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Abu Elhassan U, Al-Mani SY, Alqahtani SMA, Elnamaky M, Alfaifi A, Alshehri MA, Alasiri HA, Kadasah AS, Musleh A, Alshafa FA, Qureshi MSS, Assiri AY, Falqi AI, Asiri BI, Ahmed HMO, Alshehry S, Abdalla AM. Impact of biological therapies on laboratory outcomes and FEV1 in patients with severe eosinophilic asthma with chronic rhinosinusitis: a real-life study from Saudi Arabia. Multidiscip Respir Med 2024; 19. [PMID: 39250180 DOI: 10.5826/mrm.2024.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
Abstract Background: Few studies have addressed the effects of biological therapies on laboratory outcomes and changes in FEV1 in patients with severe asthma (SA) and chronic rhinosinusitis (CRS). We aimed to study the effect of three biological therapies on laboratory outcomes and FEV1 in Saudi Arabian patients with SA and CRS. METHODS From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital-Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of 3 biological therapies (benralizumab, dupilumab, and omalizumab) in adults with SA and concomitant CRS in terms of FEV1 and laboratory parameters (serum IgE and eosinophilic counts). RESULTS Eighty patients were enrolled, with a mean age of 46.68. There were 45 (56%) females and 35 (44%) males. There were significant improvements in FEV1 and laboratory parameters (serum IgE and eosinophilic counts) after 6 &12 months of biological therapies compared to pre-biological therapies (p<0.001, each). The response was different among different biological therapies. The improvements in FEV1, serum IgE, and eosinophilic counts were manifest with benralizumab and dupilumab but not with omalizumab. CONCLUSIONS Results from the first study from two large Saudi Arabian tertiary centers for patients with severe asthma and chronic rhinosinusitis agree with and support those of worldwide real-life ones. One-year follow-up of patients with SA and CRS showed the effectiveness of benralizumab and dupilumab, but not omalizumab, regarding FEV1, serum IgE, and eosinophilic counts. Further prospective multicenter studies are warranted.
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Affiliation(s)
- Usama Abu Elhassan
- Assistant Professor of Pulmonary Medicine, Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt. Consultant of Pulmonary Medicine, Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Salihah Y Al-Mani
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Saad M A Alqahtani
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Medhat Elnamaky
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia. Department of Pulmonary Medicine, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Abdulaziz Alfaifi
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Mohammed A Alshehri
- 2Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Haneen A Alasiri
- 2Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Ali S Kadasah
- 2Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Abdullah Musleh
- Otorhinolaryngology Division, Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Fawwaz A Alshafa
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Muhammad S S Qureshi
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Abdulmohsen Y Assiri
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Abdulrahman I Falqi
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Bader I Asiri
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Haider M O Ahmed
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
| | - Saleem Alshehry
- Internal Medicine Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdelrahman M Abdalla
- Department of Pulmonary Medicine, Faculty of Medicine, Beni Seuf University, Egypt. 2Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, Saudi Arabia
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2
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Wechsler ME, Scelo G, Larenas-Linnemann DES, Torres-Duque CA, Maspero J, Tran TN, Murray RB, Martin N, Menzies-Gow AN, Hew M, Peters MJ, Gibson PG, Christoff GC, Popov TA, Côté A, Bergeron C, Dorscheid D, FitzGerald JM, Chapman KR, Boulet LP, Bhutani M, Sadatsafavi M, Jiménez-Maldonado L, Duran-Silva M, Rodriguez B, Celis-Preciado CA, Cano-Rosales DJ, Solarte I, Fernandez-Sanchez MJ, Parada-Tovar P, von Bülow A, Bjerrum AS, Ulrik CS, Assing KD, Rasmussen LM, Hansen S, Altraja A, Bourdin A, Taille C, Charriot J, Roche N, Papaioannou AI, Kostikas K, Papadopoulos NG, Salvi S, Long D, Mitchell PD, Costello R, Sirena C, Cardini C, Heffler E, Puggioni F, Canonica GW, Guida G, Iwanaga T, Al-Ahmad M, García U, Kuna P, Fonseca JA, Al-Lehebi R, Koh MS, Rhee CK, Cosio BG, Perez de Llano L, Perng DWS, Huang EWC, Wang HC, Tsai MJ, Mahboub B, Salameh LIJ, Jackson DJ, Busby J, Heaney LG, Pfeffer PE, Goddard AG, Wang E, Hoyte FCL, Chapman NM, Katial R, Carter V, Bulathsinhala L, Eleangovan N, Ariti C, Lyu J, Porsbjerg C, Price DB. Association Between T2-related Comorbidities and Effectiveness of Biologics in Severe Asthma. Am J Respir Crit Care Med 2024; 209:262-272. [PMID: 38016003 DOI: 10.1164/rccm.202305-0808oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
Rationale: Previous studies investigating the impact of comorbidities on the effectiveness of biologic agents have been relatively small and of short duration and have not compared classes of biologic agents. Objectives: To determine the association between type 2-related comorbidities and biologic agent effectiveness in adults with severe asthma (SA). Methods: This cohort study used International Severe Asthma Registry data from 21 countries (2017-2022) to quantify changes in four outcomes before and after biologic therapy-annual asthma exacerbation rate, FEV1% predicted, asthma control, and long-term oral corticosteroid daily dose-in patients with or without allergic rhinitis, chronic rhinosinusitis (CRS) with or without nasal polyps (NPs), NPs, or eczema/atopic dermatitis. Measurements and Main Results: Of 1,765 patients, 1,257, 421, and 87 initiated anti-IL-5/5 receptor, anti-IgE, and anti-IL-4/13 therapies, respectively. In general, pre- versus post-biologic therapy improvements were noted in all four asthma outcomes assessed, irrespective of comorbidity status. However, patients with comorbid CRS with or without NPs experienced 23% fewer exacerbations per year (95% CI, 10-35%; P < 0.001) and had 59% higher odds of better post-biologic therapy asthma control (95% CI, 26-102%; P < 0.001) than those without CRS with or without NPs. Similar estimates were noted for those with comorbid NPs: 22% fewer exacerbations and 56% higher odds of better post-biologic therapy control. Patients with SA and CRS with or without NPs had an additional FEV1% predicted improvement of 3.2% (95% CI, 1.0-5.3; P = 0.004), a trend that was also noted in those with comorbid NPs. The presence of allergic rhinitis or atopic dermatitis was not associated with post-biologic therapy effect for any outcome assessed. Conclusions: These findings highlight the importance of systematic comorbidity evaluation. The presence of CRS with or without NPs or NPs alone may be considered a predictor of the effectiveness of biologic agents in patients with SA.
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Affiliation(s)
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | | | - Carlos A Torres-Duque
- CINEUMO/Centro Internacional de Investigación en Neumología, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Ruth B Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
- University of Leicester, Leicester, United Kingdom
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom
- Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Andréanne Côté
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Celine Bergeron
- Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Libardo Jiménez-Maldonado
- Fundación Neumológica Colombiana, Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma (ASMAIRE) Programa, Bogotá, Colombia
| | - Mauricio Duran-Silva
- Fundación Neumológica Colombiana, Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma (ASMAIRE) Programa, Bogotá, Colombia
| | | | - Carlos Andres Celis-Preciado
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | | | - Ivan Solarte
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, San Ignacio University Hospital, Bogota, Colombia
- Faculty of Medicine, Pontificia University Javeriana, Bogota, Colombia
| | - Patricia Parada-Tovar
- CINEUMO/Centro Internacional de Investigación en Neumología, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Anne Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus City, Denmark
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Arnaud Bourdin
- PhyMedExp, Université de Montpellier, Centre National de Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Camille Taille
- Department of Respiratory Diseases, Bichat Hospital, Public Assistance-Hospitals of Paris North, Paris City University, Paris, France
| | - Jeremy Charriot
- PhyMedExp, Université de Montpellier, Centre National de Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nicolas Roche
- Department of Respiratory Medicine, Public Assistance-Hospitals of Paris North, Paris City University, Cochin Hospital and Institute (Unité Mixte de Recherche 1016), Paris, France
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | | | | | - Richard Costello
- Clinical Research Centre, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giuseppe Guida
- Department of Clinical and Biological Sciences, Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Ulises García
- Department of Allergy and Immunology, National Medical Center of Bajio, University of Guanajuato, Guanajuato, Mexico
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Łódź, Łódź, Poland
| | - João A Fonseca
- Center for Health Technology and Services Research (CINTESIS)
- Health Research Network (RISE), and
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Borja G Cosio
- Hospital Universitari Son Espases, Fundación Instituto de Investigación Sanitaria Islas Baleares-Ciberes, Mallorca, Spain
| | - Luis Perez de Llano
- Pneumology Service, Lucus Augusti University Hospital, Sergas (Galician Healthcare Service) Integrated Management Structure (EOXI) Lugo, Monforte e Cervo, Lugo, Spain
| | - Diahn-Warng Steve Perng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Erick Wan-Chun Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hao-Chien Wang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and
- School of Medicine, College of Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Laila Ibraheem Jaber Salameh
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences and
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health National Hospital Service Trust, London, United Kingdom
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | - Flavia C L Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | | | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, and
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Con Ariti
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Juntao Lyu
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
| | - Celeste Porsbjerg
- Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark; and
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Domínguez-Ortega J, Mullol J, Álvarez Gutiérrez FJ, Miguel-Blanco C, Castillo JA, Olaguibel JM, Blanco-Aparicio M. The effect of biologics in lung function and quality of life of patients with united airways disease: A systematic review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100174. [PMID: 37915724 PMCID: PMC10616425 DOI: 10.1016/j.jacig.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023]
Abstract
Background Increasing evidence supports the united airway disease concept for the management of upper and lower respiratory tract diseases, particularly in patients with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). However, evidence for a combined approach in asthma and CRSwNP is scarce. Objective In this systematic review, we focused on the role of biologics in the lung function and quality of life in patients with severe asthma and CRSwNP. Methods We conducted a systematic search of 3 electronic databases using 2 search strategies to identify studies published from January 2010 to March 2022. Quality assessment was performed with the Critical Appraisal Skills Programme. Results Of 1030 studies identified, 48 original studies reporting data of benralizumab (12), dupilumab (14), mepolizumab (10), omalizumab (13), and reslizumab (2) were analyzed. Primary diagnosis was mostly asthma or CRSwNP, with only 15 studies, mainly observational, performed in populations with united airway disease. In total, 18 studies reported data on quality of life (mostly 22-item Sino-Nasal Outcome Test score), 8 on lung function (mostly FEV1), and 22 on both outcomes. Significant FEV1 and 22-item Sino-Nasal Outcome Test score improvements were consistently observed after 24-week treatment, and thereafter, mostly in real-world studies that included variable proportions of patients with asthma/CRSwNP. Conclusions The use of biologics in patients with severe asthma and CRSwNP was overall associated with significant improvements in lung function and quality of life. However, we observed a high heterogeneity of populations and outcome measurements across studies. Notwithstanding the need of larger studies, our results reinforce the joint management of asthma and CRSwNP as united airway disease in clinical practice.
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Affiliation(s)
- Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | | | | | | | - Jose María Olaguibel
- Department of Allergy, Hospital Universitario de Navarra, CIBER of Respiratory Diseases (CIBERES), Navarra, Spain
| | - Marina Blanco-Aparicio
- Department of Respiratory Medicine, Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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4
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Al-Ahmad M, Ali A, Maher A. Factors influencing poor response to type 2 targeted therapies in severe asthma: a retrospective cohort study. BMC Pulm Med 2023; 23:490. [PMID: 38053108 DOI: 10.1186/s12890-023-02786-w] [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: 07/04/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND A significant breakthrough has been made in treating severe asthma, with the recognition of various asthma phenotypes and an updated management guideline. Type 2 targeted therapies, such as benralizumab and omalizumab; have been identified as an effective treatment for severe asthma, improving patient response, lung function tests and asthma symptom control. This study aimed to evaluate factors contributing to poor response to therapy. METHODS A retrospective single-center cohort study of 162 patients with severe asthma who started biologic therapy; their data were retrieved from medical records for further analysis. Poor responders were patients remained clinically and functionally uncontrolled despite even after augmenting all treatment options. RESULTS Childhood-onset asthma, bronchiectasis, poor symptom control (ACT below 19), severe airway obstruction (< 60% predicted), and maintenance oral corticosteroid (mOCS) use were significantly associated with poor response to omalizumab and benralizumab; p = 0.0.4 and 0.01; 0.003 and 0.01; 0.01 and 0.001, 0.05 and 0.04; 0.006 and 0.02, respectively. However, chronic rhinosinusitis and IgE < 220kIU/L were associated with higher poor response rates to omalizumab (p = 0.01 and 0.04, respectively). At the same time, female patients and those with blood eosinophils level < 500 cells/mm3 had a higher poor response rate to benralizumab (p = 0.02 and 0.01, respectively). Ischemic heart disease (IHD), bronchiectasis, and continued use of OCS increased the likelihood of poor response to omalizumab by 21, 7, and 24 times (p = 0.004, 0.008, and 0.004, respectively). In contrast, the female gender, childhood-onset asthma and higher BMI increased the likelihood of poor response to benralizumab by 7, 7 and 2 times more, p = 0.03, 0.02 and 0.05, respectively. CONCLUSION Poor response to omalizumab treatment was independently associated with ischemic heart disease (IHD), bronchiectasis, and a history of maintenance oral corticosteroid (mOCS) use. Conversely, poor response to benralizumab therapy was independently linked to female gender, childhood-onset asthma and higher body mass index (BMI).
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Affiliation(s)
- Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, P.O. Box 24923, Kuwait City, 13110, Kuwait.
- Department of Allergy, Al-Rashed allergy center, Ministry of Health, Kuwait City, Kuwait.
| | - Asmaa Ali
- Department of Laboratory medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China
- Department of Allergy, Al-Rashed allergy center, Ministry of Health, Kuwait City, Kuwait
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt
| | - Ahmed Maher
- Department of Allergy, Al-Rashed allergy center, Ministry of Health, Kuwait City, Kuwait
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5
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Oda T, Iwamoto H, Takeno S, Kawasumi T, Takemoto K, Nishida M, Chikuie N, Horibe Y, Yamaguchi K, Sakamoto S, Higaki N, Taruya T, Horimasu Y, Masuda T, Hamamoto T, Nakashima T, Ishino T, Ueda T, Fujitaka K, Hamada H, Hattori N. Exhaled Nitric Oxide and Olfactory Dysfunction in Patients with Asthma: Association with Chronic Rhinosinusitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1776. [PMID: 37893494 PMCID: PMC10608782 DOI: 10.3390/medicina59101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Abstract
Objectives: Olfactory dysfunction is a clinical sign that is important to detect with coexistent upper airway comorbidities in patients with asthma. This study aimed to investigate the etiology of olfactory dysfunction in patients with asthma and the relationship between fractional exhaled nitric oxide (FeNO) levels. Materials and Methods: This study included 47 asthma patients who were evaluated for olfactory dysfunction at Hiroshima University Hospital between 2012 and 2020. The etiologies of olfactory dysfunction were evaluated, and they were classified according to the FeNO levels of patients with asthma. Results: Olfactory dysfunction was observed in 30 patients with asthma, with chronic rhinosinusitis (77%) being the most prevalent etiology. Eosinophilic chronic rhinosinusitis (ECRS) was the most prevalent etiology of olfactory dysfunction in asthma patients with high FeNO levels (≥25 ppb), while non-eosinophilic chronic rhinosinusitis (NCRS) was the most prevalent etiology in asthma patients with low FeNO levels (<25 ppb). Additionally, the prevalence of ECRS was significantly higher in asthma patients with olfactory dysfunction and high FeNO levels (74%) than in those with either high FeNO levels or olfactory dysfunction and those with low FeNO levels and no olfactory dysfunction (12% and 9%, respectively). Conclusions: We found that ECRS was the predominant cause of olfactory dysfunction in patients with high FeNO levels, while NCRS was more common in those with low FeNO levels. The present study showed that both ECRS and NCRS are common etiologies of olfactory dysfunction in patients with asthma. Additionally, this study supports the link between upper and lower airway inflammation in patients with asthma complicated with olfactory dysfunction.
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Affiliation(s)
- Takashi Oda
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Tomohiro Kawasumi
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Kota Takemoto
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Manabu Nishida
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Nobuyuki Chikuie
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Yuichiro Horibe
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Naoko Higaki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Takayuki Taruya
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Takao Hamamoto
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Takashi Ishino
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (T.O.); (T.K.); (K.T.); (M.N.); (N.C.); (Y.H.); (T.T.); (T.H.); (T.I.); (T.U.)
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan;
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (H.I.); (K.Y.); (S.S.); (N.H.); (Y.H.); (T.M.); (T.N.); (K.F.); (N.H.)
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Delgado J, Navarro A, Álvarez-Gutiérrez FJ, Cisneros C, Domínguez-Ortega J. [Unmet Needs in Severe Allergic Asthma]. OPEN RESPIRATORY ARCHIVES 2023; 5:100282. [PMID: 38053757 PMCID: PMC10694599 DOI: 10.1016/j.opresp.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Severe asthma affects 3%-10% of the world's population, according to estimates by the Global Initiative for ASTHMA (GINA). Allergic asthma is one of the most common phenotypes of severe asthma and it is characterized by allergen-induced type 2 inflammation in which immunoglobulin E (IgE) is a key mediator, making it an important therapeutic target. The introduction of targeted biological therapies or treatments has entered the management for severe asthma in the era of precision medicine, and the goal of treatment is clinical remission of the disease. There is a significant percentage of patients with severe allergic asthma who do not respond to treatments and whose symptoms are not controlled. In this paper, a group of experts in the management of severe allergic asthma reviewed and evaluated the most relevant evidence regarding the pathophysiology and phenotypes of severe allergic asthma, the role of IgE in allergic inflammation, allergen identification, techniques, biomarkers and diagnostic challenges, available treatments and strategies for disease management, with a special focus on biological treatments. From this review, recommendations were developed and validated through a Delphi consensus process with the aim of offering improvements in the management of severe allergic asthma to the professionals involved and identifying the unmet needs in the management of this pathology.
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Affiliation(s)
- Julio Delgado
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Ana Navarro
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | | | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, Instituto de Investigación IDiPAZ, Madrid, España
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Gill AS, Alt JA, Detwiller KY, Rowan NR, Gray ST, Hellings PW, Joshi SR, Lee JT, Soler ZM, Tan BK, Taylor-Cousar JL, Wise SK, Wu TJ, Beswick DM. Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2023; 13:1758-1782. [PMID: 36579899 DOI: 10.1002/alr.23130] [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: 12/05/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence-based management strategies for CRS in this population. METHODS Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full-text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit-harm assessments, as well as value judgment and recommendations, were provided RESULTS: Strong evidence confirms the benefit of oral and topical medications on sinonasal-specific outcomes in individuals with CRSwA; there is low-grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal- and asthma-specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal- and asthma-specific outcomes. CONCLUSION Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second-line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremiah A Alt
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kara Y Detwiller
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and neck Surgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stacey T Gray
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, and Department of Otorhinolaryngology, Upper Airway Research Laboratory, University of Ghent, Ghent, Belgium
| | - Shyam R Joshi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jivianne T Lee
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zach M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer L Taylor-Cousar
- National Jewish Health, Departments of Internal Medicine and Pediatrics, Pulmonary Divisions, Denver, Colorado, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Tara J Wu
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, California, USA
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Tiotiu A, Mendez-Brea P, Ioan I, Romero-Fernandez R, Oster JP, Hoang TCT, Roux P, Ochoa-Gutierrez DC, Bonniaud P, de Blay F, Gonzalez-Barcala FJ. Real-Life Effectiveness of Benralizumab, Mepolizumab and Omalizumab in Severe Allergic Asthma Associated with Nasal Polyps. Clin Rev Allergy Immunol 2023; 64:179-192. [PMID: 35420388 DOI: 10.1007/s12016-022-08938-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/29/2022]
Abstract
Biological therapies are available for the treatment of the severe allergic asthma (SAA) with blood eosinophil count ≥ 0.3 × 109/L. Several of them also showed benefits on nasal polyps (NP), one of the most frequent comorbidities of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking. The aim of this study is to compare the effectiveness of benralizumab, mepolizumab and omalizumab in patients with SAA-NP in real-life settings. A retrospective, observational, multicenter real-life study was realized including patients with SAA-NP treated by benralizumab, mepolizumab or omalizumab for 6 months. We analysed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging and the blood eosinophil count 6 months before and after treatment. Seventy-two patients with SAA-NP were included: 16 treated by benralizumab, 21 by mepolizumab and 35 by omalizumab. After 6 months of treatment, almost all studied parameters were improved (except sinus imaging) with a greater effect of omalizumab on the nasal pruritus (p = 0.001) and more benefits of benralizumab on exacerbations rate, asthma attacks per week and lung function (all p < 0.05). Benralizumab and mepolizumab were more effective to improve the NP endoscopic score and the blood eosinophil count (both p < 0.001). All three biological therapies showed effectiveness by improving asthma and nasal outcomes in patients with SAA-NP. Several differences have been found that should be confirmed by larger comparative studies.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 9 Rue du Morvan, 54500, Vandoeuvre-Les-Nancy, Nancy, France.
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, Nancy, France.
| | - Paula Mendez-Brea
- Department of Allergy, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iulia Ioan
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, Nancy, France
- Lung Function Testing Lab, Children's University Hospital of Nancy, Nancy, France
| | - Rodrigo Romero-Fernandez
- Department of Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Pauline Roux
- Department of Pulmonology, University Hospital of Besançon, Besançon, France
| | | | - Philippe Bonniaud
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital of Dijon, Dijon, France
- LNC UMR866, LipSTIC LabEx Team, Inserm, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Frederic de Blay
- Department of Pulmonology-Allergology, University Hospital of Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Francisco-Javier Gonzalez-Barcala
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Spanish Biomedical Research Networking Centre-CIBERES, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
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Sun J, Bai S, Zhao J, Li D, Ma X, Ma L, Su X. Mapping knowledge structure and research of the biologic treatment of asthma: A bibliometric study. Front Immunol 2023; 14:1034755. [PMID: 36845128 PMCID: PMC9947831 DOI: 10.3389/fimmu.2023.1034755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background Bronchial asthma (asthma) is a chronic inflammatory disease of the airways, involving a variety of cells and cellular components, that manifests clinically as recurrent episodes of wheezing, shortness of breath, with or without chest tightness or cough, airway hyperresponsiveness, and variable airflow limitation. The number of people with asthma has reached 358 million worldwide and asthma causes huge economic loss. However, there is a subset of patients who are not sensitive to existing drugs and the existing drugs have many adverse effects. Therefore, it's important to find new drugs for asthma patients. Methods Publications related to biologics in asthma published from 2000 to 2022 were retrieved from Web of Science Core Collection. The search strategies were as follows: topic: TS=(biologic* OR "biologic* product*" OR "biologic* therap*" OR biotherapy* OR "biologic* agent*" OR Benralizumab OR "MEDI-563" OR Fasenra OR "BIW-8405" OR Dupilumab OR SAR231893 OR "SAR-231893" OR Dupixent OR REGN668 OR "REGN-668" OR Mepolizumab OR Bosatria OR "SB-240563" OR SB240563 OR Nucala OR Omalizumab OR Xolair OR Reslizumab OR "SCH-55700" OR SCH55700 OR "CEP-38072" OR CEP38072 OR Cinqair OR "DCP-835" OR DCP835 OR Tezspire OR "tezepelumab-ekko" OR "AMG-157" OR tezspire OR "MEDI-9929" OR "MEDI-19929" OR MEDI9929 OR Itepekimab OR "REGN-3500"OR REGN3500 OR "SAR-440340"OR SAR440340 OR Tralokinumab OR "CAT-354" OR Anrukinzumab OR "IMA-638" OR Lebrikizumab OR "RO-5490255"OR "RG-3637"OR "TNX-650"OR "MILR1444A"OR "MILR-1444A"OR"PRO301444"OR "PRO-301444"OR Pitrakinra OR altrakincept OR "AMG-317"OR"AMG317" OR Etokimab OR Pascolizumab OR "IMA-026"OR Enokizumab OR "MEDI-528"OR "7F3COM-2H2" OR 7F3COM2H2 OR Brodalumab OR "KHK-4827" OR "KHK4827"OR "AMG-827"OR Siliq OR Ligelizumab OR "QGE-031" OR QGE031 OR Quilizumab OR Talizumab OR "TNX-901" OR TNX901 OR Infliximab OR Etanercept OR "PRS-060") AND TS=asthma*. The document type was set to articles and review articles and the language restriction was set to English. Three different analysis tools including one online platform, VOS viewer1.6.18, and CiteSpace V 6.1.R1 software were used to conduct this bibliometric study. Results This bibliometric study included 1,267 English papers published in 244 journals from 2,012 institutions in 69 countries/regions. Omalizumab, benralizumab, mepolizumab, and tezepelumab in relation to asthma were the research hotspots in the field. Conclusion This study systematically uncovers a holistic picture of existing literature related to the biologic treatment of asthma over the past 20 years. We consulted scholars in order to understand key information in this field from the perspective of bibliometrics, which we believe may greatly facilitate future research in this field.
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Affiliation(s)
| | | | | | | | | | | | - Xinming Su
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, The First Hospital of China Medical University, China Medical University, Shenyang, China
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Berger P, Menzies-Gow A, Peters AT, Kuna P, Rabe KF, Altincatal A, Soler X, Pandit-Abid N, Siddiqui S, Jacob-Nara JA, Deniz Y, Rowe PJ. Long-term efficacy of dupilumab in asthma with or without chronic rhinosinusitis and nasal polyps. Ann Allergy Asthma Immunol 2023; 130:215-224. [PMID: 36356712 DOI: 10.1016/j.anai.2022.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coexisting chronic rhinosinusitis and nasal polyps (CRS-NPs) substantially increases the disease burden of asthma. Dupilumab, a fully human monoclonal antibody, has established efficacy and an acceptable safety profile in asthma and CRS with NP. OBJECTIVE To evaluate long-term dupilumab efficacy in TRAVERSE (NCT02134028) patients with uncontrolled, moderate-to-severe (QUEST) or oral corticosteroid (OCS)-dependent (VENTURE) asthma with or without coexisting CRS-NP. METHODS In TRAVERSE, 317 of 1530 (21%) QUEST and 61 of 187 (48%) VENTURE patients had self-reported CRS-NP; they received subcutaneous 300 mg dupilumab every 2 weeks up to 96 weeks. Patients were categorized by parent study treatment group (placebo/dupilumab, dupilumab/dupilumab). End points included annualized asthma exacerbation rates and mean change from parent study baseline in prebronchodilator forced expiratory volume in 1 second, Asthma Control Questionnaire 5 score, Asthma Quality of Life Questionnaire score, and OCS dose. RESULTS Patients with coexisting CRS-NP had higher OCS dose and a history of more exacerbations. Concluding TRAVERSE, exacerbation rates decreased from 2.39 to 0.32 and 2.32 to 0.35 in dupilumab/dupilumab and 2.36 to 0.41 and 2.36 to 0.45 in placebo/dupilumab by week 96 from QUEST and VENTURE baselines, respectively. Non-CRS-NP results were similar. Improvements in forced expiratory volume in 1 second, Asthma Control Questionnaire 5 score, and Asthma Quality of Life Questionnaire score during parent studies were maintained in TRAVERSE; placebo/dupilumab patients achieved similar improvements to dupilumab/dupilumab by week 48. By week 96, 71% and 39% of OCS-dependent patients with CRS-NP and 83% and 47% without CRS-NP treated with dupilumab/dupilumab and placebo/dupilumab, respectively, stopped OCS. CONCLUSION Long-term dupilumab efficacy was maintained in patients with asthma with or without self-reported coexisting CRS-NP, including OCS-sparing effects observed in OCS-dependent severe asthma. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02528214, NCT02414854, and NCT02134028.
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Affiliation(s)
- Patrick Berger
- Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Pessac, France; INSERM, U1045, Pessac, France; Service d'exploration fonctionnelles respiratoires, CHU de Bordeaux, Pessac, France.
| | | | - Anju T Peters
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Łódź, Łódź, Poland
| | - Klaus F Rabe
- Airway Research Center North (ARCN), LungenClinic Grosshansdorf (member of the German Center for Lung Research [DZL]), Grosshansdorf, Germany; Airway Research Center North (ARCN), Christian-Albrechts University (member of the German Center for Lung Research [DZL]), Kiel, Germany
| | | | - Xavier Soler
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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11
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Busse WW, Pavord ID, Siddiqui S, Khan AH, Praestgaard A, Nash S, Jacob-Nara JA, Rowe PJ, Deniz Y. Dupilumab Improves Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps and Coexisting Asthma Irrespective of Baseline Asthma Characteristics. J Asthma Allergy 2023; 16:411-419. [PMID: 37096015 PMCID: PMC10122472 DOI: 10.2147/jaa.s391896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease frequently coexisting with other type 2 conditions including asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD). Coexisting asthma leads to increased CRSwNP symptom burden. Dupilumab, a monoclonal antibody that blocks the shared receptor component for interleukin-4 and -13, demonstrated efficacy in adults with severe CRSwNP in the Phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies, including in patients with coexisting asthma/NSAID-ERD. However, the impact of different asthma characteristics on dupilumab treatment in this population is unknown. We report CRSwNP and asthma outcomes with dupilumab in patients with CRSwNP and coexisting asthma according to baseline asthma characteristics. Methods Change from baseline at Week 24 (pooled studies) and Week 52 (SINUS-52) in CRSwNP outcomes (nasal polyp score, nasal congestion, 22-item Sino-Nasal Outcome Test [SNOT-22], loss of smell score, University of Pennsylvania Smell Identification Test) and asthma outcomes (5-item Asthma Control Questionnaire [ACQ-5], pre-bronchodilator forced expiratory volume in 1 second [FEV1]) were analyzed post hoc for placebo and dupilumab 300 mg every 2 weeks according to baseline blood eosinophils ≥150/≥300 cells/µL, ACQ-5 scores <1.5/≥1.5, and FEV1 <80%. Results In the pooled studies, 428/724 patients (59.1%) had coexisting asthma, of which 181/428 (42.3%) had coexisting NSAID-ERD. Dupilumab significantly improved all CRSwNP and asthma outcomes vs placebo at Week 24 (P < 0.001) regardless of baseline eosinophil or ACQ-5 category, or FEV1 <80%. Similar magnitude of improvement was seen at Week 52 (SINUS-52) and in patients with NSAID-ERD (pooled studies, Week 24). By Week 24, improvements with dupilumab exceeded the minimum clinically important differences for ACQ-5 and SNOT-22 in 35.2% to 74.2% and 72.0% to 78.7% of patients, respectively. Conclusion Dupilumab improved CRSwNP outcomes in patients with CRSwNP and coexisting asthma, and improved asthma outcomes, regardless of differences in baseline asthma characteristics.
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Affiliation(s)
- William Walter Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA
- Correspondence: William Walter Busse, Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA, Tel +1 608 263-6183, Email
| | - Ian Douglas Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | | | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | | | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Abstract
PURPOSE OF REVIEW To provide a literature review of what is on the market and under study for some diseases treated with drugs targeting type 2 (T2) inflammation. RECENT FINDINGS Literature data have shown that drugs targeting type 2 inflammation are effective in asthma and nasal polyposis, conditions for which they are on the market, and have promising expectations in the case of eosinophilic esophagitis, especially using anti-IL-5/IL-5 receptor and IL-4 receptor antibodies, while concerning eosinophilic granulomatosis with polyangitis (EGPA), mepolizumab (MEP) was approved by FDA and EMA as a drug for the treatment of this condition because of the promising results obtained in trials and in real life. SUMMARY The use of these drugs is certainly an important achievement in the treatment of complex diseases such as those mentioned above, which are too often orphaned from innovative treatments and limited to the use of immunosuppressants and systemic corticosteroid for their control.
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Taniguchi M, Heffler E, Olze H, White A, Côrte-Real J, Olsson P, Lazarewicz S. The Role of Omalizumab in NSAID-Exacerbated Respiratory Disease: A Narrative Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2570-2578. [PMID: 35764285 DOI: 10.1016/j.jaip.2022.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is a condition characterized by the triad of chronic rhinosinusitis with nasal polyps, bronchial asthma, and hypersensitivity to nonsteroidal anti-inflammatory drugs. This article explores the current knowledge on the various pathological mechanism(s) of N-ERD-such as arachidonic acid metabolism, cysteinyl leukotrienes, prostaglandins, platelets, IgE, mast cells, eosinophils, basophils, and innate immune system-and the role of omalizumab in its management. The authors dive deep into the role of IgE in N-ERD and its potential as a therapeutic target. IgE plays a significant role in mediating allergic reactions, is intricately linked with mast cells, interacts with multiple immunopathological pathways involved in N-ERD, and tends to be elevated in patients with N-ERD. Multiple real-world studies, observational studies, and case series, as well as 2 phase III trials, have demonstrated the effectiveness of omalizumab in the management of N-ERD. For a disease with such a well-documented history, the pathophysiology of N-ERD and the most effective ways to manage it remain a mystery. With this background, the authors ask-is IgE a missing piece of the N-ERD puzzle, thus explaining the efficacy of omalizumab in the treatment of the disease?
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Affiliation(s)
- Masami Taniguchi
- Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan; Center for Clinical Research, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Heidi Olze
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Charité Universitätsmedizin, Berlin, Germany
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Biological Therapy of Severe Asthma and Nasal Polyps. J Pers Med 2022; 12:jpm12060976. [PMID: 35743760 PMCID: PMC9225008 DOI: 10.3390/jpm12060976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023] Open
Abstract
Chronic rhinosinusitis is a common disease worldwide and can be categorized into chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma. Severe asthma is effectively treated with biologics and the coexistence of severe asthma with chronic rhinosinusitis with nasal polyps presents a phenotype that is more likely to respond to such treatment. In this review, we focus on the link between asthma and nasal polyps, and we review the treatment effect of various monoclonal antibodies in patients with severe asthma and nasal polyps as well as in patients with nasal polyps without asthma or with mild-to-moderate asthma. With the enhancement of our armamentarium with new monoclonal antibodies the right choice of biologic becomes an important target and one that is difficult to achieve due to the lack of comparative head-to-head studies.
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Bagnasco D, Testino E, Nicola S, Melissari L, Russo M, Canevari RF, Brussino L, Passalacqua G. Specific Therapy for T2 Asthma. J Pers Med 2022; 12:593. [PMID: 35455709 PMCID: PMC9031027 DOI: 10.3390/jpm12040593] [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: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Asthma is a disease with high incidence and prevalence, and its severe form accounts for approximately 10% of asthmatics. Over the last decade, the increasing knowledge of the mechanisms underlying the disease allowed the development of biological drugs capable of sufficiently controlling symptoms and reducing the use of systemic steroids. The best-known mechanisms are those pertaining to type 2 inflammation, for which drugs were developed and studied. Those biological treatments affect crucial points of bronchial inflammation. Among the mechanisms explored, there were IgE (Omalizumab), interleukin 5 (Mepolizumab and Reslizumab), interleukin 5 receptor alpha (Benralizumab) and interleukin 4/13 receptor (Dupilumab). Under investigation and expected to be soon commercialized is the monoclonal antibody blocking the thymic stromal lymphopoietin (Tezepelumab). Seemingly under study and promising, are anti-interleukin-33 (itepekimab) and anti-suppressor of tumorigenicity-2 (astegolimab). With this study, we want to provide an overview of these drugs, paying particular attention to their mechanism of action, the main endpoints reached in clinical trials, the main results obtained in real life and some unclear points regarding their usage.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy; (E.T.); (L.M.); (M.R.); (G.P.)
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
| | - Elisa Testino
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy; (E.T.); (L.M.); (M.R.); (G.P.)
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
| | - Stefania Nicola
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, 10124 Turin, Italy; (S.N.); (L.B.)
| | - Laura Melissari
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy; (E.T.); (L.M.); (M.R.); (G.P.)
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
| | - Maria Russo
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy; (E.T.); (L.M.); (M.R.); (G.P.)
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
| | - Rikki Frank Canevari
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy
| | - Luisa Brussino
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, 10124 Turin, Italy; (S.N.); (L.B.)
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy; (E.T.); (L.M.); (M.R.); (G.P.)
- IRCCS Policlinico San Martino, 16132 Genoa, Italy;
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16
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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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Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:422-432. [PMID: 34763123 DOI: 10.1016/j.jaip.2021.10.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an important factor in biologic selection, especially given the documented ability of some biologics to reduce OCS dependence. Comorbid diseases and relevant safety considerations to each biologic should also be considered. More data are needed to determine whether biomarker profiles identify patients suited to one biologic versus another as limited data support differential predictors of response. Further prospective head-to-head trials and post hoc analyses of clinical trial data are warranted. The authors believe that these recommendations have value as they offer expert opinion to assist health care providers in making difficult decisions regarding the quality of care in severe, type 2 asthma with biologic medications. They remain conditional and are based on limited data owing to a lack of head-to-head comparisons.
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Laidlaw TM, Bachert C, Amin N, Desrosiers M, Hellings PW, Mullol J, Maspero JF, Gevaert P, Zhang M, Mao X, Khan AH, Kamat S, Patel N, Graham NMH, Ruddy M, Staudinger H, Mannent LP. Dupilumab improves upper and lower airway disease control in chronic rhinosinusitis with nasal polyps and asthma. Ann Allergy Asthma Immunol 2021; 126:584-592.e1. [PMID: 33465455 DOI: 10.1016/j.anai.2021.01.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 asthma share the same inflammatory pathophysiology and are frequent comorbidities. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin 4 and interleukin 13, which are key and central drivers of type 2 inflammation. OBJECTIVE We report the effect of dupilumab vs placebo on outcome measures of the upper and lower airways and health-related quality of life (HRQoL) in the pooled population of patients with CRSwNP and comorbid asthma from the phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies. METHODS In these randomized, double-blind, placebo-controlled trials, patients received subcutaneous dupilumab 300 mg (n = 438) or placebo (n = 286) every 2 weeks on a background of mometasone furoate nasal spray. Changes from baseline at week 24 in the upper and lower airway outcome measures are reported. RESULTS Of the 724 patients randomized, 428 (59.1%) had comorbid asthma. In patients with asthma at week 24, dupilumab vs placebo improved the nasal polyp score (-2.04), patient-reported nasal congestion score (-1.04), Lund-Mackay computed tomography scan score (-6.43), peak nasal inspiratory flow (46.15 L/min), and 22-item sinonasal outcome test score (-21.42; all P < .001). The forced expiratory volume in 1 second and 6-item asthma control questionnaire scores were also markedly improved with dupilumab vs placebo. The most common adverse events (nasopharyngitis, headache, injection-site erythema, worsening of nasal polyposis, and asthma) were more frequent with placebo than dupilumab. CONCLUSION Dupilumab improved upper and lower airway outcome measures and HRQoL in patients with severe CRSwNP and comorbid asthma and was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02912468 (SINUS-24) and NCT02898454 (SINUS-52).
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Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Claus Bachert
- Department of Head & Skin, Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium; Division of Ear, Nose and Throat (ENT) Diseases, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Nikhil Amin
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Martin Desrosiers
- Department of Otolaryngology, Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada
| | - Peter W Hellings
- Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic, The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, Ciber De Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Philippe Gevaert
- Department of Head & Skin, Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
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Emson C, Corren J, Sałapa K, Hellqvist Å, Parnes JR, Colice G. Efficacy of Tezepelumab in Patients with Severe, Uncontrolled Asthma with and without Nasal Polyposis: A Post Hoc Analysis of the Phase 2b PATHWAY Study. J Asthma Allergy 2021; 14:91-99. [PMID: 33568920 PMCID: PMC7868291 DOI: 10.2147/jaa.s288260] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin, an epithelial cytokine implicated in asthma pathogenesis, from binding to its heterodimeric receptor. In the phase 2b PATHWAY study, tezepelumab significantly reduced annualized asthma exacerbation rates (AAERs) versus placebo, irrespective of baseline disease characteristics, and improved lung function and symptom control, in adults with severe, uncontrolled asthma. This post hoc analysis assessed the efficacy of tezepelumab in adults with severe, uncontrolled asthma with and without nasal polyposis (NP). Methods In this post hoc analysis of the PATHWAY study (NCT02054130), participants (N=550) were randomized 1:1:1:1 to receive subcutaneous tezepelumab 70 mg every 4 weeks (Q4W), 210 mg Q4W or 280 mg every 2 weeks (Q2W), or placebo Q2W, for 52 weeks. The AAER over 52 weeks and the change from baseline to week 52 in blood eosinophil count, fractional exhaled nitric oxide (FeNO) levels and serum levels of interleukin (IL)-5 and IL-13 with tezepelumab 210 mg (the phase 3 dose) and placebo were analyzed in patients grouped by self-reported presence (NP+) or absence (NP-) of NP at screening. Results At baseline, NP+ patients had higher blood eosinophil counts, higher FeNO levels and higher serum IL-5 and IL-13 levels than NP- patients. Tezepelumab 210 mg reduced the AAER versus placebo to a similar extent in both NP+ and NP- patients (NP+, 75% [95% confidence interval (CI): 15, 93], n=23; NP-, 73% [95% CI: 47, 86], n=112). Patients treated with tezepelumab 210 mg demonstrated greater reductions in blood eosinophil count and levels of FeNO, IL-5 and IL-13 than placebo-treated patients, irrespective of NP status. Discussion Tezepelumab reduced exacerbations and reduced type 2 inflammatory biomarkers in patients with and those without NP, supporting its efficacy in a broad population of patients with severe asthma.
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Affiliation(s)
- Claire Emson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Jonathan Corren
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kinga Sałapa
- Biometrics, Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - Åsa Hellqvist
- Biometrics, Late-Stage Development, Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden
| | | | - Gene Colice
- Late-Stage Development Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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