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Suhling H, Skowasch D, Bergmann KC, Mümmler C, Buhl R, Ehmann R, Hamelmann E, Idzko M, Margret Jandl, Schulz C, Schmidt O, Taube C, Korn S, Milger K. Initiation, response assessment, and switch of antibody therapies in patients with severe asthma - A survey among German specialists. World Allergy Organ J 2023; 16:100844. [PMID: 38033455 PMCID: PMC10682826 DOI: 10.1016/j.waojou.2023.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background For therapy of severe asthma 5 monoclonal antibodies have been available in Germany up to November 2022, but no clear rules exist on choice of initial therapy, assessment of response, and switch. Objective To assess current practice on all aspects of biologic therapy by specialists in Germany. Methods A questionnaire was created by specialists for severe asthma, which was tested and modified by further experts. We invited 119 pulmonologists of the German Asthma Net (GAN) to complete the survey and used SoSci Survey and SPSS for data collection and analysis. Results Forty-seven pulmonologists took part in the survey with a median annual number of patients treated with biologics of 35, 55% worked in an outpatient practice, and 40% in a hospital. Exacerbations and oral steroid use were the most important factors for the decision to start a biologic therapy. Accordingly, these parameters were also the most relevant for assessment of response. Most participants considered type-2 inflammation biomarkers and comorbidities (foremost CRSwNP and AD) for choosing initial biologic. Asthma Control Test (ACT) was the most common instrument for assessing status of disease control. There was no consensus on thresholds for response of pulmonary function tests including FEV1, FVC, and RV. Eighty-five percent of participants distinguished between "responders", "partial responders" and "non-responders". Comorbidities played an important role for the decision to switch to another biologic, eg, when initial therapy had insufficient effectiveness on CRSwNP. Conclusion This study provides a detailed insight into current opinions and practice of biologic use in severe asthma in Germany.
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Affiliation(s)
- Hendrik Suhling
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
| | - Karl-Christian Bergmann
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carlo Mümmler
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
| | - Marco Idzko
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Margret Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - Christian Schulz
- Bereich Pneumologie Klinik und Poliklinik für Innere Medizin II, University Hospital Regensburg, Regensburg, Germany
| | - Olaf Schmidt
- Pneumologische Gemeinschaftspraxis und Studienzentrum KPPK, Koblenz, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Stephanie Korn
- IKF Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - the GAN registry group
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Germany
- Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
- Ambulante Pneumologie Stuttgart, Stuttgart, Germany
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
- Bereich Pneumologie Klinik und Poliklinik für Innere Medizin II, University Hospital Regensburg, Regensburg, Germany
- Pneumologische Gemeinschaftspraxis und Studienzentrum KPPK, Koblenz, Germany
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
- IKF Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany
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Mümmler C, Suhling H, Walter J, Kneidinger N, Buhl R, Kayser MZ, Drick N, Behr J, Welte T, Korn S, Milger K. Overall Response to Anti-IL-5/Anti-IL5-Rα Treatment in Severe Asthma Does Not Depend on Initial Bronchodilator Responsiveness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3174-3183. [PMID: 35870725 DOI: 10.1016/j.jaip.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/04/2022] [Accepted: 07/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Positive bronchodilator responsiveness (BDR) (change in forced expiratory volume in 1 second [ΔFEV1] ≥ +200 mL and ≥ +12%) after inhalation of a short-acting beta-2 agonist has been an inclusion criterion in licensing trials of anti-interleukin 5/anti-interleukin 5 receptor alpha (anti-IL-5/anti-IL-5Rα) biologics in severe asthma. However, in clinical practice, patients with severe uncontrolled asthma frequently show a negative BDR. OBJECTIVE To investigate whether the response to anti-IL5/anti-IL5Rα therapies differs between patients with positive and negative BDR at baseline. METHODS Retrospective multicenter analysis of treatment outcomes in patients with severe asthma receiving anti-IL-5/anti-IL-5Rα stratified for baseline BDR. RESULTS Of 133 patients included, 37 had a positive and 96 had a negative BDR at baseline. Following anti-IL-5/anti-IL-5Rα treatment, FEV1 improved significantly in both groups compared with baseline (P < .0001), with no significant difference between patients with positive and negative BDR (ΔFEV1 +493 mL vs +306 mL; P = .06). Forced vital capacity (FVC) increased (ΔFVC: +85 mL vs +650 mL; P < .01) and residual volume (RV) decreased (ΔRV +113 mL vs -307 mL; P < .01) significantly in patients with negative BDR. Median annualized exacerbations (0 vs 0; P = .7), reduction of exacerbation rate (Δexacerbations 0 vs -2; P = .07), continuous oral corticosteroids (OCS) use (Δpatients on OCS -35% vs -39%; P = .99) and improvement of Asthma Control Test (ACT) score (ΔACT 6 vs 5; P = .7) were similar in both groups. Multivariate logistic regression analysis showed no significant correlations of positive versus negative BDR with response parameters. CONCLUSIONS Both groups improved following treatment with similar responses concerning reduction of OCS therapy, exacerbations, and improvement of symptom control. Pulmonary function also improved in both groups during anti-IL-5/anti-IL-5Rα treatment, with differences in response patterns noted.
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Affiliation(s)
- Carlo Mümmler
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Julia Walter
- Department of Medicine V, University Hospital, LMU Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Roland Buhl
- Clinical Research Centre for Respiratory Medicine, Mainz, Germany
| | - Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Stephanie Korn
- IKF Pneumologie Mainz, Mainz, Germany; Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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