQoL), asthma-related mortality, acquisition price of the biological therapy, and time horizon. CONCLUSIONS Most studies recommended carefully targeting biological therapy to specific populations such as responders or discounting acquisition price in order to further improve value. The quality of the studies was generally satisfactory, but improved evidence is needed linking HRQoL to utilities as well as understanding interventions' impact on asthma-related mortality. Key recommendations from this review may allow for greater comparability across future cost-effectiveness studies.
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Affiliation(s)
- R Brett McQueen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
| | - Danielle N Sheehan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Melanie D Whittington
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Job F M van Boven
- Department of General Practice and Elderly Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jonathan D Campbell
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
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Al-Ahmad M, Arifhodzic N, Nurkic J, Maher A, Rodriguez-Bouza T, Al-Ahmed N, Sadek A, Jusufovic E. "Real-life" Efficacy and Safety Aspects of 4-Year Omalizumab Treatment for Asthma. Med Princ Pract 2018; 27:260-266. [PMID: 29414831 PMCID: PMC6062694 DOI: 10.1159/000487482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of omalizumab in asthma in a real-life setting. SUBJECTS AND METHODS This 4-year observational study included 65 patients treated with omalizumab during clinic visits; treatment response was rated as excellent, good, and partial based on a modified physician's Global Evaluation of Treatment Effectiveness (mGETE) scale of emergency room visits (ERV), hospitalization, use of oral corticosteroids, inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) dose, and short-acting β-agonist rescue. The following tests were done: forced expiratory volume in 1 s (FEV1) and the asthma control test (ACT). Measurements were performed 1 month before therapy and at 16 weeks, 1 year, and 4 years of treatment. Statistical analyses were done using the Wilcoxon signed-rank test, Spearman rank correlation, and McNemar χ2 test. RESULTS The dropout rate was 15 (18.5%): 8 nonresponders (10.0%); 2 patients died (2.5%), and 5 were lost to follow-up (6.25%). Treatment response was excellent in 35 (53.8%); good in 23 (35.4%), and partial in 7 patients (10.8%). The number of excellent responders increased from 35 (53.8%) at 16 weeks to 48 (73.8%) at the 4-year follow-up. The number of patients who did not require ERV improved from 0 to 59 (90.8%), and the lowest rate of hospitalization was 1 in year 4 (p < 0.001); patients who did not require courses of oral corticosteroids improved from 0 to 54 (83%). ICS/LABA dose significantly reduced from 65 (100%) to 25 (38.5%) after 4 years of treatment (p < 0.001); ACT scores significantly increased from 15 ± 3 at baseline to 23 ± 3 (p < 0.001) and FEV1 level from 55.6 ± 10.6 to 76.63 ± 10.34 at year 4. CONCLUSION In this study, omalizumab therapy resulted in better asthma control, and was effective and well tolerated as an add-on therapy for patients with moderate-to-severe asthma.
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Affiliation(s)
- Mona Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Al-Rashed Allergy Center, Ministry of Health, Kuwait, Kuwait
- *Dr. Mona Al-Ahmad, Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110 (Kuwait), E-Mail
| | | | - Jasmina Nurkic
- Al-Rashed Allergy Center, Ministry of Health, Kuwait, Kuwait
| | - Ahmed Maher
- Al-Rashed Allergy Center, Ministry of Health, Kuwait, Kuwait
| | | | - Nasser Al-Ahmed
- Al-Rashed Allergy Center, Ministry of Health, Kuwait, Kuwait
| | - Ali Sadek
- National Center of Health Information, Ministry of Health, Kuwait, Kuwait
| | - Edin Jusufovic
- Cathedra for Internal Medicine Department, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia-Herzegovina
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Menzella F, Galeone C, Bertolini F, Castagnetti C, Facciolongo N. Innovative treatments for severe refractory asthma: how to choose the right option for the right patient? J Asthma Allergy 2017; 10:237-247. [PMID: 28919788 PMCID: PMC5587160 DOI: 10.2147/jaa.s144100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The increasing understanding of the molecular biology and the etiopathogenetic mechanisms of asthma helps in identification of numerous phenotypes and endotypes, particularly for severe refractory asthma. For a decade, the only available biologic therapy that met the unmet needs of a specific group of patients with severe uncontrolled allergic asthma has been omalizumab. Recently, new biologic therapies with different mechanisms of action and targets have been approved for marketing, such as mepolizumab. Other promising drugs will be available in the coming years, such as reslizumab, benralizumab, dupilumab and lebrikizumab. Moreover, since 2010, bronchial thermoplasty has been successfully introduced for a limited number of patients. This is a nonpharmacologic endoscopic procedure which is considered a promising therapy, even though several aspects still need to be clarified. Despite the increasing availability of new therapies, one of the major problems of each treatment is still the identification of the most suitable patients. This sudden abundance of therapeutic options, sometimes partially overlapping with each other, increases the importance to identify new biomarkers useful to guide the clinician in selecting the most appropriate patients and treatments, without forgetting the drug-economic aspects seen in elevated direct cost of new therapies. The aim of this review is, therefore, to update the clinician on the state of the art of therapies available for refractory asthma and, above all, to give useful directions that will help understand the different choices that sometimes partially overlap and to dispel the possible doubts that still exist.
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Affiliation(s)
- Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Carla Galeone
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Claudia Castagnetti
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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15
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Menzella F, Galeone C, Formisano D, Castagnetti C, Ruggiero P, Simonazzi A, Zucchi L. Real-life Efficacy of Omalizumab After 9 Years of Follow-up. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:368-372. [PMID: 28497924 PMCID: PMC5446952 DOI: 10.4168/aair.2017.9.4.368] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 01/26/2023]
Abstract
Omalizumab is frequently used as add-on treatment to inhaled corticosteroids (ICS) and long-acting β2-agonists in patients with suboptimal control of severe asthma. Patients with severe asthma will typically require chronic treatment, although due to the limited amount of data available there are still some concerns about the safety and efficacy of long-term therapy with omalizumab. Herein, in an extension of a previous 4-year study, we report disease-related outcomes of 8 patients with severe persistent allergic asthma who have been followed for a total of 9 years in a real-life setting. Both quality of life (QoL) (evaluated using the Juniper Asthma-Related QoL Questionnaire [AQLQ]) and forced expiratory volume in 1 second (FEV1) showed sustained improvement at 9 years. The median values of AQLQ and FEV1 at 4 years were 5.5 and 82.0% compared to 5.9 and 85.5%, respectively, at 9 years, which were all significantly increased from baseline. After 9 years, the mean annual number of severe exacerbations was 0.63 compared to 5 at baseline. There also appeared to be a trend toward use of a lower dose of ICS at longer follow-up times. After 9 years, there were no safety concerns for continued use of omalizumab, and no asthma-related hospitalizations or emergency department visits were documented over the last 5 years. The present analysis is the longest reported clinical follow-up of omalizumab. Long-term maintenance treatment with omalizumab for up to 9 years is associated with continued benefits in reducing symptoms, exacerbations, and medication burden without any safety concerns.
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Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Debora Formisano
- Scientific Directorate, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Claudia Castagnetti
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Patrizia Ruggiero
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Anna Simonazzi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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Menzella F, Lusuardi M, Galeone C, Facciolongo N, Zucchi L. The clinical profile of benralizumab in the management of severe eosinophilic asthma. Ther Adv Respir Dis 2016; 10:534-548. [PMID: 27612492 PMCID: PMC5933597 DOI: 10.1177/1753465816667659] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite several therapeutic choices, 10–20% of patients with severe uncontrolled
asthma do not respond to maximal best standard treatments, leading to a
healthcare expenditure of up to 80% of overall costs for asthma. Today, there
are new important therapeutic strategies, both pharmacological and
interventional, that can result in improvement of severe asthma management, such
as omalizumab, bronchial thermoplasty and other biological drugs, for example,
mepolizumab, reslizumab and benralizumab. The availability of these new
treatments and the increasing knowledge of the different asthmatic phenotypes
and endotypes makes correct patient selection increasingly complex and
important. In this article, we discuss the features of benralizumab compared
with other anti-interleukin-5 biologics and omalizumab, the identification of
appropriate patients, the safety profile and future developments.
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Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Menzella F, Lusuardi M, Galeone C, Taddei S, Facciolongo N, Zucchi L. Mepolizumab for severe refractory eosinophilic asthma: evidence to date and clinical potential. Ther Adv Chronic Dis 2016; 7:260-277. [PMID: 27803792 DOI: 10.1177/2040622316659863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe asthma is characterized by major impairment of quality of life, poor symptom control and frequent exacerbations. Inflammatory, clinical and causative factors identify different phenotypes and endotypes of asthma. In the last few years, new treatment options have allowed for targeted treatments according to the different phenotypes of the disease. To accurately select a specific treatment for each asthmatic variant, the identification of appropriate biomarkers is required. Eosinophilic asthma is a distinct phenotype characterized by thickening of the basement membrane and corticosteroid responsiveness. This review reports the latest evidence on an anti-IL-5 monoclonal antibody, mepolizumab, a new and promising biological agent recently approved by the FDA specifically for the treatment of severe eosinophilic refractory asthma.
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Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Sofia Taddei
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
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Menzella F, Lusuardi M, Galeone C, Taddei S, Zucchi L. Profile of anti-IL-5 mAb mepolizumab in the treatment of severe refractory asthma and hypereosinophilic diseases. J Asthma Allergy 2015; 8:105-14. [PMID: 26504401 PMCID: PMC4603708 DOI: 10.2147/jaa.s40244] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Asthma is a complex disorder frequently associated with a poor symptom control, concomitant morbidity, mortality, and significant health care costs due to lack of compliance or inadequate therapeutic options. Interleukin-5 (IL-5) plays a key role in the pathogenesis of eosinophilic disorders, and in the latest years has become a definite target for treatment. Besides asthma, other hypereosinophilic disorders include the hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, sinonasal polyposis, COPD with eosinophilic airway inflammation, allergic rhinitis, atopic dermatitis, eosinophilic esophagitis. The introduction of mepolizumab, a fully humanized monoclonal antibody that binds to IL-5, may represent a useful therapeutic option to control exacerbations and improve asthma-related quality of life in a subgroup of patients with persistent airway eosinophilia and moderate to severe asthma. Several studies carried out in recent years allow, at present, a careful patient selection for appropriate individualized treatment in severe asthma. Further research is anyway needed in order to better understand the pathogenetic mechanisms of asthma and to find new biomarkers. The high costs of biological agents as compared with standard drugs may be largely offset by increased clinical efficacy and good safety profile in selected patients.
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Affiliation(s)
- Francesco Menzella
- Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, Azienda Unità Sanitaria Locale Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sofia Taddei
- Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. J Asthma 2015; 52:529-37. [PMID: 25539023 DOI: 10.3109/02770903.2014.999283] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma has an important impact in terms of both direct and indirect costs. In Europe, the disease costs € 19 000 million a year. Moreover, the cost is greater among patients with severe uncontrolled asthma and is even higher when the work productivity is also taken into account. Improved control of the disease results in cost savings. In this context, cost-effectiveness and cost-utility studies offer important information for clinicians in deciding the best treatment options for asthmatic patients and contribute to ensure an efficient use of the available healthcare resources. METHODS An English and Spanish literature search using electronic search engines (PubMed and EMBASE) was conducted in peer-review journals, from 2009 to June 2014. In order to perform the search for the most suitable and representative articles, key words were selected ("asthma", "cost-effectiveness", "cost-utility", "QALY", "cost-benefit", "economic impact of asthma" "healthcare cost", "asthma treatment" and "work productivity with asthma"). RESULTS Two-hundred forty-three titles and abstracts were identified by the primary literature search. The full text of the potentially 76 eligible papers was reviewed, and 22 articles were qualified to be finally included. CONCLUSIONS This article provides a comprehensive review on the evidence of cost-effectiveness of asthma treatments derived from the published literature and offers an overall summary of the socioeconomic burden of asthma and its relationship with the degree of disease control. Management alternatives, such as the use of combination therapy with ICS/LABA or omalizumab, when administered according to their current therapeutic indications, have been shown to be cost-effective.
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Affiliation(s)
- Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research (IdiPAZ) , Madrid , Spain
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Ruggeri M, Manca A, Coretti S, Codella P, Iacopino V, Romano F, Mascia D, Orlando V, Cicchetti A. Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:709-720. [PMID: 26297100 DOI: 10.1016/j.jval.2015.03.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/27/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. METHODS A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. RESULTS One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. CONCLUSIONS Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.
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Affiliation(s)
- Matteo Ruggeri
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Silvia Coretti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Codella
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Iacopino
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Mascia
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Orlando
- Inter-departmental Research Centre of PharmacoEconomics and Drug utilization (CIRFF), Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Americo Cicchetti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Licari A, Marseglia G, Castagnoli R, Marseglia A, Ciprandi G. The discovery and development of omalizumab for the treatment of asthma. Expert Opin Drug Discov 2015; 10:1033-42. [PMID: 25979110 DOI: 10.1517/17460441.2015.1048220] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The evolution in immunological methods used to assess human allergic diseases has led to the identification of immunoglobulin E (IgE) as a diagnostic biomarker and a potential therapeutic target. Innovative technologies in molecular biology and immunogenetics contributed to the development of a selective blocking agent, disclosing new therapeutic perspectives in the treatment of allergic asthma. Omalizumab is the most advanced humanized anti-IgE monoclonal antibody that specifically binds serum-free IgE. Omalizumab also interrupts the allergic cascade by preventing binding of IgE with FcεRI receptors on mast cells, basophils, antigen-presenting cells and other inflammatory cells. AREAS COVERED This review discusses the discovery strategy and preclinical development of omalizumab. Furthermore, it also provides a clinical overview of the key trials leading to its launch and a detailed analysis of safety and post-marketing data. EXPERT OPINION The clinical efficacy of omalizumab in allergic asthma has been well documented in clinical trials, involving adults, adolescents and children with moderate-to-severe and severe allergic asthma. To date, omalizumab has also been approved in chronic idiopathic urticaria for patients 12 years and older who remain symptomatic despite high dosages of H1 antihistamines. Omalizumab has also been investigated in many other different patient populations beyond allergic asthma and may yet have an application to other indications. While omalizumab is the only mAb available for treating allergic asthma, the authors anticipate that new mAbs will emerge in the future that overcome omalizumab's current limitations.
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Affiliation(s)
- Amelia Licari
- University of Pavia, Foundation IRCCS Policlinico San Matteo, Department of Pediatrics , Pavia , Italy
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Abstract
Patients with severe asthma or COPD have often a suboptimal symptom control due to inadequate treatment. A better understanding of pathogenetic mechanisms, phenotypes, endotypes and the new technologies available in the fields of molecular biology and immunogenetics have made it possible to synthesize specific monoclonal antibodies virtually able to interact with any target antigen, or to open a way for new therapeutic target options. At the moment, the only biologic drug available in clinical practice is omalizumab. To overcome the limits of omalizumab, the research has focused on new monoclonal antibodies presenting higher avidity for IgE (e.g. ligelizumab and lumiximab) and ability to interact also with low affinity IgE receptor (FcϵRII). At present, many new biological drugs with different mechanisms of action and targets are matter of research. It is very important to identify the asthmatic phenotype in order to select the most appropriate drug for the individual patient. The most promising agents are targeted against cytokines of Th2 pattern and related receptors, such as IL-2 (daclizumab) and IL-13 (lebrikizumab) or IL-5 in patients with hypereosinophilia (mepolizumab, reslizumab and benralizumab). Other interesting drugs have as a target TNF-α or its soluble receptor (infliximab, golimumab and etanercept) or IL-1 (canakinumab), a cytokine with an important systemic proinflammatory action. Finally, the discovery of increased levels of C5a in the airways of asthmatic patients has led to the synthesis of a specific monoclonal antibody (eculizumab). Further help should come from the identification of biomarkers that can guide in choosing the best treatment for the individual patient, such as IgE for omalizumab or periostin for lebrikizumab.
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The real-life clinical effects of 52 weeks of omalizumab therapy for severe persistent allergic asthma. Int J Clin Pharm 2014; 37:36-43. [PMID: 25394832 DOI: 10.1007/s11096-014-0034-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Omalizumab was introduced in Malta in 2011. To date, no local data have been published. OBJECTIVE To obtain baseline characteristics of our local cohort, determine effectiveness of omalizumab at 52 weeks, compare clinical outcomes 52 weeks pre- and postomalizumab therapy and to assess its safety and tolerability. SETTING The Mater Dei Hospital in Malta. METHOD All consented adult patients who were eligible to start treatment with omalizumab for asthma were enrolled in this open, prospective observational real-life study. A questionnaire was completed and an Asthma Control Test and spirometry performed. Patients were reviewed on a regular basis. Any undesirable symptoms were recorded. Treatment effectiveness was evaluated at 16 and 52 weeks, during which a decision was taken whether patients were responders. Outcomes were compared 52 weeks pre- and post- treatment initiation. Main outcome measure To determine effectiveness of treatment following 1 year of omalizumab by assessing its impact on the rate of asthma-related exacerbations and health care utilization including hospitalizations. RESULTS Our cohort included 22 patients, all non-smokers (mean age 52.7 ± 11, 64 % males). The mean baseline IgE level was 448.6 ± 444 IU/ml. At week 12, treatment was stopped in one patient due to arthralgias. The drug was stopped in two patients at week 16 due to treatment ineffectiveness. At week 20, treatment was stopped in another patient in view of arthralgias. A significant reduction in the number of asthma exacerbations (p = .03) and number of systemic steroid courses required (p = .03) was identified at 52 weeks. There was a significant improvement in the ACT score (p < .001) after 52 weeks but no significant improvement in FEV1. There was a non-significant decline in the number of hospitalizations (p = .6), asthma-related healthcare visits (p = .2) and days off work (p = .09). Adverse events occurred in 10 % of patients. Costs related to asthma hospital-stay and medicines administered during hospitalisations were decreased by half following 1 year on omalizumab. CONCLUSION Omalizumab treatment resulted in an improved asthma control, with a significant reduction in asthma exacerbations and systemic steroid courses required and improvement on ACT score. Adverse events were infrequent and the drug was well tolerated.
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A budget impact analysis of bronchial thermoplasty for severe asthma in clinical practice. Adv Ther 2014; 31:751-61. [PMID: 25009004 DOI: 10.1007/s12325-014-0135-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Fully 80% of asthma-related deaths occur in patients with uncontrolled disease and 50% of all costs are attributable to this subgroup. Although asthma is costly, direct costs and loss of productivity have only recently been extensively studied, partly as a result of the introduction of new and more costly treatment options. A 5-year population-based budget impact model in the perspective of the Emilia Romagna of Italy regional healthcare service compared the impact of adding adjuvant bronchial thermoplasty (BT) for a population of patients with severe, uncontrolled asthma treated with standard care (SC) with or without adjuvant omalizumab (OMAL). METHODS The model compared the budget impact of two scenarios: the first examined a population treated either with SC alone or with administration of OMAL concurrent to SC; the second examined a population treated either with SC alone or with either the concurrent administration of OMAL or BT. RESULTS The cost for treating asthmatics patients in Emilia Romagna with BT would require 17.7 million Euros during the initial year; these costs would be offset by savings of 1 million Euros, 10.5 million Euros, and up to 19.2 million Euros during third, fourth, and fifth years, respectively. CONCLUSION Despite the increase in direct costs, the complementary treatment of patients with either BT or OMAL in addition to SC may not only help the clinician to meet the needs of a greater number of patients, but also decreases emergency room visits and hospitalizations, as well as generates economic savings in the longer term.
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Solèr M. Omalizumab for severe allergic asthma: 7 years and open questions. ACTA ACUST UNITED AC 2014; 88:158-61. [PMID: 24818580 DOI: 10.1159/000360771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
Anti-IgE treatment for severe allergic asthma has been available for more than seven years now. This treatment has clear clinical benefits and a good safety record. However, important questions concerning long-term dosing and treatment duration remain unanswered. This paper discusses the available information concerning the long-term use of omalizumab.
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Loss of asthma control after cessation of omalizumab treatment: real life data. Postepy Dermatol Alergol 2014; 31:1-5. [PMID: 24683390 PMCID: PMC3952048 DOI: 10.5114/pdia.2014.40553] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Many clinical and observational studies have demonstrated effectiveness of omalizumab (OMA) in the treatment of severe asthma, but the optimal duration of the therapy remains unknown. AIM The article presents the authors' clinical experience on OMA cessation in routine practice. MATERIAL AND METHODS Due to new reimbursement criteria, OMA therapy has been interrupted in 11 subjects (6 women/5 men). The mean age of patients was 50.73 ±14.16 years, the mean time of severe asthma duration was 13.54 ±6.05 years. All of them had an excellent/good response to OMA. The duration of OMA therapy was 67.73 ±11.64 months. RESULTS Nine out of 11 patients had severe asthma exacerbation within the first 5 months after the OMA withdrawal. The mean time to the first severe exacerbation was 7.56 ±2.67 weeks. Between the time of OMA cessation and the time of reassessment, the mean score of Asthma Control Questionnaire increased from 2.58 ±0.71 to 3.63 ±1.26 points and the mean score of Asthma Quality of Life Questionnaire decreased from 4.3 ±1.91 to 3.18 ±1.17 points. The mean oral corticosteroids (OCS) dose increased from 4.61 ±3.0 mg/day to 33.33 ±13.12 mg/day. The number of exacerbations within the last 12 months increased from 1.6 ±0.67 to 5.2 ±1.4, and the number of hospitalizations or emergency room (ER) attendence increased from 0.11 ±0.31 to 1.56 ±1.26. CONCLUSIONS These data indicate that the withdrawal of OMA therapy after the successful long-term therapy may cause severe asthma exacerbations. Therefore, the decision regarding cessation of OMA treatment should be undertaken individually after careful weighing benefits and risks, especially in patients with a long history of severe asthma, treated with high doses of OCS before OMA introduction, near-fatal asthma events and/or aggravation of asthma during previous episodes of interruptions in OMA treatment.
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Incorvaia C, Mauro M, Russello M, Formigoni C, Riario-Sforza GG, Ridolo E. Omalizumab, an anti-immunoglobulin E antibody: state of the art. Drug Des Devel Ther 2014; 8:197-207. [PMID: 24532966 PMCID: PMC3923619 DOI: 10.2147/dddt.s49409] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A large number of trials show that the anti-immunoglobulin (Ig) E antibody omalizumab is very effective in patients with severe allergic asthma. This is acknowledged in consensus documents. The drug also has a good safety profile and a pharmacoeconomic advantage due to a reduction in the number of hospitalizations for asthma attacks. In recent years, some studies have shown that omalizumab is effective also in nonallergic asthma. Effects on the complex signaling mechanisms leading to activation of effector cells and to mediator release may account for this outcome. Indeed, omalizumab has been reported to be effective in a number of IgE-mediated and non-IgE-mediated disorders. Concerning the former, clinical efficacy has been observed in rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, and anaphylaxis. In addition, omalizumab has been demonstrated to be able to prevent systemic reactions to allergen immunotherapy, thus enabling completion of treatment in patients who otherwise would have to stop it. Concerning non-IgE-mediated disorders, omalizumab has been reported to be effective in nasal polyposis, autoimmune urticaria, chronic idiopathic urticaria, physical urticaria, idiopathic angioedema, and mastocytosis. Current indications for treatment with omalizumab are confined to severe allergic asthma. Consequently, any other prescription can only be off-label. However, it is reasonable to expect that the use of omalizumab will be approved for particularly important indications, such as anaphylaxis, in the near future.
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Affiliation(s)
- Cristoforo Incorvaia
- Allergy/Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| | | | | | | | | | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Buhl R, Marco AG, Cohen D, Canonica GW. Eligibility for treatment with omalizumab in Italy and Germany. Respir Med 2013; 108:50-6. [PMID: 24315468 DOI: 10.1016/j.rmed.2013.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
Omalizumab is an add-on therapy for patients with uncontrolled severe allergic asthma. In Europe, patients must fulfil a number of additional criteria to become eligible for omalizumab therapy, creating a challenge for epidemiology studies to quantify the potential patient pool. Thus, and in the absence of robust data, the number of omalizumab-eligible patients has remained unclear. To assess eligible patient numbers, a chart-audit design approach was employed to measure epidemiology variables based on patient-level data. 770 patient charts were reviewed in designated towns in Germany and Italy, in collaboration with >200 primary care physicians (PCPs) and respiratory specialists (RS). This study sample represents >50% and >70% of local RS in these designated towns of Germany and Italy, respectively. Of patient charts evaluated, 4 patients were currently receiving omalizumab. A further 31 patients (12 PCP; 19 RS) were evaluated as omalizumab-eligible (i.e. fulfilled all product label criteria) but were not receiving the drug. Extrapolating to a national level, this yields >6500 eligible patients in Germany, and >3200 in Italy. Furthermore, this study sample revealed a significant number of PCPs treating uncontrolled severe asthma patients without referral to RS; these patients are not consistently evaluated for FEV1, aero-allergen sensitivity, a qualitative understanding of severe exacerbations, and day and night-time symptoms. This study suggests that significant numbers of omalizumab-naïve severe allergic asthma patients in Germany/Italy are eligible for omalizumab therapy. Despite proven benefits in uncontrolled severe allergic asthma, adjunctive omalizumab therapy is underutilized.
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Affiliation(s)
- Roland Buhl
- Pulmonary Department, University Hospital, Johannes Gutenberg-University, Langenbeckstr, D-55131 Mainz, Germany
| | | | | | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases, DIMI, University of Genoa, Largo Rosanna Benzi 10, Genoa 16132, Italy.
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Özgür ES, Özge C, Ïlvan A, Naycı SA. Assessment of long-term omalizumab treatment in patients with severe allergic asthma long-term omalizumab treatment in severe asthma. J Asthma 2013; 50:687-94. [PMID: 23557459 DOI: 10.3109/02770903.2013.792348] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Several clinical studies have demonstrated the effectiveness of omalizumab in patients with severe allergic asthma but the treatment period has always been relatively short (4-12 months). In the literature, there are a few data about the long-term omalizumab therapy. We aimed to assess the long-term clinical and functional effectiveness of omalizumab treatment in severe allergic asthmatic patients, METHODS Medical records describing the patients' status before the start of treatment, and also having been registered at the end of 4th, 12th, and 36th months from the commencement of treatment, and at the last visit where the patient was evaluated were used for omalizumab effectiveness assessments. Twenty-six patients (female/male: 21/5) with severe allergic asthma, uncontrolled despite GINA 2006 Step 4 therapy, were included in the study. Effectiveness outcomes included spirometry measurements, level of asthma control measured by asthma control test (ACT), systemic glucocorticosteroid (sGCS) use, emergency room (ER) visits, and hospitalizations for severe exacerbations. In addition, the quality of life was assessed using the quality of life questionnaire AQLQ(S) before, 4, and 36 months after treatment, RESULTS The mean age was 47.6 ± 13.9 and duration of allergic asthma was 22.7 ± 10.1 years. Serum total IgE levels were 322.0 ± 178.1 IU/mL. Mean duration of omalizumab treatment was 40.81 ± 8.2 months. FEV1 improved significantly at all control points versus baseline (p < .05). The level of asthma control as evaluated by ACT improved significantly after treatment (p < .05). We determined significantly reduced numbers of exacerbation, emergency visits, hospitalizations, sGCS, and SABA use by the end of 36 months (p < .05). The proportion of patients with improvements larger than 1.5 points in AQLQ(S) total score was 80.7% at the 4th month and 96.1% at the 36th month of treatment, CONCLUSIONS This study showed that long-term therapy with omalizumab for up to 3 years was well tolerated with significant improvement both in symptoms and lung functions. Accordingly, long-term omalizumab treatment may be recommended for responders.
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Affiliation(s)
- Eylem Sercan Özgür
- Department of Chest Diseases, Mersin University School of Medicine, Mersin, Turkey.
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Affiliation(s)
- Priyanka Vashisht
- Creighton University, Allergy Immunology/Internal Medicine,
601 N 30th Street, Omaha, Omaha, NE 68131, USA
| | - Thomas Casale
- Creighton University, Allergy and Immunology,
601 N 30th Street, Omaha, NE 68131, USA
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