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Bogart M, Germain G, Laliberté F, Mahendran M, Duh MS, DiRocco K, Noorduyn SG, Paczkowski R, Balkissoon R. Real-World Study of Single-Inhaler Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol on Asthma Control in the US. J Asthma Allergy 2023; 16:1309-1322. [PMID: 38058516 PMCID: PMC10697089 DOI: 10.2147/jaa.s424055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Real-world asthma control data among patients initiating fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) are limited. This study assessed rescue medication use and asthma-related exacerbations in patients with asthma before and after initiating single-inhaler FF/UMEC/VI using administrative claims data. Patients and Methods This retrospective, pre-post cohort study analyzed data from the IQVIA PharMetrics Plus database (September 18, 2016‒March 31, 2020). Patients aged ≥18 years that had ≥1 dispensing of single-inhaler FF/UMEC/VI 100/62.5/25 mcg (first dispensing = index date), ≥12 months of continuous health insurance enrollment prior to (pre-treatment) and following (post-treatment) FF/UMEC/VI initiation and ≥1 diagnosis of asthma during the pre-treatment period or on the index date were included. The primary endpoint was the number of oral corticosteroid (OCS) dispensings per patient per year during pre- and post-treatment periods. Secondary endpoints included asthma-related exacerbation rates and short-acting β2-agonist (SABA) use. Comparisons between pre- and post-treatment periods were made using risk and rate ratios. Results Overall, 890 patients with asthma initiating treatment with FF/UMEC/VI were included. The most recently dispensed controller medications prior to FF/UMEC/VI initiation were inhaled corticosteroids/long-acting β2-agonists (33.5%) and leukotriene modifiers (33.0%). Patients had a 29% reduction in the number of OCS dispensings (rate ratio [95% confidence interval (CI)]: 0.71 [0.65, 0.77], P < 0.001) during post-treatment versus pre-treatment, with a 23% reduction in the proportion of patients with ≥1 OCS dispensing post-treatment (risk ratio [95% CI]: 0.77 [0.73, 0.82], P < 0.001). Significant reductions in rates (rate ratio [95% CI]) of asthma-related exacerbations (0.59 [0.52, 0.67], P < 0.001) and SABA use (0.80 [0.74, 0.86], P < 0.001) were also observed. Conclusion In this real-world study, patients with asthma had significantly lower OCS use, asthma-related exacerbations, and SABA use following treatment initiation with FF/UMEC/VI compared with their pre-treatment period. These results suggest better asthma control following initiation of FF/UMEC/VI in a routine clinical practice setting.
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Affiliation(s)
- Michael Bogart
- U.S. Value Evidence and Outcomes, R&D U.S., GSK, Research Triangle Park, Durham, NC, USA
| | | | | | | | | | | | - Stephen G Noorduyn
- Global Value Evidence and Outcomes, GSK, Mississauga, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Sinha S, Kumar S, Narwaria M, Singh A, Haque M. Severe Acute Bronchial Asthma with Sepsis: Determining the Status of Biomarkers in the Diagnosis of the Disease. Diagnostics (Basel) 2023; 13:2691. [PMID: 37627950 PMCID: PMC10453001 DOI: 10.3390/diagnostics13162691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Bronchial asthma is a widely prevalent illness that substantially impacts an individual's health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition are linked to viral respiratory tract infections (RTI), and bacterial infection appears to have an insignificant impact. However, antibiotics are recommended when there is a high-grade fever, a consolidation on the chest radiograph, and purulent sputum that contains polymorphs rather than eosinophils. Managing acute bronchial asthma with sepsis, specifically the choice of whether or not to initiate antimicrobial treatment, remains difficult since there are currently no practical clinical or radiological markers that allow for a simple distinction between viral and bacterial infections. Researchers found that serum procalcitonin (PCT) values can efficiently and safely minimize antibiotic usage in individuals with severe acute asthma. Again, the clinical manifestations of acute asthma and bacterial RTI are similar, as are frequently used test values, like C-reactive protein (CRP) and white blood cell (WBC) count, making it harder for doctors to differentiate between viral and bacterial infections in asthma patients. The role and scope of each biomarker have not been precisely defined yet, although they have all been established to aid healthcare professionals in their diagnostics and treatment strategies.
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Affiliation(s)
- Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, 33 KDA Avenue, Hotel Royal Crossing, Khulna Sadar, Khulna 9100, Bangladesh
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, SG Highways, Ahmedabad 380054, Gujarat, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, SG Highways, Ahmedabad 380054, Gujarat, India
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
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Tibble H, Sheikh A, Tsanas A. Estimating medication adherence from Electronic Health Records: comparing methods for mining and processing asthma treatment prescriptions. BMC Med Res Methodol 2023; 23:167. [PMID: 37438684 PMCID: PMC10337150 DOI: 10.1186/s12874-023-01935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case. Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study. METHODS Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared. RESULTS Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures. CONCLUSIONS We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
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Affiliation(s)
- Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh, Scotland.
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland.
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
| | - Athanasios Tsanas
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
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Megersa S, Chala G, Fikremariam K. Determinants of Asthma Attack Among Adult Asthmatic Patients Attending at Public Hospitals of West Shoa Zone, Oromia Regional State, Ethiopia, 2021: Case-Control Study. J Asthma Allergy 2022; 15:1143-1154. [PMID: 36042713 PMCID: PMC9420415 DOI: 10.2147/jaa.s376499] [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: 06/03/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Asthma attacks are life-threatening episodes that place a costly burden on the individual and the community in both high- and low-income countries including Ethiopia. There is scant information on the determinant of it in the study area. Objective To identify determinants of asthma attack among adult asthmatic patients attending at public hospitals of West Shoa Zone, Oromia Regional State, Ethiopia. Methods An institutional-based unmatched case–control study design was conducted. In this study, 300 participants (100 cases and 200 controls) were included. A pre-tested structured questionnaire was used to collect data. After the data were entered into Epidata version 3.1, it was exported to SPSS version 25 for analysis. First, bivariable logistic regression was performed. Independent variables with a p-value < 0.25 in binary logistic regression were entered into a multivariable logistic regression model. In the multivariable logistic regression model, independent variables with a p-value < 0.05 were considered to be significant determinants of the outcome variable of the study. Results This finding identified that upper respiratory tract infection (AOR = 5.89, 95% CI: 2.72, 12.79), obstructive sleep apnea (AOR = 3.48, 95% CI: 1.58, 7.66), passive smoker (AOR = 5.93, 95% CI: 2.07, 16.96), spring season (AOR = 2.49, 95% CI: 1.27, 4.89), pet ownership (AOR = 3.63, 95% CI: 1.82, 7.22), kitchen smoke (AOR = 2.31, 95% CI: 1.6, 4.6), rhinitis (AOR = 4.49, 95% CI: 2.25, 8.93) and being jobless (AOR = 5.68, 95% CI: 1.94, 16.68) were significant determinants of asthma attack. Conclusion In this study, upper respiratory tract infection, obstructive sleep apnea, passive smoker, spring season, kitchen smoke, pet ownership, rhinitis, and being jobless were identified as significant determinants of an asthma attack. Because asthma attacks are life-threatening events, effective methods and interventions on determinants of asthma attack incidence should be implemented.
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Affiliation(s)
- Shiferaw Megersa
- Department of Public Health, College of Health and Medical Sciences, Ambo University, Ambo, Ethiopia
| | - Getahun Chala
- Department of Medical Physiology, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kena Fikremariam
- Department of Public Relation and Communication, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
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Tibble H, Sheikh A, Tsanas A. Estimating Medication Adherence from Electronic Health Records Using Rolling Averages of Single Refill-based Estimates. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3554-3557. [PMID: 36086002 DOI: 10.1109/embc48229.2022.9871486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medication adherence is usually defined as the manner in which a patient takes their medication, in relation to the regimen agreed to with their healthcare provider. Electronic Health Records (EHRs) can be used to estimate adherence in a cost-effective and non-invasive manner across large-scale populations, although there is no universally agreed optimal approach to doing so. We sought to explore patterns of asthma ICS prescription refills in a large EHR dataset, and to evaluate the use of rolling-average based measures towards short-term adherence estimation. Over 1.6 million asthma controllers were prescribed for our cohort of 91,332 individuals, between January 2009 and March 2017. The Continuous Single interval measures of medication Availability (CSA) and Gaps (CSG) were calculated for individual prescriptions, as well as rolling-average adherence measures of the CSA over 3, 5, or 10 past prescription intervals. 16.7% of the study population had only a single prescription during their follow-up (a median duration of 7.1 years). 51% of prescriptions were refilled before (or on the day that) supply was exhausted, and for 19% of prescription refills, the amount of medication dispensed should have lasted at least twice as long as the duration before the next refill was filled. The rolling average measures had statistically strong associations (Spearman |R|>0.7) with the estimate for the subsequent prescription refill. Rolling averages of multiple individual refill-level adherence estimates provide a novel and simple way to crudely smoothen estimates from individual prescription refills, which are strongly influenced by common (and adherent) real-world behaviors, for more meaningful and effective trend detection. Clinical Relevance- This demonstrates a novel methodology for estimating medication adherence which can detect recent changes in trends.
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Abstract
ABSTRACT Severe asthma is "asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy." The state of control was defined by symptoms, exacerbations and the degree of airflow obstruction. Therefore, for the diagnosis of severe asthma, it is important to have evidence for a diagnosis of asthma with an assessment of its severity, followed by a review of comorbidities, risk factors, triggers and an assessment of whether treatment is commensurate with severity, whether the prescribed treatments have been adhered to and whether inhaled therapy has been properly administered. Phenotyping of severe asthma has been introduced with the definition of a severe eosinophilic asthma phenotype characterized by recurrent exacerbations despite being on high dose ICS and sometimes oral corticosteroids, with a high blood eosinophil count and a raised level of nitric oxide in exhaled breath. This phenotype has been associated with a Type-2 (T2) inflammatory profile with expression of interleukin (IL)-4, IL-5, and IL-13. Molecular phenotyping has also revealed non-T2 inflammatory phenotypes such as Type-1 or Type-17 driven phenotypes. Antibody treatments targeted at the T2 targets such as anti-IL5, anti-IL5Rα, and anti-IL4Rα antibodies are now available for treating severe eosinophilic asthma, in addition to anti-immunoglobulin E antibody for severe allergic asthma. No targeted treatments are currently available for non-T2 inflammatory phenotypes. Long-term azithromycin and bronchial thermoplasty may be considered. The future lies with molecular phenotyping of the airway inflammatory process to refine asthma endotypes for precision medicine.
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Zhang L, Gao Y, Li M, Xu C, Davis JD, Kanamaluru V, Lu Q. Population pharmacokinetic analysis of dupilumab in adult and adolescent patients with asthma. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:941-952. [PMID: 34313019 PMCID: PMC8376131 DOI: 10.1002/psp4.12667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
A population pharmacokinetic model was developed using data from healthy subjects and patients with moderate‐to‐severe asthma receiving intravenous or subcutaneous dupilumab doses. A total of nine phase I to phase III studies were pooled (202 healthy subjects and 1912 patients with asthma including 68 adolescents) in the model development. The best model was a two‐compartment model with parallel linear and nonlinear Michaelis–Menten elimination with first order absorption. The PK parameter estimates were distribution volume of central compartment 2.76 L, linear elimination rate 0.0418 1/day, and subcutaneous bioavailability 60.9%. Pharmacokinetics (PK) properties of dupilumab in patients with asthma were determined to be comparable to those of healthy subjects and patients with atopic dermatitis. Only body weight exerts a notable effect explaining between‐subject variability in dupilumab PK, but dose adjustment for weight is not warranted based on results from clinical studies. There is no PK difference between adolescent and adult patients with asthma after correction for body weight.
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Affiliation(s)
- Li Zhang
- Sanofi, Bridgewater, New Jersey, USA
| | - Yue Gao
- Sanofi, Bridgewater, New Jersey, USA
| | - Meng Li
- Sanofi, Bridgewater, New Jersey, USA
| | | | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Qiang Lu
- Sanofi, Bridgewater, New Jersey, USA
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Tibble H, Chan A, Mitchell EA, Horne E, Doudesis D, Horne R, Mizani MA, Sheikh A, Tsanas A. A data-driven typology of asthma medication adherence using cluster analysis. Sci Rep 2020; 10:14999. [PMID: 32929109 PMCID: PMC7490405 DOI: 10.1038/s41598-020-72060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an intervention study of electronic inhaler monitoring devices, comprising 211 patients yielding 35,161 person-days of data. Five adherence measures were extracted: the percentage of doses taken, the percentage of days on which zero doses were taken, the percentage of days on which both doses were taken, the number of treatment intermissions per 100 study days, and the duration of treatment intermissions per 100 study days. We applied principal component analysis on the measures and subsequently applied k-means to determine cluster membership. Decision trees identified the measure that could predict cluster assignment with the highest accuracy, increasing interpretability and increasing clinical utility. We demonstrate the use of adherence measures towards a three-group categorization of medication non-adherence, which succinctly describes the diversity of patient medication taking patterns in asthma. The percentage of prescribed doses taken during the study contributed to the prediction of cluster assignment most accurately (84% in out-of-sample data).
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Affiliation(s)
- Holly Tibble
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.
| | - Amy Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elsie Horne
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Dimitrios Doudesis
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Mehrdad A Mizani
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Health Data Research UK, London, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
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Tibble H, Flook M, Sheikh A, Tsanas A, Horne R, Vrijens B, De Geest S, Stagg HR. Measuring and reporting treatment adherence: What can we learn by comparing two respiratory conditions? Br J Clin Pharmacol 2020; 87:825-836. [PMID: 32639589 DOI: 10.1111/bcp.14458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 01/03/2023] Open
Abstract
Medication non-adherence, defined as any deviation from the regimen recommended by their healthcare provider, can increase morbidity, mortality and side effects, while reducing effectiveness. Through studying two respiratory conditions, asthma and tuberculosis (TB), we thoroughly review the current understanding of the measurement and reporting of medication adherence. In this paper, we identify major methodological issues in the standard ways that adherence has been conceptualised, defined and studied in asthma and TB. Between and within the two diseases there are substantial variations in adherence reporting, linked to differences in dosing intervals and treatment duration. Critically, the communicable nature of TB has resulted in dose-by-dose monitoring becoming a recommended treatment standard. Through the lens of these similarities and contrasts, we highlight contemporary shortcomings in the generalised conceptualisation of medication adherence. Furthermore, we outline elements in which knowledge could be directly transferred from one condition to the other, such as the application of large-scale cost-effective monitoring methods in TB to resource-poor settings in asthma. To develop a more robust evidence-based approach, we recommend the use of standard taxonomies detailed in the ABC taxonomy when measuring and discussing adherence. Regimen and intervention development and use should be based on sufficient evidence of the commonality and type of adherence behaviours displayed by patients with the relevant condition. A systematic approach to the measurement and reporting of adherence could improve the value and generalisability of research across all health conditions.
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Affiliation(s)
- Holly Tibble
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Mary Flook
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.,Health Data Research UK, London, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium.,Liège University, Liège, Belgium
| | - Sabina De Geest
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Helen R Stagg
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Asthma mortality in children and adolescents of Brazil over a 20-year period. J Pediatr (Rio J) 2020; 96:432-438. [PMID: 31009618 PMCID: PMC9432052 DOI: 10.1016/j.jped.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/31/2018] [Accepted: 02/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the number of asthma deaths and the temporal trend of the asthma-specific mortality rate in children and adolescents up to 19 years of age in Brazil. METHODS This is an ecological time-series study of asthma deaths reported in Brazil, in the population up to 19 years of age, between 1996 and 2015. The specific asthma mortality rate and its temporal trend were analyzed. RESULTS There were 5014 deaths during the 20 years evaluated, with the majority, 68.1%, being recorded in children under 5 years of age. The specific asthma mortality rate ranged from 0.57/100,000 in 1997 to 0.21/100,000 in 2014, with a significant reduction of 59.8%. Regarding the place of death, 79.4% occurred in a hospital setting. In this sample, the adolescents had a 1.5-fold higher chance of death out-of-hospital than children up to nine years of age. There was no significant difference in the temporal trend between the genders and no significant decrease in out-of-hospital deaths. CONCLUSIONS This study found a temporal trend for a reduction in asthma deaths over 20 years in children and adolescents in Brazil. Mortality rates varied across the geographic regions of the country and were higher in the Northeast. The prevalence of deaths under 5 years of age may be associated with the greater vulnerability of this age group in low-income countries. In adolescence, deaths outside the hospital environment are noteworthy. Asthma deaths are rare but unacceptable events, considering the treatable nature of the disease and the presence of avoidable factors in most of fatal outcomes.
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Pitchon RR, Alvim CG, Andrade CRD, Lasmar LMDLBF, Cruz ÁA, Reis APD. Asthma mortality in children and adolescents of Brazil over a 20‐year period. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cataldo D, Louis R, Michils A, Peché R, Pilette C, Schleich F, Ninane V, Hanon S. Severe asthma: oral corticosteroid alternatives and the need for optimal referral pathways. J Asthma 2020; 58:448-458. [PMID: 31928102 DOI: 10.1080/02770903.2019.1705335] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Patients with severe asthma require high-dose inhaled corticosteroids, with or without add-on treatments, to maintain asthma control. Because symptom control remains unsatisfactory in some patients despite these therapies, maintenance therapy with oral corticosteroids (OCS) remains considered a treatment option by physicians. Besides physician-diagnosed exacerbations, many patients intermittently self-medicate with OCS during episodes of worsening symptoms or as a prevention of such episodes. However, long-term OCS use is associated with several comorbidities that may decrease health-related quality of life, worsen prognosis, and should ideally require monitoring and management. In this review, we discuss the adverse effects of OCS use, the OCS-sparing effect of biologics in severe asthma, and the need for optimal referral pathways to ensure the best outcomes for those at-risk asthma patients. DATA SOURCES PubMed. STUDY SELECTION Studies with results on the OCS-sparing effect of biologics in adult severe asthma were selected. RESULTS Chronic and intermittent OCS use in asthma is associated with considerable adverse effects in asthma. Omalizumab, mepolizumab, benralizumab, and dupilumab reduce the need for OCS in severe asthma, while also reducing the exacerbation rate and improving several patient-related outcomes. CONCLUSION Targeted biologic therapies have revolutionized the treatment of uncontrolled severe asthma by reducing or even eliminating the need for OCS and improving other major outcomes. Novel agents are now rapidly increasing the therapeutic armamentarium, but additional efforts are needed to optimize referral pathways in order to ensure sustainable access to these therapies.
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Affiliation(s)
- Didier Cataldo
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Alain Michils
- Chest Department, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Rudi Peché
- Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium
| | - Charles Pilette
- Department of Pulmonary Medicine, Cliniques Universitaires St Luc, and Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Florence Schleich
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Vincent Ninane
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Belgium
| | - Shane Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Principe S, Benfante A, Calzetta L, Rogliani P, Scichilone N. Age does not affect the efficacy of anti-IL-5/IL-5R in severe asthmatics. World Allergy Organ J 2019; 12:100081. [PMID: 31890084 PMCID: PMC6931205 DOI: 10.1016/j.waojou.2019.100081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background Healthcare decisions made on the basis of insufficient evidence may potentially have ineffective or even harmful consequences. The proportion of older ages (over 65 years) in randomized controlled trials (RCTs) for severe asthma is not enough to establish whether anti-IL-5/IL-5R therapies are equally effective in the elderly as in younger subjects. Methods In order to assess the relationship between age and the efficacy of anti-IL-5 monoclonal antibodies (mABs) with respect to the risk of exacerbations and changes in FEV1, a meta-regression analysis via random-effect method was carried out by plotting the effect estimates (outcome variables) resulting from the pairwise meta-analysis with the age of asthmatic subjects (explanatory variable). A comprehensive literature search was performed for pivotal RCTs on the effects of anti-IL-5/IL-5R in severe asthma, with the following keywords: "asthma and mepolizumab", "asthma and reslizumab" and "asthma and benralizumab". The study was restricted to "clinical trials", "age over 65" and "humans". Data were checked for age, exacerbation rates, changes from baseline in FEV1, and blood eosinophil (Eos) count. Secondary outcomes included inhaled and oral medication use, clinical scores and quality of life. Results A total of 10 studies were analysed. Age did not modulate the efficacy of anti-IL-5/IL-5R treatment against the risk of exacerbation neither in the overall population (coefficient -0.007, P = 0.89), nor in patients with high blood Eos count (coefficient 0.075, P = 0.30). The blood Eos level drove the efficacy of anti-IL-5/IL-5R mABs against the risk of exacerbation regardless of age (coefficient -0.27, P < 0.001). Age did not significantly affect the efficacy of anti-IL-5/IL-5R mABs with respect to the change in FEV1 (coefficient -7.15, P = 0.190); however, in high Eos subjects this improvement tended to be less evident in the more advanced age ranges (coefficient -15.18, P = 0.087). In addition, anti-IL-5/IL-5R mABs reduced ACQ score (P < 0.001 vs. placebo), SGRQ score (P < 0.001 vs. placebo), Total Asthma Symptom Score (P < 0.05 vs. placebo), and the use of oral glucocorticoids (P < 0.001 vs. placebo). Conclusions Age does not negatively affect the efficacy of anti-IL-5/IL-5R mABs. These findings support the use of anti-IL-5/IL-5R mABs in asthmatics of different age ranges.
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Affiliation(s)
- Stefania Principe
- University of Palermo, Dipartimento Universitario di Promozione Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) c/o Pneumologia AOUP "Paolo Giaccone", Palermo, Italy
| | - Alida Benfante
- University of Palermo, Dipartimento Universitario di Promozione Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) c/o Pneumologia AOUP "Paolo Giaccone", Palermo, Italy
| | - Luigino Calzetta
- University of Rome "Tor Vergata", Pulmonary Pharmacology & Therapeutics Unit of Respiratory Clinical Pharmacology Dept. of Experimental Medicine and Surgery, Rome, Italy
| | - Paola Rogliani
- University of Rome "Tor Vergata", Pulmonary Pharmacology & Therapeutics Unit of Respiratory Clinical Pharmacology Dept. of Experimental Medicine and Surgery, Rome, Italy
| | - Nicola Scichilone
- University of Palermo, Dipartimento Universitario di Promozione Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) c/o Pneumologia AOUP "Paolo Giaccone", Palermo, Italy
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Tibble H, Tsanas A, Horne E, Horne R, Mizani M, Simpson CR, Sheikh A. Predicting asthma attacks in primary care: protocol for developing a machine learning-based prediction model. BMJ Open 2019; 9:e028375. [PMID: 31292179 PMCID: PMC6624024 DOI: 10.1136/bmjopen-2018-028375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Asthma is a long-term condition with rapid onset worsening of symptoms ('attacks') which can be unpredictable and may prove fatal. Models predicting asthma attacks require high sensitivity to minimise mortality risk, and high specificity to avoid unnecessary prescribing of preventative medications that carry an associated risk of adverse events. We aim to create a risk score to predict asthma attacks in primary care using a statistical learning approach trained on routinely collected electronic health record data. METHODS AND ANALYSIS We will employ machine-learning classifiers (naïve Bayes, support vector machines, and random forests) to create an asthma attack risk prediction model, using the Asthma Learning Health System (ALHS) study patient registry comprising 500 000 individuals across 75 Scottish general practices, with linked longitudinal primary care prescribing records, primary care Read codes, accident and emergency records, hospital admissions and deaths. Models will be compared on a partition of the dataset reserved for validation, and the final model will be tested in both an unseen partition of the derivation dataset and an external dataset from the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. ETHICS AND DISSEMINATION Permissions for the ALHS project were obtained from the South East Scotland Research Ethics Committee 02 [16/SS/0130] and the Public Benefit and Privacy Panel for Health and Social Care (1516-0489). Permissions for the SIVE II project were obtained from the Privacy Advisory Committee (National Services NHS Scotland) [68/14] and the National Research Ethics Committee West Midlands-Edgbaston [15/WM/0035]. The subsequent research paper will be submitted for publication to a peer-reviewed journal and code scripts used for all components of the data cleaning, compiling, and analysis will be made available in the open source GitHub website (https://github.com/hollytibble).
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Affiliation(s)
- Holly Tibble
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Athanasios Tsanas
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Elsie Horne
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Robert Horne
- Asthma UK Centre for Applied Research, Edinburgh, UK
- University College London, London, UK
| | - Mehrdad Mizani
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Colin R Simpson
- Asthma UK Centre for Applied Research, Edinburgh, UK
- School of Health, Victoria University of Wellington, Wellington, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
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[Prevalence and control of asthma among medical students at Parakou, Benin]. Rev Mal Respir 2019; 36:664-671. [PMID: 31204234 DOI: 10.1016/j.rmr.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/06/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The objective of this study was to determine the prevalence and to assess the control of asthma among students at the faculty of medicine of the university of Parakou in Benin. METHODS This cross-sectional study was carried out between January and November 2017. The Asthma Screening Questionnaire (ASQ) was filled out by medical students, followed by the Asthma Control Test questionnaire for those who were suspected of having clinical asthma (ASQ≥4). All students with clinical asthma or with a history of asthma were invited to perform a spirometry test. RESULTS Overall, 837 (73.7%) students out of 1136 were included. The prevalence was 9.1% for ever diagnosed asthma, 14% for clinical asthma and 5.3% for confirmed asthma. Among 761 students, without a previous asthma diagnosis, 10.4% had clinical asthma and 3.3% a confirmed asthma. Female sex (aOR=2.1; 95%CI =1.0-4.1), a previous diagnosis of asthma (aOR=7; 95% CI=3.2-15.2) and allergic rhinitis (aOR=3.9; 95% CI=1.9-7.8) were associated with confirmed asthma. Asthma symptoms were controlled in 92 (78.6%) students, partly controlled in 20 (17.1%), and not controlled in 5 (4.3%). CONCLUSION Clinical manifestations of asthma are frequent among medical students at Parakou. Some are not well controlled, suggesting a need for greater awareness and an improvement in clinical follow-up.
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Gómez Sáenz JT, Gérez Callejas MJ, Hidalgo Requena A, Ginel Mendoza L, González Aguilera J, Quintano Jiménez JA. [Mortality due to asthma in Spain, 1990-2015]. Semergen 2019; 45:449-457. [PMID: 31105029 DOI: 10.1016/j.semerg.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.
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Abstract
BACKGROUND Benralizumab, a humanized, anti-interleukin-5 (anti-IL-5) receptor α monoclonal antibody that directly and rapidly depletes eosinophils, has shown significant efficacy in reducing asthma exacerbations and improving lung function in moderate to severe eosinophilic asthma patients. However, there is some controversy regarding the adverse events (AEs) of benralizumab and a comprehensive analysis of these AEs has not been performed. This study aimed to assess the incidence of these AEs in published randomized controlled trials (RCTs). METHODS We searched for RCTs in the Embase, PubMed and Cochrane databases that compared benralizumab with placebo in moderate to severe eosinophilic asthma patients. The outcome was the incidence of AEs during the observation period. RESULTS Eight RCTs were analyzed in this study. Patients treated with benralizumab had a lower risk of overall AEs (risk ratio (RR) 0.94; 95% confidence interval (CI) 0.90-0.98), serious adverse events (SAEs) (RR 0.82; 95% CI 0.68-0.98), asthma exacerbation (RR 0.72, 95% CI 0.61-0.85), bronchitis (RR 0.76, 95% CI 0.59-0.96) and sinusitis (RR 0.64, 95% CI 0.48-0.85), but had a higher risk of headache (RR 1.42, 95% CI 1.07-1.87) and pyrexia (RR 2.26, 95% CI 1.32-3.87) than patients treated with placebo. No increased incidence of death, hypersensitivity, injection-site reactions, nasopharyngitis, rhinitis, upper respiratory tract infection, influenza, cough, nausea, back pain or arthralgia was observed with benralizumab compared with placebo. CONCLUSIONS Benralizumab reduced the risk of SAEs, asthma exacerbation, bronchitis and sinusitis, and aggravated the risk of headache and pyrexia. Other AEs were comparable between the benralizumab group and placebo group. Therefore, benralizumab is a relatively safe drug, but vigilance regarding AEs is imperative during long-term treatment.
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Affiliation(s)
- Wanshu Liu
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou City
| | - Xuesu Ma
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou City
| | - Weikang Zhou
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou City
- Department of Allergy, Chongqing General Hospital, Chongqing, China
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18
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Song WJ, Lee JH, Kang Y, Joung WJ, Chung KF. Future Risks in Patients With Severe Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:763-778. [PMID: 31552713 PMCID: PMC6761069 DOI: 10.4168/aair.2019.11.6.763] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
A major burden of severe asthma is the future risk of adverse health outcomes. Patients with severe asthma are prone to serious exacerbation and deterioration of lung function and may experience side effects of medications such as oral corticosteroids (OCSs). However, such future risk is not easily measurable in daily clinical practice. In particular, currently available tools to measure asthma control and asthma-related quality of life incompletely predict the future risk of medication-related morbidity. This is a significant issue in asthma management. This review summarizes the current evidence of future risk in patients with severe asthma. As future risk is poorly perceived by controlled asthmatics, our review focuses on the risk in patients with ‘controlled’ severe asthma. Of note, it is likely that long-term OCS therapy may not prevent future asthma progression, including lung function decline. In addition, the risk of drug side effects increases even during low-dose OCS therapy. Thus, novel treatments are highly desirable for reducing future risks without any loss of asthma control.
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Affiliation(s)
- Woo Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Ji Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yewon Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Woo Joung Joung
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield NHS Trust, London, United Kingdom
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Leuppi JD, Schmid-Grendelmeier P, Rothe T, von Garnier C, Simon HU, Schuoler C, Pendl G, Solèr M. [Benralizumab: Targeting the IL-5 Receptor in Severe Eosinophilic Asthma]. PRAXIS 2019; 108:469-476. [PMID: 31136272 DOI: 10.1024/1661-8157/a003222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Benralizumab: Targeting the IL-5 Receptor in Severe Eosinophilic Asthma Abstract. For patients with difficult-to-control, severe bronchial asthma, highly effective, targeted treatment options are available in addition to inhaled medication. In the presence of eosinophilia, inhibition of the interleukin-5 (IL‑5) axis with specific monoclonal antibodies promises to be an effective alternative to continuous systemic steroid therapy with few side effects. This review summarizes the data on benralizumab, a specific antibody against the IL-5 receptor alpha preventing receptor stimulation by IL-5 and activating a NK-cell mediated cytotoxic reaction with apoptosis of eosinophils. The s.c.-application of benralizumab leads within days to a virtually complete depletion of blood eosinophils with consecutive improvement in lung function and stabilization of asthma. For selected severe asthmatics, this is a promising therapy option.
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Affiliation(s)
- Jörg D Leuppi
- 1 Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal
| | - Peter Schmid-Grendelmeier
- 2 Allergiestation, Dermatologische Klinik, Universitätsspital Zürich, Zürich und Christine-Kühne Center for Allergy Research and Education (CK-CARE), Davos
| | | | | | | | | | | | - Markus Solèr
- 7 7 Abteilung für Pneumologie, St. Claraspital, Basel
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20
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Leuppi JD, Schmid-Grendelmeier P, Rothe T, von Garnier C, Simon HU, Schuoler C, Pendl G, Solèr M. [Benralizumab: Targeting the IL-5 Receptor in Severe Eosinophilic Asthma]. PRAXIS 2019; 108:1-8. [PMID: 31136278 DOI: 10.1024/1661-8157/a003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Benralizumab: Targeting the IL-5 Receptor in Severe Eosinophilic Asthma Abstract. Abstract:For patients with difficult-to-control, severe bronchial asthma, highly effective, targeted treatment options are available in addition to inhaled medication. In the presence of eosinophilia, inhibition of the interleukin-5 (IL-5) axis with specific monoclonal antibodies promises to be an effective alternative to continuous systemic steroid therapy with few side effects. This review summarizes the data on benralizumab, a specific antibody against the IL-5 receptor alpha preventing receptor stimulation by IL-5 and activating a NK-cell mediated cytotoxic reaction with apoptosis of eosinophils. The s.c.-application of benralizumab leads within days to a virtually complete depletion of blood eosinophils with consecutive improvement in lung function and stabilization of asthma. For selected severe asthmatics, this is a promising therapy option.
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Affiliation(s)
- Jörg D Leuppi
- 1 Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal
| | - Peter Schmid-Grendelmeier
- 2 Allergiestation, Dermatologische Klinik, Universitätsspital Zurich, Zurich und Christine-Kühne Center for Allergy Research and Education (CK-CARE), Davos
| | | | | | | | | | | | - Markus Solèr
- 7 Abteilung für Pneumologie, St. Claraspital, Bâle
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21
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Chen S, Golam S, Myers J, Bly C, Smolen H, Xu X. Systematic literature review of the clinical, humanistic, and economic burden associated with asthma uncontrolled by GINA Steps 4 or 5 treatment. Curr Med Res Opin 2018; 34:2075-2088. [PMID: 30047292 DOI: 10.1080/03007995.2018.1505352] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study sought to characterize the epidemiologic, clinical, humanistic, and economic burden of patients with asthma uncontrolled by GINA Steps 4 or 5 treatment (severe, uncontrolled asthma [SUA]). METHODS A systematic literature review adhering to PRISMA guidelines was performed. Relevant publications were searched for in MEDLINE and EMBASE from January 2004 to September 2016 and in a conference proceedings database from January 2012 to October 2016. Studies were screened using the Population, Intervention, Comparator, Outcomes, Study Design, and Time (PICOS-T) framework. Studies of SUA with observational (prospective and retrospective), randomized, or nonrandomized study designs; adult patient populations; sample sizes ≥20 patients; epidemiologic or clinical outcomes, patient-reported outcomes (PROs), or economic outcomes were included. For our analysis, SUA was defined as inadequate control of asthma, despite the use of medium- to high-dosage inhaled corticosteroids and at least one additional treatment. RESULTS A total of 195 articles reporting unique study populations were included. Prevalence of SUA was as great as 87.4% for patients with severe asthma, although values varied depending on the criteria used to define asthma control. Compared with patients with severe asthma who were controlled, patients with SUA experienced more symptoms, night-time awakenings, rescue medication use, and worse PROs. SUA-associated costs were 3-times greater than costs for patients with severe, controlled disease. CONCLUSION Despite the availability of approved asthma treatments, this literature analysis confirms that SUA poses a substantial epidemiologic, clinical, humanistic, and economic burden. Published data are limited for certain aspects of SUA, highlighting a need for further research.
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Affiliation(s)
| | | | - Julie Myers
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Chris Bly
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Harry Smolen
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Xiao Xu
- a AstraZeneca , Gaithersburg , MD, USA
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22
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Chipps BE, Newbold P, Hirsch I, Trudo F, Goldman M. Benralizumab efficacy by atopy status and serum immunoglobulin E for patients with severe, uncontrolled asthma. Ann Allergy Asthma Immunol 2018; 120:504-511.e4. [PMID: 29409951 DOI: 10.1016/j.anai.2018.01.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/09/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with severe asthma can have eosinophilic inflammation and/or allergen sensitization. Benralizumab is an anti-eosinophilic monoclonal antibody indicated for add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype. OBJECTIVE To investigate the efficacy of benralizumab by atopic status and serum immunoglobulin E (IgE) concentrations. METHODS We analyzed pooled results from the SIROCCO (NCT01928771) and CALIMA (NCT01914757) phase III studies. Patients 12 to 75 years old with severe, uncontrolled asthma on high-dosage inhaled corticosteroids plus long-acting β2-agonists received 30 mg of subcutaneous benralizumab every 4 weeks or every 8 weeks (first 3 doses every 4 weeks) or placebo every 4 weeks. The analysis stratified patients who did and did not meet similar omalizumab-qualifying criteria of atopy and serum IgE levels 30 to 700 kU/L. Patients also categorized as having high serum IgE (≥150 kU/L) or low serum IgE (<150 kU/L) and as having atopy or no atopy. Efficacy outcomes were for all patients and by blood eosinophil counts and included annual exacerbation rate ratio and pre-bronchodilator forced expiratory volume in 1 second change at treatment end vs placebo. RESULTS Benralizumab every 8 weeks decreased exacerbations by 46% (95% confidence interval 26-61, P = .0002) and increased forced expiratory volume in 1 second by 0.125 L (95% confidence interval 0.018-0.232, P = .0218) vs placebo for patients with at least 300 eosinophils/μL who met the atopy and IgE criteria. For patients with eosinophilia and high or low IgE, treatment with benralizumab every 8 weeks resulted in 42% and 43% decreases in exacerbation rate (P ≤ .0004) and 0.123- and 0.138-L increases in forced expiratory volume in 1 second (P ≤ .0041) vs placebo, respectively. CONCLUSION Benralizumab treatment decreased exacerbations and improved lung function for patients with severe, uncontrolled eosinophilic asthma regardless of serum IgE concentrations and atopy status.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California.
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23
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Fernandes SDSC, Andrade CRD, Alvim CG, Camargos PAM, Ibiapina CDC. Epidemiological trends of allergic diseases in adolescents. J Bras Pneumol 2018; 43:368-372. [PMID: 29160383 PMCID: PMC5790655 DOI: 10.1590/s1806-37562016000000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 05/04/2017] [Indexed: 01/07/2023] Open
Abstract
Objective: To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here. Methods: This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002. Results: The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002). Conclusions: The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.
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Affiliation(s)
| | - Cláudia Ribeiro de Andrade
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Cristina Gonçalves Alvim
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | | | - Cássio da Cunha Ibiapina
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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FitzGerald JM, Bleecker ER, Menzies-Gow A, Zangrilli JG, Hirsch I, Metcalfe P, Newbold P, Goldman M. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. THE LANCET RESPIRATORY MEDICINE 2017; 6:51-64. [PMID: 28919200 DOI: 10.1016/s2213-2600(17)30344-2] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Benralizumab is an anti-eosinophilic, anti-interleukin-5 receptor α monoclonal antibody that has been shown to significantly reduce asthma exacerbations and improve lung function for patients with severe, uncontrolled asthma. We further explored the efficacy of benralizumab for patients with different baseline blood eosinophil thresholds and exacerbation histories. METHODS This study is a pooled analysis of the results from the randomised, double-blind, placebo-controlled SIROCCO (NCT01928771) and CALIMA (NCT01914757) phase 3 studies. In these studies, patients with severe, uncontrolled asthma were randomly assigned (1:1:1) to receive subcutaneous benralizumab 30 mg, either every 4 weeks or every 8 weeks (with first three doses given every 4 weeks), or placebo every 4 weeks. The primary endpoint was annual exacerbation rate (AER) ratio versus placebo, analysed by baseline eosinophil counts (≥0, ≥150, ≥300, or ≥450 cells per μL) and by number of exacerbations (two vs three or more) during the year before enrolment. The analyses were done in accordance with the intention-to-treat principle. FINDINGS Of 2295 patients, 756 received benralizumab every 4 weeks, 762 received benralizumab every 8 weeks, and 777 patients received placebo. AER among patients with baseline blood eosinophil counts of at least 0 cells per μL was 1·16 (95% CI 1·05-1·28) in patients who received placebo versus 0·75 (0·66-0·84) in patients who received benralizumab every 8 weeks (rate ratio 0·64, 0·55-0·75; p<0·0001). In patients who received benralizumab every 4 weeks who had eosinophil counts of 0 or more cells per μL, AER was 0·73 (0·65-0·82); rate ratio versus placebo was 0·63 (0·54-0·74; p<0·0001). The extent to which exacerbation rates were reduced increased with increasing blood eosinophil thresholds and with greater exacerbation history in patients in the 4-weekly and 8-weekly benralizumab groups. Greater improvements in AER were seen with benralizumab compared with placebo for patients with a combination of high blood eosinophil thresholds and a history of more frequent exacerbations. INTERPRETATION These results will help to guide clinicians when they are deciding whether to use benralizumab to treat patients with severe, uncontrolled, eosinophilic asthma. FUNDING AstraZeneca.
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Affiliation(s)
- J Mark FitzGerald
- The Lung Centre, Vancouver General Hospital, UBC Institute for Heart and Lung Health, Gordon and Leslie Diamond Health Care, Vancouver, BC, Canada.
| | - Eugene R Bleecker
- Center for Applied Genetics and Genomics Medicine, University of Arizona School of Medicine, Tucson, AZ, USA
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Goldman M, Hirsch I, Zangrilli JG, Newbold P, Xu X. The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies. Curr Med Res Opin 2017. [PMID: 28644104 DOI: 10.1080/03007995.2017.1347091] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Benralizumab, an anti-eosinophilic monoclonal antibody, in combination with high-dosage inhaled corticosteroids and long-acting β2-agonists (ICS/LABA), significantly reduced asthma exacerbations, improved lung function, and reduced symptoms for patients with severe, uncontrolled asthma with blood eosinophil counts ≥300 cells/μL in the Phase III SIROCCO and CALIMA studies. To understand the efficacy and safety of benralizumab for patients with eosinophil-driven disease with blood eosinophil counts lower than 300 cells/μL, we evaluated the effect of applying an eosinophil cutoff of ≥150 cells/μL. METHODS Adult patients with uncontrolled asthma despite high-dosage ICS/LABA ± additional asthma controller(s) received subcutaneous benralizumab 30 mg every 8 weeks (Q8W; first three doses every 4 weeks) or placebo for 48 (SIROCCO) or 56 (CALIMA) weeks. Efficacy measures including annual exacerbation rate, prebronchodilator FEV1, and total asthma symptom score were analyzed by baseline blood eosinophil counts ≥150 vs. <150 cells/μL. RESULTS Benralizumab reduced asthma exacerbation rates by 42% in SIROCCO (rate ratio = 0.58; 95% CI = 0.46-0.74; p < 0.001; n = 325) and 36% in CALIMA (rate ratio = 0.64; 95% CI = 0.50-0.81; p < 0.001; n = 300) vs. placebo (n = 306 for SIROCCO, n = 315 for CALIMA) for patients with blood eosinophil counts ≥150 cells/μL. Benralizumab increased prebronchodilator FEV1 (both studies, p ≤ 0.002) and improved total asthma symptom score in SIROCCO (p = 0.009) at end of treatment vs. placebo for patients with blood eosinophil counts ≥150 cells/μL. The overall adverse events frequency was similar between treatment groups and eosinophil count cohorts. CONCLUSION These results support the efficacy and safety of benralizumab for patients with severe asthma and blood eosinophil counts ≥150 cells/μL.
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Affiliation(s)
| | | | | | | | - Xiao Xu
- a AstraZeneca , Gaithersburg , MD , USA
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Suzuki C, Lopes da Silva N, Kumar P, Pathak P, Ong SH. Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. J Med Econ 2017; 20:832-839. [PMID: 28532191 DOI: 10.1080/13696998.2017.1333513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. METHODS A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. RESULTS An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. LIMITATIONS Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. CONCLUSION Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross domestic product.
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Affiliation(s)
| | | | - Praveen Kumar
- b Novartis Healthcare Private Ltd , Hyderabad , India
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Varricchi G, Senna G, Loffredo S, Bagnasco D, Ferrando M, Canonica GW. Reslizumab and Eosinophilic Asthma: One Step Closer to Precision Medicine? Front Immunol 2017; 8:242. [PMID: 28344579 PMCID: PMC5344894 DOI: 10.3389/fimmu.2017.00242] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/20/2017] [Indexed: 12/29/2022] Open
Abstract
Human eosinophils represent approximately 1% of peripheral blood leukocytes. However, these cells have the propensity to leave the blood stream and migrate into inflamed tissues. Eosinophilic inflammation is present in a significant proportion of patients with severe asthma. Asthma is a chronic inflammatory disorder that affects more than 315 million people worldwide, with 10% having severe uncontrolled disease. Although the majority of patients can be efficiently treated, severe asthmatics continue to be uncontrolled and are at risk of exacerbations and even death. Interleukin-5 (IL-5) plays a fundamental role in eosinophil differentiation, maturation, activation and inhibition of apoptosis. Therefore, targeting IL-5 is an appealing approach to the treatment of patients with severe eosinophilic asthma. Reslizumab, a humanized anti-IL-5 monoclonal antibody, binds with high affinity to amino acids 89–92 of IL-5 that are critical for binding to IL-5 receptor α. Two phase III studies have demonstrated that reslizumab administration in adult patients with severe asthma and eosinophilia (≥400 cells/μL) improved lung function, asthma control, and symptoms. Thus, the use of blood eosinophils as a baseline biomarker could help to select patients with severe uncontrolled asthma who are likely to achieve benefits in asthma control with reslizumab. In conclusion, targeted therapy with reslizumab represents one step closer to precision medicine in patients with severe eosinophilic asthma.
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Affiliation(s)
- Gilda Varricchi
- Division of Clinical Immunology and Allergy, Department of Translational Medical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University, General Hospital , Verona , Italy
| | - Stefania Loffredo
- Division of Clinical Immunology and Allergy, Department of Translational Medical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genova , Genova , Italy
| | - Matteo Ferrando
- Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genova , Genova , Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Science, Humanitas University , Rozzano, Milano , Italy
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Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, Sproule S, Gilmartin G, Aurivillius M, Werkström V, Goldman M. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β 2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet 2016; 388:2115-2127. [PMID: 27609408 DOI: 10.1016/s0140-6736(16)31324-1] [Citation(s) in RCA: 883] [Impact Index Per Article: 110.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eosinophilia is associated with worsening asthma severity and decreased lung function, with increased exacerbation frequency. We assessed the safety and efficacy of benralizumab, a monoclonal antibody against interleukin-5 receptor α that depletes eosinophils by antibody-dependent cell-mediated cytotoxicity, for patients with severe, uncontrolled asthma with eosinophilia. METHODS We did a randomised, double-blind, parallel-group, placebo-controlled phase 3 study at 374 sites in 17 countries. We recruited patients (aged 12-75 years) with a physician-based diagnosis of asthma for at least 1 year and at least two exacerbations while on high-dosage inhaled corticosteroids and long-acting β2-agonists (ICS plus LABA) in the previous year. Patients were randomly assigned (1:1:1) by an interactive web-based voice response system to benralizumab 30 mg either every 4 weeks (Q4W) or every 8 weeks (Q8W; first three doses every 4 weeks) or placebo Q4W for 48 weeks as add on to their standard treatment. Patients were stratified 2:1 according to blood eosinophil counts of at least 300 cells per μL and less than 300 cells per μL. All patients and investigators involved in patient treatment or clinical assessment were masked to treatment allocation. The primary endpoint was annual exacerbation rate ratio versus placebo, and key secondary endpoints were prebronchodilator forced expiratory volume in 1 s (FEV1) and total asthma symptom score at week 48, for patients with blood eosinophil counts of at least 300 cells per μL. Efficacy analyses were by intention to treat (based on the full analysis set); safety analyses included patients according to study drug received. This study is registered with ClinicalTrials.gov, number NCT01928771. FINDINGS Between Sept 19, 2013, and March 16, 2015, 2681 patients were enrolled, 1205 of whom met the study criteria and were randomly assigned: 407 to placebo, 400 to benralizumab 30 mg Q4W, and 398 to benralizumab 30 mg Q8W. 267 patients in the placebo group, 275 in the benralizumab 30 mg Q4W group, and 267 in the benralizumab 30 mg Q8W group had blood eosinophil counts at least 300 cells per μL and were included in the primary analysis population. Compared with placebo, benralizumab reduced the annual asthma exacerbation rate over 48 weeks when given Q4W (rate ratio 0·55, 95% CI 0·42-0·71; p<0·0001) or Q8W (0·49, 0·37-0·64; p<0·0001). Both benralizumab dosing regimens significantly improved prebronchodilator FEV1 in patients at week 48 compared with placebo (least-squares mean change from baseline: Q4W group 0·106 L, 95% CI 0·016-0·196; Q8W group 0·159 L, 0·068-0·249). Compared with placebo, asthma symptoms were improved by the Q8W regimen (least-squares mean difference -0·25, 95% CI -0·45 to -0·06), but not the Q4W regimen (-0·08, -0·27 to 0·12). The most common adverse events were worsening asthma (105 [13%] of 797 benralizumab-treated patients vs 78 [19%] of 407 placebo-treated patients) and nasopharyngitis (93 [12%] vs 47 [12%]). INTERPRETATION These results confirm the efficacy and safety of benralizumab for patients with severe asthma and elevated eosinophils, which are uncontrolled by high-dosage ICS plus LABA, and provide support for benralizumab to be an additional option to treat this disease in this patient population. FUNDING AstraZeneca and Kyowa Hakko Kirin.
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Affiliation(s)
- Eugene R Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - J Mark FitzGerald
- Centre for Heart and Lung Health, The Lung Centre Vancouver General Hospital, UBC Institute for Heart and Lung Health, Vancouver, BC, Canada
| | - Pascal Chanez
- Département des Maladies Respiratoires, Aix Marseille University, APHM INSERM U1067 and CIC Nord, Marseille, France
| | - Alberto Papi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Wu MK, Wang HY, Chen YW, Lin PY, Wu CK, Tseng PT. Significantly Higher Prevalence Rate of Asthma and Bipolar Disorder Co-Morbidity: A Meta-Analysis and Review Under PRISMA Guidelines. Medicine (Baltimore) 2016; 95:e3217. [PMID: 27043688 PMCID: PMC4998549 DOI: 10.1097/md.0000000000003217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Asthma and bipolar disorder (BD) are 2 distinct diseases that share similar pathophysiology. This study aimed to determine their relationship thorough a meta-analysis of articles on their comorbidity rate. The aim of the study is to examine the overall prevalence rate of BD in asthmatic patients and of asthma in BD patients compared to healthy controls. Electronic research of PubMed and ClinicalTrials.gov was performed. Articles discussing the prevalence rate of BD in patients with/without asthma and the prevalence rate of asthma in those with/without BD, as well as clinical trials in humans and case-controlled trials or cohort studies, were all included. Case reports or series and nonclinical trials were excluded. Through a random-effects model, a meta-analysis of the results of 4 studies comparing the prevalence rate of BD in patients with/without asthma, and in 6 studies comparing the prevalence rate of asthma in subjects with/without BD were performed. There were significantly higher prevalence rates of BD in asthmatic patients than in healthy controls (P < 0.001) and of asthma in BD patients than in healthy controls (P < 0.001). Only the patient's mean age significantly modulated the odds ratio of the prevalence rate of asthma in BD patients (slope = 0.015, P < 0.001). Only 10 studies were included and most were cross-sectional studies. The possible confounding effect of medication on BD or asthma onset was not investigated. Any possible etiology of the comorbidity was also not determined. This meta-analysis highlights the importance of the significantly high comorbid rate of BD and asthma, and the positive association with age. Special attention must be given to the comorbidity of asthma and BD, especially in older patients.
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Affiliation(s)
- Ming-Kung Wu
- From the Department of Psychiatry (MKW, P-YL), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Center for Translational Research in Biomedical Sciences (M-KW, P-YL), Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Psychiatry (H-YW, C-KW, P-TT), Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home; and Department of Neurology (Y-WC), E-Da Hospital, Kaohsiung, Taiwan
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