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Denton E, Hew M, Peters MJ, Upham JW, Bulathsinhala L, Tran TN, Martin N, Bergeron C, Al-Ahmad M, Altraja A, Larenas-Linnemann D, Murray R, Celis-Preciado CA, Al-Lehebi R, Belhassen M, Bhutani M, Bosnic-Anticevich SZ, Bourdin A, Brusselle GG, Busby J, Canonica GW, Heffler E, Chapman KR, Charriot J, Christoff GC, Chung LP, Cosio BG, Côté A, Costello RW, Cushen B, Fingleton J, Fonseca JA, Gibson PG, Heaney LG, Huang EWC, Iwanaga T, Jackson DJ, Koh MS, Lehtimäki L, Máspero J, Mahboub B, Menzies-Gow AN, Mitchell PD, Papadopoulos NG, Papaioannou AI, Perez-de-Llano L, Perng DW, Pfeffer PE, Popov TA, Porsbjerg CM, Rhee CK, Roche N, Sadatsafavi M, Salvi S, Schmid JM, Sheu CC, Sirena C, Torres-Duque CA, Salameh L, Patel PH, Ulrik CS, Wang E, Wechsler ME, Price DB. Real-world biologics response and super-response in the International Severe Asthma Registry cohort. Allergy 2024. [PMID: 38923444 DOI: 10.1111/all.16178] [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: 11/14/2023] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Biologic asthma therapies reduce exacerbations and long-term oral corticosteroids (LTOCS) use in randomized controlled trials (RCTs); however, there are limited data on outcomes among patients ineligible for RCTs. Hence, we investigated responsiveness to biologics in a real-world population of adults with severe asthma. METHODS Adults in the International Severe Asthma Registry (ISAR) with ≥24 weeks of follow-up were grouped into those who did, or did not, initiate biologics (anti-IgE, anti-IL5/IL5R, anti-IL4/13). Treatment responses were examined across four domains: forced expiratory volume in 1 second (FEV1) increase by ≥100 mL, improved asthma control, annualized exacerbation rate (AER) reduction ≥50%, and any LTOCS dose reduction. Super-response criteria were: FEV1 increase by ≥500 mL, new well-controlled asthma, no exacerbations, and LTOCS cessation or tapering to ≤5 mg/day. RESULTS 5.3% of ISAR patients met basic RCT inclusion criteria; 2116/8451 started biologics. Biologic initiators had worse baseline impairment than non-initiators, despite having similar biomarker levels. Half or more of initiators had treatment responses: 59% AER reduction, 54% FEV1 increase, 49% improved control, 49% reduced LTOCS, of which 32%, 19%, 30%, and 39%, respectively, were super-responses. Responses/super-responses were more frequent in biologic initiators than in non-initiators; nevertheless, ~40-50% of initiators did not meet response criteria. CONCLUSIONS Most patients with severe asthma are ineligible for RCTs of biologic therapies. Biologics are initiated in patients who have worse baseline impairments than non-initiators despite similar biomarker levels. Although biologic initiators exhibited clinical responses and super-responses in all outcome domains, 40-50% did not meet the response criteria.
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Affiliation(s)
- Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, 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
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John W Upham
- Frazer Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | - Celine Bergeron
- Centre for Lung Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | | | | | - Carlos Andrés Celis-Preciado
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | | | - Mohit Bhutani
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Alberta, Canada
| | - Sinthia Z Bosnic-Anticevich
- Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Jérémy Charriot
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | - Li Ping Chung
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Andréanne Côté
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Richard W Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - James Fingleton
- Capital and Coast District Health Board, Wellington, New Zealand
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Erick Wan-Chun Huang
- Department of Internal Medicine, Division of Pulmonary Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, UK
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Bassam Mahboub
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, UK
- Lung Division, Royal Brompton & Harefield Hospital, London, UK
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Diahn-Warng Perng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Todor A Popov
- University Hospital St. Ivan Rilski, Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Chin Kook Rhee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Nicolas Roche
- Department of Respiratory Medicine, APHP-Centre University Paris Cité, Cochin Hospital and Institute (UMR1016), Paris, France
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | | | - Chau-Chyun Sheu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Laila Salameh
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Eileen Wang
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, Colorado, USA
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Biener L, Mümmler C, Hinze CA, Suhling H, Korn S, Fisser C, Biener A, Pizarro C, Lenoir A, Hackl C, Skowasch D, Milger K. Real-World Data on Tezepelumab in Patients With Severe Asthma in Germany. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00625-1. [PMID: 38866104 DOI: 10.1016/j.jaip.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Tezepelumab is a novel biologic blocking thymic stromal lymphopoetin, approved for severe asthma irrespective of biomarker levels or phenotype. OBJECTIVE To characterize a real-world tezepelumab patient cohort and the efficacy among various asthma phenotypes. METHODS We performed a retrospective, multicenter study on patients with severe asthma initiating tezepelumab. Clinical response was evaluated at 3 and 6 months. RESULTS We included 129 patients with an average age of 52.5 ± 13.1 years, 59.7% were female. The majority (86.0%) had increased type 2 (T2) biomarkers, 68.2% an allergic and 31.8% an eosinophilic phenotype. 23.3% of patients were biologic-naive. 22 (18.2%) patients discontinued tezepelumab therapy owing to suspected side effects or insufficient efficacy. At 6 months' follow-up, median reduction in annualized exacerbation rate was-1 [25th percentile; 75% percentile {-2.9; 0.0}], the reduction of oral corticosteroid dose among patients with long-term oral corticosteroid therapy was -5 mg [-10; 0] and the Asthma Control Test (ACT) improved by 2 [0; 5] points. A treatment response according to Biologic Asthma Response Score of 80.8% was demonstrated. There were no significant differences in treatment response between T2-high versus T2-low, early- versus adult-onset and eosinophilic versus non-eosinophilic asthma. Prior treatment with other biologics was associated with inferior treatment response. CONCLUSIONS In this real-life cohort, including a large proportion of patients with history of previous biologic use and encompassing various subgroups, the majority responded to tezepelumab. Our data further suggest a steroid-sparing effect of tezepelumab.
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Affiliation(s)
- Leonie Biener
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany.
| | - Carlo Mümmler
- Department of Medicine V, Ludwig-Maximilians-Universität (LMU) University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Stephanie Korn
- Institut für Klinische Forschung (IKF) Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
| | - Arne Biener
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany
| | - Alexandra Lenoir
- Department of Medicine V, Ludwig-Maximilians-Universität (LMU) University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Caroline Hackl
- Department of Medicine V, Ludwig-Maximilians-Universität (LMU) University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany
| | - Katrin Milger
- Department of Medicine V, Ludwig-Maximilians-Universität (LMU) University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
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Mohan A, Qiu AY, Lugogo N. Long-term safety, durability of response, cessation and switching of biologics. Curr Opin Pulm Med 2024; 30:303-312. [PMID: 38426355 DOI: 10.1097/mcp.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Severe asthma patients suffer from decreased quality of life, and increased asthma symptoms, exacerbations, hospitalizations, and risk of death. Biologics have revolutionized treatment for severe asthma. However, with multiple biologic agents now available, clinicians must consider initial selection the long-term effectiveness of biologics. Additionally, patients have overlapping eligibilities and clinicians may consider switching between biologics for improved response. Finally, careful assessment of biologics cessation is needed for severe asthma patients who depend on these add-on therapies for asthma control. RECENT FINDINGS Evidence for long-term durability and safety varies by biologic agent. In general, initial benefits noted from these agents (ex. exacerbation reduction) is, at minimum, sustained with long term use. Rates of adverse events and serious adverse events, including those requiring cessation of a biologics are low with long term use. Further studies are needed to understand the development of antidrug antibodies but currently their prevalence rates are low. Adverse events and insufficient efficacy are common reasons for biologic cessation or switching. Discontinuation maybe associated with waning of benefits but can be considered in certain situations. Biologic switching can be associated with improved asthma control. SUMMARY Biologics are safe and effective long-term therapies for the management of asthma. Discontinuation must be carefully considered and if possible avoided. Reasons for insufficient efficacy must be evaluated and if needed, biologic switching should be considered.
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Affiliation(s)
- Arjun Mohan
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna Y Qiu
- Division of Pulmonary, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Njira Lugogo
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
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4
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Cameli P, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Caruso C, Centanni S, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Senna G, Vultaggio A, Benci M, Boarino S, Menzella F. Sustained Effectiveness of Benralizumab in Naïve and Biologics-Experienced Severe Eosinophilic Asthma Patients: Results from the ANANKE Study. J Asthma Allergy 2024; 17:273-290. [PMID: 38562251 PMCID: PMC10982664 DOI: 10.2147/jaa.s438981] [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: 11/08/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Severe eosinophilic asthma (SEA) patients often present overlapping inflammatory features rendering them eligible for multiple biologic therapies; switching biologic treatment is a strategy adopted to optimize asthma control when patients show partial or no response to previous biologics. Patients and Methods ANANKE is a retrospective, multicenter Italian study (NCT04272463). Here, we outline the characteristics and long-term clinical outcomes in naïve-to-biologics and biologics-experienced patients treated with benralizumab for up to 96 weeks. Bio-experienced patients were split into omalizumab and mepolizumab subsets according to the type of biologic previously used. Results A total of 124 (76.5%) naïve and 38 (23.5%) bio-experienced patients were evaluated at index date; 13 patients (34.2%) switched from mepolizumab, 21 patients (55.3%) switched from omalizumab, and four patients (10.5%) received both biologics. The mepolizumab subset was characterized by the longest SEA duration (median of 4.6 years), the highest prevalence of chronic rhinosinusitis with nasal polyposis (CRSwNP) (76.5%), and the greatest oral corticosteroid (OCS) daily dosage (median of 25 mg prednisone equivalent). The omalizumab group showed the highest severe annual exacerbation rate (AER) (1.70). At 96 weeks, treatment with benralizumab reduced any and severe AER by more than 87% and 94%, respectively, across all groups. Lung function was overall preserved, with major improvements observed in the mepolizumab group, which also revealed a 100% drop of the median OCS dose. Asthma Control Test (ACT) score improved in the naïve group while its increment was more variable in bio-experienced patients; among these, a marked difference was noticed between omalizumab and mepolizumab subsets (median ACT score of 23.5 and 18, respectively). Conclusion Benralizumab promotes durable and profound clinical benefits in naïve and bio-experienced groups, indicating that a nearly complete depletion of eosinophils is highly beneficial in the control of SEA, independently of previous biologic use.
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Affiliation(s)
- Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese (MI), Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, Università degli Studi di Torino; SCDU Immunologia e Allergologia, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Centanni
- Respiratory Unit ASST Santi Paolo e Carlo, Department of Health Sciences Universita’ degli Studi di Milano, Milano, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Roma, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Roma, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti (BA), Italy
| | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Marco Benci
- Medical Affairs R&I, AstraZeneca, Milano, Italy
| | | | - Francesco Menzella
- Pulmonology Unit, Ospedale “S. Valentino”, AULSS 2 Marca Trevigiana, Montebelluna (TV), Italy
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Cottu A, Groh M, Desaintjean C, Marchand-Adam S, Guillevin L, Puechal X, Beaumesnil S, Lazaro E, Samson M, Taille C, Durel CA, Diot E, Nicolas S, Guilleminault L, Ebbo M, Cathebras P, Dupin C, Yildiz H, Belfeki N, Pugnet G, Chauvin P, Jouneau S, Lifermann F, Martellosio JP, Cottin V, Terrier B. Benralizumab for eosinophilic granulomatosis with polyangiitis. Ann Rheum Dis 2023; 82:1580-1586. [PMID: 37550002 DOI: 10.1136/ard-2023-224624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Benralizumab is effective in the treatment of eosinophilic asthma and is being investigated for the treatment of other eosinophil-associated diseases. Reports on the use of benralizumab for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) are limited to case reports and small case series. METHODS We conducted a multicentre, retrospective study including EGPA patients treated with off-label benralizumab. The primary endpoint was the rate of complete response defined as no disease activity (Birmingham Vasculitis Activity Score=0) and a prednisone dose ≤4 mg/day. Partial response was defined as no disease activity and a prednisone dose ≥4 mg/day. RESULTS Sixty-eight patients were included, including 31 (46%) who had previously received mepolizumab. The use of benralizumab was warranted by uncontrolled asthma in 54 (81%), persistent ear, nose and throat (ENT) manifestations in 27 (40%) and persistent glucocorticoids (GCs) use in 48 (74%) patients. Median (IQR) follow-up after starting benralizumab was 23 (9-34) months. Thirty-three patients (49%) achieved a complete response, 24 (36%) achieved a partial response and 10 (15%) did not respond. Among the 57 patients who initially responded, 10 (18%) eventually required further line treatments. GCs were discontinued in 23 patients (38%). Prior mepolizumab use was associated with a higher rate of primary failure (26.7% vs 5.4%, p=0.034) and less frequent GCs discontinuation (14.8% vs 55.9%, p=0.001). Vasculitis flares occurred in 7 patients (11%) and were associated with histological evidence of vasculitis and/or antineutrophil cytoplasmic antibodies positivity at benralizumab initiation (p=0.004). CONCLUSIONS Benralizumab appears to be an effective treatment for refractory asthma or ENT manifestations in EGPA and allows GC-sparing. However, its efficacy was lower after prior failure of mepolizumab.
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Affiliation(s)
- Adrien Cottu
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndrome (CEREO), Department of Internal Medicine, Hopital Foch, Suresnes, France
| | - Charlene Desaintjean
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Xavier Puechal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Stacy Beaumesnil
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre, Dijon, France
| | - Camille Taille
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Inserm 1152, Hospital Bichat - Claude-Bernard, Paris, France
| | | | - Elizabeth Diot
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Sarah Nicolas
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Laurent Guilleminault
- Department of Respiratory Medicine, University Hospital Centre Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, Toulouse 2 University, Toulouse, France
| | - Mikael Ebbo
- Departement of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Clairelyne Dupin
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Hospital Bichat - Claude-Bernard, Paris, France
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Nabil Belfeki
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - Pierre Chauvin
- Department of Respiratory Diseases, University Hospital Centre Rennes, Rennes, France
| | - Stephane Jouneau
- Department of Respiratory Diseases, IRSET UMR 1085, Rennes 1 University, Pontchaillou Hospital, Rennes, France
| | | | | | - Vincent Cottin
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
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Davis J, McMahon PM, Simon A, Haffenreffer K, Jamal-Allial A, McMahill-Walraven CN, Kline AM, Brown JS, Van Dyke MK, Jakes RW, Wu AC. The association of varying treatment thresholds of mepolizumab on asthma exacerbations in adults. J Asthma 2023; 60:2198-2206. [PMID: 37347586 DOI: 10.1080/02770903.2023.2228900] [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: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
Background: Asthma has a high healthcare burden globally, with up to 10% of the asthma population suffering from severe disease. Biologic agents are a newer class of asthma treatments for severe asthma, with good evidence for efficacy in clinical trials. Nevertheless, real-world studies of its impact on clinical outcomes are limited.Methods: This is an observational cohort study using administrative claims data. The study population consisted of patients aged ≥18 years who had a diagnosis of asthma and initiated mepolizumab after November 4, 2015 and had continuous medical and drug coverage in both the 365 days prior to and following mepolizumab initiation. In patients treated with mepolizumab, we described clinically significant asthma exacerbations by minimum continuous treatment thresholds following initiation of mepolizumab, medication switching patterns and chronic oral corticosteroid (≥28 days) use.Results: We identified 2,536 adults with asthma who initiated mepolizumab. There was an association toward reduction in severe asthma-related events over the first one year of exposure. We observed associations with reduced dispensings of oral corticosteroids over the first year after mepolizumab initiation. Very few patients switched to other biologics during the study period.Conclusions: Treatment with mepolizumab may be associated with fewer asthma-related events in the first year. Over the first one year after initiating mepolizumab, we found associations with decreased concomitant dispensings of oral corticosteroids and medium to high dose ICS/LABA. Additionally, most patients who initiated mepolizumab did not switch to other biologics.
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Affiliation(s)
| | - Pamela M McMahon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Andrew Simon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Katherine Haffenreffer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | | | - Jeffrey S Brown
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Melissa K Van Dyke
- Respiratory Epidemiology Therapy Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Rupert W Jakes
- Respiratory Epidemiology Therapy Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Ann Chen Wu
- Boston Children's Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Nieto A, El-Sayed ZA, Gómez RM, Hossny E, Jiu-Yao W, Kalayci Ö, Morais-Almeida M, Phipatanakul W, Pitrez PM, Pozo Beltrán CF, Xepapadaki P, Papadopoulos NG. Unanswered questions on the use of biologics in pediatric asthma. World Allergy Organ J 2023; 16:100837. [PMID: 38020283 PMCID: PMC10656246 DOI: 10.1016/j.waojou.2023.100837] [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: 02/16/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
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Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit. Health Research Institute. Children's Hospital La Fe, Valencia, Spain
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Wang Jiu-Yao
- Research Center of Allergy, Immunology, and Microbiome (A.I.M.). China Medical University Children's Hospital, Taichung, Taiwan
| | - Ömer Kalayci
- Pediatric Allergy and Asthma, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo Marcio Pitrez
- School of Medicine, Pediatric Pulmonary Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK
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Scioscia G, Tondo P, Nolasco S, Pelaia C, Carpagnano GE, Caiaffa MF, Valenti G, Maglio A, Papia F, Triggiani M, Crimi N, Pelaia G, Vatrella A, Foschino Barbaro MP, Crimi C. Benralizumab in Patients with Severe Eosinophilic Asthma: A Multicentre Real-Life Experience. J Clin Med 2023; 12:4362. [PMID: 37445397 DOI: 10.3390/jcm12134362] [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: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Mepolizumab and benralizumab are monoclonal antibodies directed against anti-IL-5 and anti-IL5R, respectively, and their use reduces the exacerbation rate and maintains oral corticosteroid requirements in severe eosinophilic asthma. Previous studies have tested the therapeutic switch between two biologics with excellent results, further demonstrating the heterogeneity of asthmatic disease and the complexity of the therapeutic choice. It remains unclear if such patients may improve following a switch from mepolizumab to benralizumab. AIMS Within a multicentre real-life setting, we decided to evaluate the potential effectiveness of a therapeutic switch to benralizumab in patients with severe eosinophilic asthma initially treated with mepolizumab, who experienced sub-optimal responses. The secondary aim was to identify the clinical factors associated with a better response to benralizumab. METHODS We retrospectively assessed patients with severe eosinophilic asthma treated at six Italian specialist centres, who were switched from mepolizumab to benralizumab following a sub-optimal response, defined as a partial or total lack of clinical remission (i.e., frequent severe exacerbations and/or poorly controlled symptoms and/or higher OCS daily use in patients with a poor or moderate response in the global evaluation of treatment effectiveness scale), after at least 12 months of treatment. RESULTS Twenty-five patients were included in the analysis (mean age 56.76 ± 11.97 years, 65% female). At 6 months of treatment with benralizumab, the ACT score was significantly higher than the ACT score with mepolizumab (20.24 ± 3.38 vs. 16.77 ± 3.48, p < 0.0001); the mean number of daily SABA inhalations was significantly lower after 6 months and 12 months of treatment with benralizumab than that after treatment with mepolizumab; OCS intake and the prednisone median dosage at 6 months of treatment with benralizumab were significantly lower than those with mepolizumab. Benralizumab treatment resulted in a marked improvement in asthma control, suppressed blood eosinophil levels and reduction in the number of exacerbations in the subgroup of patients with severe eosinophilic asthma and nasal polyposis. CONCLUSIONS Patients diagnosed with severe eosinophilic asthma who experience a partial response to mepolizumab could benefit from switching to benralizumab, and even more those who have nasal polyposis.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "Aldo Moro" of Bari, 70121 Bari, Italy
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | | | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
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Venkitakrishnan R, Augustine J, Ramachandran D, Cleetus M. Biological therapy for severe asthma - Indian perspectives and challenges. Lung India 2023; 40:253-259. [PMID: 37148024 PMCID: PMC10298827 DOI: 10.4103/lungindia.lungindia_432_22] [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: 08/28/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 05/07/2023] Open
Abstract
Asthma is a complex and heterogeneous disease. Severe asthma makes up only a minority of asthma patients encountered in clinical settings but accounts for substantial healthcare utilisation in terms of manpower as well as economic allocation. The availability of monoclonal antibodies has a major impact on severe asthmatics and has provided excellent clinical results in properly selected patients. The discovery of new molecules might present uncertainties to clinicians as to the best agent to institute in an individual patient. The practice scenario in India is unique when it comes to the commercial availability of monoclonal antibodies, patient attitudes, and allocation of the healthcare budget. The present review dissects and summarises the available monoclonal antibodies for asthma treatment in India, the perspectives of Indian patients on biological therapy, and the challenges encountered by patients and physicians in this regard. We provide practical suggestions for utilising monoclonal antibodies and deciding on the optimal agent for a given patient.
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Affiliation(s)
| | - Jolsana Augustine
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
| | - Divya Ramachandran
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
| | - Melcy Cleetus
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
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Blanco-Aparicio M, Domínguez-Ortega J, Cisneros C, Colás C, Casas F, Del Cuvillo A, Alobid I, Quirce S, Mullol J. Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:34. [PMID: 37088840 PMCID: PMC10124060 DOI: 10.1186/s13223-023-00780-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/27/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. METHODS Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. RESULTS A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios. CONCLUSION We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items.
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Affiliation(s)
- Marina Blanco-Aparicio
- Department of Respiratory Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Javier Domínguez-Ortega
- Department of Respiratory Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carolina Cisneros
- Department of Pulmonology, Hospital Universitario La Princesa, Health Research Institute (IP), Madrid, Spain
| | - Carlos Colás
- Department of Allergy, Hospital Clínico-Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Francisco Casas
- Department of Respiratory Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Alfonso Del Cuvillo
- Rhinology & Asthma Unit, ENT Department, Hospital Universitario de Jerez, Cádiz, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, ENT Department, CIBERES, Hospital Clinic Barcelona, Universitat de Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Santiago Quirce
- 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, CIBERES, Hospital Clinic Barcelona, Universitat de Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
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Tohda Y, Nakamura Y, Fujisawa T, Ebisawa M, Msihid J, Djandji M, Ortiz B, Jacob-Nara JA, Deniz Y, Rowe PJ, Ishida M, Arima K. Efficacy of dupilumab in patients with uncontrolled, moderate-to-severe asthma recruited from Japanese centers in the phase 3 LIBERTY ASTHMA TRAVERSE study. Allergol Int 2023; 72:89-99. [PMID: 36114102 DOI: 10.1016/j.alit.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/11/2022] [Accepted: 07/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Safety and efficacy data for dupilumab beyond 1 year are lacking for patients from Japan with moderate-to-severe asthma. METHODS The TRAVERSE open-label extension (OLE) study (NCT02134028) assessed the safety and efficacy of dupilumab 300 mg every 2 weeks up to 96 weeks in 2282 patients who completed a previous dupilumab asthma study. The primary endpoint was incidence of treatment-emergent adverse events (TEAEs). Secondary endpoints included annualized severe exacerbation rate and change from parent study baseline in pre-bronchodilator forced expiratory volume in 1 second (FEV1), asthma control, quality of life, and blood eosinophil levels. Anti-drug antibodies (ADA) were evaluated. We report results in 160 (7.8% of exposed population) patients recruited from Japanese centers with non-oral corticosteroid (OCS)-dependent asthma rolled over from two parent studies, and in subgroups with a type 2 inflammatory phenotype. RESULTS TEAEs were consistent with the parent studies and the known safety profile of dupilumab. One patient permanently discontinued treatment due to TEAEs. Exacerbation rates remained low and were sustained to Week 96, as were improvements in pre-bronchodilator FEV1. Rapid, sustained improvements were observed in dupilumab-treated patients who previously received placebo in a parent study, while further improvements in exacerbation rates, asthma control, and asthma-related quality of life were observed in those continuing dupilumab. Blood eosinophil levels decreased progressively while on treatment. Treatment-emergent ADA responses were highest in patients who had previously received placebo. Efficacy results were consistent in patients with a type 2 phenotype. CONCLUSIONS Long-term dupilumab treatment was well tolerated and efficacious in patients with non-OCS-dependent, moderate-to-severe asthma recruited from Japan. (Funded by Sanofi and Regeneron Pharmaceuticals, Inc.; ClinicalTrials.gov identifier, NCT02134028).
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Affiliation(s)
- Yuji Tohda
- Kindai University Hospital, Osakasayama, Japan.
| | | | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | | | | | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Chung Y, Maselli DJ, Mu F, Cook EE, Yang D, Young JA, Betts KA, Genofre E, Carstens D. Impact of benralizumab on asthma exacerbation-related medical healthcare resource utilization and medical costs: results from the ZEPHYR 2 study. J Med Econ 2023; 26:954-962. [PMID: 37441729 DOI: 10.1080/13696998.2023.2236867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND AIM Benralizumab is a biologic add-on treatment for severe eosinophilic asthma that can reduce the rate of asthma exacerbations, but data on the associated medical utilization are scarce. This retrospective study evaluated the economic value of benralizumab by analyzing healthcare resource utilization (HRU) and medical costs in a large patient population in the US. METHODS Insurance claims data (11/2016-6/2020) were analyzed. A pre-post design was used to compare asthma exacerbation rates, medical HRU and medical costs in the 12 months pre vs. post index (day after benralizumab initiation). Patients were aged ≥12 years, with ≥2 records of benralizumab and ≥2 asthma exacerbations pre index, and constituted non-mutually exclusive cohorts: biologic-naïve, biologic-experienced (switched from omalizumab or mepolizumab to benralizumab), or with extended follow-up (18 or 24 months). RESULTS In all cohorts (mean age 51-53 years; 67-70% female; biologic-naïve, N = 1,292; biologic-experienced, N = 349; 18-month follow-up, N = 419; 24-month follow-up, N = 156), benralizumab treatment reduced the rate of asthma exacerbation by 53-68% (p < .001). In the biologic-naïve cohort, inpatient admissions decreased by 58%, emergency department visits by 54%, and outpatient visits by 58% post index (all p < .001), with similar reductions in exacerbation-related medical HRU in other cohorts. Exacerbation-related mean total medical costs decreased by 51% in the biologic-naïve cohort ($4691 pre-index, $2289 post-index), with cost differences ranging from 16% to 64% across other cohorts (prior omalizumab: $2686 to $1600; prior mepolizumab: $5990 to $5008; 18-month: $3636 to $1667; 24-month: $4014 to $1449; all p < .001). Medical HRU and cost reductions were durable, decreasing by 64% in year 1 and 66% in year 2 in the 24 month follow-up cohort. CONCLUSION Patients treated with benralizumab with prior exacerbations experienced reductions in asthma exacerbations and exacerbation-related medical HRU and medical costs regardless of prior biologic use, with the benefits observed for up to 24 months after treatment initiation.
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Affiliation(s)
- Yen Chung
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health, San Antonio, TX, USA
| | - Fan Mu
- Analysis Group, Inc, Boston, MA, USA
| | | | | | | | | | - Eduardo Genofre
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Donna Carstens
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
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13
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Nagase H, Suzukawa M, Oishi K, Matsunaga K. Biologics for severe asthma: The real-world evidence, effectiveness of switching, and prediction factors for the efficacy. Allergol Int 2023; 72:11-23. [PMID: 36543689 DOI: 10.1016/j.alit.2022.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Biologics have been a key component of severe asthma treatment, and there are currently biologics available that target IgE, IL-5, IL-4/IL-13, and TSLP. Randomized controlled trials have established clinical evidence, but a significant portion of patients with severe asthma in real-life settings would have been excluded from those trials. Therefore, real-world research is necessary, and there is a growing body of information about the long-term efficacy and safety of biologics. Multiple clinical phenotypes of severe asthma exist, and it is crucial to choose patients based on their phenotypes. Blood eosinophil count is an important biomarker for anti-IL-5 therapies, and FeNO and eosinophil counts serve as prediction markers for dupilumab. Reliable markers for predicting response, however, have not yet been fully established for omalizumab. Identification of clinical or biological prediction factors is crucial for the path toward clinical remission because the current treatment goal includes clinical remission, which is defined as a realistic goal for remission off treatment. Additionally, since there are now multiple biologic options and overlaps in eligibility for biologics in clinical practice, the evidence regarding the effectiveness of switching the biologics is crucial. Investigations into the clinical trajectory following the cessation of biologics are another important issue. Recent research on omalizumab, mepolizumab, benralizumab and dupilumab's real-world effectiveness, the prediction factor for the efficacy, and the impact of switching or discontinuation will be reviewed and discussed in this review.
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Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Maho Suzukawa
- Asthma Allergy and Rheumatology Center, Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Keiji Oishi
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
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Switching Biological Therapies in Adults with Severe Asthma: What Are the Dilemmas and Is It Worthwhile? Ann Am Thorac Soc 2022; 19:1965-1970. [PMID: 35984426 DOI: 10.1513/annalsats.202203-251ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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15
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Numata T, Araya J, Okuda K, Miyagawa H, Minagawa S, Ishikawa T, Hara H, Kuwano K. Long-Term Efficacy and Clinical Remission After Benralizumab Treatment in Patients with Severe Eosinophilic Asthma: A Retrospective Study. J Asthma Allergy 2022; 15:1731-1741. [PMID: 36471877 PMCID: PMC9719274 DOI: 10.2147/jaa.s391807] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/23/2022] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Few studies on the long-term efficacy of benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, have been conducted for patients with severe eosinophilic asthma (SEA), especially regarding the improvement of pulmonary function and clinical remission in a real-world setting. OBJECTIVE To elucidate the long-term efficacy and clinical remission rate (CRR) in patients with SEA. METHODS From July 2018 to July 2022, 23 Japanese patients with SEA received benralizumab for two years or more at Jikei University Hospital. We retrospectively evaluated the patients' characteristics, biomarkers, number of exacerbations, pulmonary function, asthma symptoms, maintenance oral corticosteroid (OCS) dose and CRR. RESULTS The mean observation period was 38.3 (24-49) months. Among the 23 patients, 10 patients switched from mepolizumab to benralizumab. After administration of benralizumab, the forced expiratory volume in one second (FEV1) increased and was maintained for two years in the biologic-naïve group and in the switching group (177 ± 404 and 151 ± 236 [mL], respectively, P = 0.80). In all patients, the %FEV1 improved from 76.7 ± 22.9% to 84.3 ± 18.4% (P = 0.016), and the number of annual exacerbations decreased from 2.5 ± 3.3 to 0.74 ± 1.7 (P = 0.014). Furthermore, the Asthma Control Test score significantly improved, and the reduction in OCS dose was maintained for three years. Ultimately, five patients met the clinical remission criteria and exhibited stabilization of pulmonary function, no exacerbation, no OCS use and well-controlled symptoms. The CRR was significantly higher in patients with a blood basophil count (BBC) ≥ 22 than in those with a BBC < 22 (/µL) (38.5% vs 0%, respectively, P = 0.046). CONCLUSION Long-term treatment with benralizumab significantly improved pulmonary function, alleviated asthma symptoms and decreased the number of exacerbations at two years in a real-world setting. The CRR may be associated with the BBC at baseline.
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Affiliation(s)
- Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Okuda
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hanae Miyagawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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Caruso C, Cameli P, Altieri E, Aliani M, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Centanni S, D’Amato M, Del Giacco S, De Michele F, Pastorello EA, Pelaia G, Rogliani P, Romagnoli M, Schino P, Caminati M, Vultaggio A, Zullo A, Rizzoli S, Boarino S, Vitiello G, Menzella F, Di Marco F. Switching from one biologic to benralizumab in patients with severe eosinophilic asthma: An ANANKE study post hoc analysis. Front Med (Lausanne) 2022; 9:950883. [PMID: 36117962 PMCID: PMC9478391 DOI: 10.3389/fmed.2022.950883] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSevere asthma is a heterogeneous inflammatory disease driven by eosinophilic inflammation in the majority of cases. Despite biologic therapy patients may still be sub-optimally controlled, and the choice of the best biologic is a matter of debate. Indeed, switching between biologics is common, but no official guidelines are available and real-world data are limited.Materials and methodsIn this post hoc analysis of the Italian, multi-center, observational, retrospective study, ANANKE. Patients with severe eosinophilic asthma treated with benralizumab were divided in two groups based on history of previous biologic therapy (biologic-experienced [suboptimal response] vs naïve). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment. Change over time in blood eosinophils, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use following benralizumab initiation were collected in the two groups.ResultsA total of 147 biologic-naïve and 58 biologic-experienced (34 omalizumab, 19 mepolizumab, and 5 omalizumab-mepolizumab) patients were enrolled. Biologic-experienced patients were more likely to be atopic and have a higher AER despite more frequent OCS use. Similar reductions in AER (>90% in both groups), OCS use (≥49% reduction in dosage and ≥41% able to eliminate OCS), ACT improvement (≥7 points gained in 48 weeks) and lung function (≥300 mL of FEV1 improvement in 48 weeks) were observed after benralizumab introduction within the two groups. There were no registered discontinuations of benralizumab for safety reasons.ConclusionIn this post hoc analysis, patients who were switched to benralizumab because of suboptimal control with a previous biologic therapy were more likely to be atopic and more often treated with omalizumab. Benralizumab is effective in both naïve patients and those previously treated with a biologic.
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Affiliation(s)
- Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Cristiano Caruso,
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese, MI, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I - Torino, Turin, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Asthma and Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II,” Ospedale Monaldi, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, Italy
| | | | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata,” Rome, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli,” Acquaviva delle Fonti, BA, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | | | - Alessandro Zullo
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Sara Rizzoli
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | | | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino,” Montebelluna (TV) - AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Fabiano Di Marco
- Department of Health Sciences and Pneumology, University of Milan, ASST Papa Giovanni XXIII, Bergamo, Italy
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O'Reilly E, Casey D, Ibrahim H, McGrath A, McHugh T, Vairamani P, Murphy J, Plant B, Murphy DM. Real-World Clinical Outcomes in Asthmatic Patients Switched from Omalizumab to Anti-Interleukin-5 Therapy. J Asthma Allergy 2022; 15:935-937. [PMID: 35844776 PMCID: PMC9285523 DOI: 10.2147/jaa.s358321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emily O'Reilly
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Deborah Casey
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Hisham Ibrahim
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Alice McGrath
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Tomás McHugh
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Punitha Vairamani
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Jill Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Barry Plant
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Desmond M Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
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18
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Minagawa S, Araya J, Watanabe N, Fujimoto S, Watanabe J, Hara H, Numata T, Kuwano K, Matsuwaki Y. Real-life effectiveness of dupilumab in patients with mild to moderate bronchial asthma comorbid with CRSwNP. BMC Pulm Med 2022; 22:258. [PMID: 35764984 PMCID: PMC9241284 DOI: 10.1186/s12890-022-02046-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dupilumab, an anti-IL-4α receptor antibody, is a new treatment for severe or refractory asthma. However, real-world evidence on the efficacy of dupilumab in patients with mild to moderate bronchial asthma is lacking. METHODS We retrospectively evaluated the effects of dupilumab in 62 patients who received dupilumab for eosinophilic sinusitis comorbid with asthma at a single centre in Japan. Type 2 inflammatory markers, ACT, respiratory function tests, and forced oscillation technique (FOT) were analysed before, three months after, and one year after dupilumab administration, mainly in patients with mild to moderate asthma. RESULTS FEV1, %FEV1, %FVC, treatment steps for asthma and ACT improved significantly after three months of dupilumab treatment. FeNO was markedly decreased, whereas IgE and eosinophil counts showed no significant changes. Pre- and post-treatment respiratory resistance (Rrs) and respiratory reactance (Xrs) correlated significantly with FEV1. Improvement in %FEV1 was associated with higher FeNO and higher serum IgE before dupilumab treatment. CONCLUSION Dupilumab treatment for sinusitis may improve respiratory functions, asthma symptoms, and asthma treatment reduction, even if the associated bronchial asthma is not severe.
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Affiliation(s)
- Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Matsuwaki Clinic Shinagawa, 6-7-29 Kitashinagawa Shinagawa-ku, Tokyo, 140-0001, Japan.
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naoaki Watanabe
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Matsuwaki Clinic Shinagawa, 6-7-29 Kitashinagawa Shinagawa-ku, Tokyo, 140-0001, Japan
| | - Shota Fujimoto
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Matsuwaki Clinic Shinagawa, 6-7-29 Kitashinagawa Shinagawa-ku, Tokyo, 140-0001, Japan
| | - Junko Watanabe
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Matsuwaki Clinic Shinagawa, 6-7-29 Kitashinagawa Shinagawa-ku, Tokyo, 140-0001, Japan
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshinori Matsuwaki
- Matsuwaki Clinic Shinagawa, 6-7-29 Kitashinagawa Shinagawa-ku, Tokyo, 140-0001, Japan
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19
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Gómez-Bastero Fernández A, Medina Gallardo JF, Delgado Romero J, Romero Falcón A, Benito Bernáldez C, Gallego Borrego J, Álvarez-Gutiérrez FJ. Effectiveness of Switching to Benralizumab in Severe Refractory Eosinophilic Asthma. J Asthma Allergy 2022; 15:727-735. [PMID: 35642210 PMCID: PMC9148608 DOI: 10.2147/jaa.s358705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Benralizumab is a monoclonal antibody that targets the α subunit of the IL-5 receptor. Clinical trials have demonstrated the efficacy of this agent with respect to lung function and symptom control in patients with refractory eosinophilic asthma. However, few studies have evaluated the efficacy of benralizumab after switching previous treatment with other monoclonal antibodies. Patients and Methods We performed a multicenter retrospective study under conditions of daily clinical practice. The study population comprised consecutively included patients with severe refractory eosinophilic asthma whose initial treatment with omalizumab or mepolizumab was switched to benralizumab. Patients were evaluated at 4 and 12 months after starting treatment with benralizumab. We analyzed asthma control, number of severe exacerbations, corticosteroid cycles, visits to the emergency department, and hospital admissions, as well as lung function. Similarly, we evaluated the response to treatment according to previously established criteria. Results We evaluated 40 patients who switched from omalizumab (n=16) or mepolizumab (n=24) to benralizumab. The reasons for switching were lack of response in 30 cases, adverse effects in 9, and patient request in 1. Switching was followed by a significant decrease in the number of exacerbations, visits to the emergency department, and corticosteroid cycles, as well as improved ACT both at 4 and 12 months. However, no significant improvement in lung function was observed. Asthma control (including complete response and control) was achieved in 55% of patients (n=22) at 12 months. Specifically, a complete response was achieved in 30% of patients at 12 months (66.7% switching from omalizumab and 33.3% from mepolizumab). Conclusion Patients diagnosed with severe refractory eosinophilic asthma who experience a partial response with omalizumab or mepolizumab could benefit from switching to benralizumab. This approach can reduce the number of exacerbations, visits to the emergency department, and corticosteroid cycles and improve control of asthma.
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Affiliation(s)
| | | | | | | | - Cristina Benito Bernáldez
- Asthma Unit of Pneumology, Virgen Macarena University Hospital, Seville, Spain
- Correspondence: Cristina Benito Bernáldez, Asthma Unit of Pneumology, Virgen Macarena University Hospital Avenue Doctor Fedriani, Seville, s/n. CP 41009, Spain, Tel +34 646 081 573, Fax +34 955 926 572, Email
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20
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Numata T, Araya J, Miyagawa H, Okuda K, Takekoshi D, Hashimoto M, Minagawa S, Ishikawa T, Hara H, Kuwano K. Real-World Effectiveness of Dupilumab for Patients with Severe Asthma: A Retrospective Study. J Asthma Allergy 2022; 15:395-405. [PMID: 35392537 PMCID: PMC8982811 DOI: 10.2147/jaa.s357548] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/23/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Takanori Numata
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
- Correspondence: Takanori Numata, Department of Respiratory Diseases, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku Tokyo, 105-8461, Japan, Tel +81-3-3433-1111 (ext. 3271), Fax +81-3-3433-1020, Email
| | - Jun Araya
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Hanae Miyagawa
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Okuda
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Takekoshi
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuo Hashimoto
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Minagawa
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Ishikawa
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromichi Hara
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Department of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
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21
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Alharbi AS, Yousef AA, Alharbi SA, Almaghamsi TM, Al Qwaiee MM, Al-Somali FM, Alahmadi TS, Alhaider SA, Alotaibi WH, Albalawi MA, Alotaibi FN, Alenizi AS, Alsaadi MM, Said YS. Severe asthma in children: An official statement from Saudi Pediatric Pulmonology Association. Saudi Med J 2022; 43:329-340. [PMID: 35414610 PMCID: PMC9998054 DOI: 10.15537/smj.2022.4.43.20210756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
In Saudi Arabia, the prevalence of pediatric asthma ranges between 8% and 25%. However, there are no sufficient data regarding severe asthma in childhood in Saudi Arabia. Therefore, a task force has been formed by the Saudi Pediatric Pulmonology Association which is a subsidiary group of the Saudi Thoracic Society and consists of Saudi experts with well-respected academic and clinical backgrounds in the fields of pediatric asthma as well as other respiratory diseases to write a consensus on definitions, phenotypes, and pathophysiology, evaluation, and management. To achieve this, the subject was divided into various sections, each of which was assigned to at least 2 experts. Without a central literature review, the authors searched the literature using their own strategies. To reach an agreement, the entire panel reviewed and voted on proposed findings and recommendations.
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Affiliation(s)
- Adel S. Alharbi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Abdullah A. Yousef
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Saleh A. Alharbi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Talal M. Almaghamsi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Mansour M. Al Qwaiee
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Faisal M. Al-Somali
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Turki S. Alahmadi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Sami A. Alhaider
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Wadha H. Alotaibi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Mona A. Albalawi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Faisal N. Alotaibi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Ahmed S. Alenizi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Muslim M. Alsaadi
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Yazan S. Said
- From the Department of Pediatrics (A. Alharbi, Alotaibi), Pediatric Pulmonology Division and Pediatric Sleep Center, from the Department of Pediatrics (Al-Somali), Pediatric Pulmonary Division, Prince Sultan Military City, from the Departments of Pediatric Pulmonology & Sleep Medicine (Albalawi), King Fahad Medical City, from the Pediatric Pulmonology And Sleep Medicine Department (Alenizi), Children’s Hospital, King Saud Medical City, from the Department of Pediatrics (Alenizi), College of Medicine and King Khalid University Hospital, King Saud University, From the Pediatric Department (Said), Security Forces Hospital, Riyadh; from the Department of Pediatrics (Yousef), Imam Abdulrahman Bin Faisal University, College of Medicine; from the Department of Pediatrics (Almaghamsi, Alhaider), King Fahad Specialist Hospital, Dammam; King Fahd Hospital of the University (Yousef), from the Department of Pediatrics (Alahmadi), Dr. Sulaiman Al Habib Hospital, Al-Khobar; Department of Pediatrics (S. Alharbi), Faculty of Medicine, Umm Alqura University, Mecca; from the Department of Pediatrics (S. Alharbi), Dr. Soliman Fakeeh Hospital; from the Pediatric Department (Al Qwaiee), King Faisal specialist hospital & Research Center, from the Department of Pediatrics (Alotaibi), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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Use of biologics for the treatment of moderate-to-severe asthma: the age of personalized medicine. Curr Opin Pulm Med 2022; 28:266-273. [PMID: 35131991 DOI: 10.1097/mcp.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW There are multiple FDA-approved biologics to treat poorly controlled moderate-to-severe asthma. Given the heterogeneity of asthma and the lack of head-to-head data between biologics, selecting the best biologic for a patient can be difficult. This review summarizes the key literature to date, in hopes of facilitating an evidence-based approach to selecting the most appropriate biologic for patients with asthma. RECENT FINDINGS In addition to unique mechanisms of action, there is increasing literature on predictors of response to each biologic, such as sensitizations to aeroallergens, peripheral eosinophil count, total serum IgE, and exhaled nitric oxide. Biologics available for asthma are also being increasingly studied in comorbid conditions with asthma, and this may facilitate selecting the most appropriate biologic for a patient. In the absence of head-to-head studies, there is literature of switching between biologics whenever necessary. SUMMARY The authors outline an approach to selecting a biologic based on various considerations, and hope this suggested approach facilitates selecting the biologic most suitable for each individual with poorly controlled moderate-to-severe asthma.
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Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center. Biomedicines 2022; 10:biomedicines10020200. [PMID: 35203409 PMCID: PMC8869384 DOI: 10.3390/biomedicines10020200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction: Biologic drugs have dramatically improved severe eosinophilic asthma (SEA) outcomes. Our aim was to evaluate the long-term efficacy of biological therapy in SEA in a real-life setting and to identify the predictors for switching to another biological drug in patients with poor asthma control. The outcomes for efficacy were decreased annual exacerbations (AE) and improved asthma control test (ACT). Methods: In 90 SEA patients being treated with a biological drug, clinical examination, ACT, blood eosinophils count and spirometry were assessed before (T0) and after 6 (T1), 12 (T2), 24 (T3) and 36 (T4) months from the start of biological therapy. Patients were considered responders (R) or non-responders (NR) to biologics depending on whether or not they had less than two AE and a 20% increase in the ACT after 12 months of treatment. Results: 75% of the patients were R, 25% NR. In R patients, biological therapy add-on was followed by significant improvement in AE and ACT throughout the whole follow-up period. The percentage of patients on oral corticosteroids (OCS) dropped from 40% to 12%. By contrast, the NR patients were shifted to another biological drug after 12 months of therapy, as they still had high AE and nearly unchanged ACT; 40% of them still needed OCS treatment. The predictors of switching to another biological drug were three or more AE, ACT below 17, nasal polyposis and former smoking (p < 0.05). In NR, the shift to another biological drug was followed by a significant decrease in AE and an increase in the ACT. Discussion: This real-life study confirms the long-term efficacy of biologics in most SEA patients and indicates that even in non-responders to a first biological drug, it is worth trying a second one. It is hoped that the availability of additional biologics with different targets will help improve the personalization of SEA therapy.
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Pérez de Llano LA, Cosío BG, Lobato Astiárraga I, Soto Campos G, Tejedor Alonso MÁ, Marina Malanda N, Padilla Galo A, Urrutia Landa I, Michel de la Rosa FJ, García-Moguel I. Asthma Control in Patients with Severe Eosinophilic Asthma Treated with Reslizumab: Spanish Real-Life Data. J Asthma Allergy 2022; 15:79-88. [PMID: 35058696 PMCID: PMC8765543 DOI: 10.2147/jaa.s340562] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Reslizumab is an anti-interleukin 5 monoclonal antibody that has demonstrated to reduce the risk of severe exacerbations and to improve symptoms, lung function, and quality of life in randomized controlled trials that included patients with severe eosinophilic uncontrolled asthma (SEUA) and a history of severe exacerbations. Objective The aim of the present study was to evaluate the effectiveness of add-on reslizumab in a cohort of patients with SEUA under real-life conditions. Methods This was a multi-centre, retrospective, real-life study that included subjects with SEUA treated with reslizumab in 44 asthma units throughout Spain. Eligible patients were those who had received at least one dose of reslizumab as part of normal clinical practice. The primary endpoint was complete asthma control at 52 weeks, defined as absence of severe exacerbations, ACT ≥20 and no maintenance oral corticosteroids (OCS). Demographic, clinical, and functional data were collected at baseline (T0), after four to six months (T1); after 12 months (T2) and beyond 12 months of therapy (T3). Results Treatment with reslizumab achieved complete asthma control in 40% of the 208 included SEUA patients and led to a significant reduction in exacerbations (from 3.0; IQR: 2.0–4.0 at V0 to 0.0; IQR: 0.0–0.0 at V2), maintenance OCS use (from 54.8% (95% CI: 48.0–61.6 at T0 to 18.5% (95% CI: 12.5–24.5 at T2) and a meaningful improvement in symptoms in the entire treated population: ACT increased from 12.8 ± 4.5 at V0 to 20.0 ± 5.1 at V2 (p < 0.001). Most of the improvement achieved at 12 months was obtained at 4–6 months. The retention (continuation) rate of reslizumab was 75% through 2 years (95CI%: 1.9–2.1). Overall, reslizumab showed an adequate safety profile. Conclusion Reslizumab is an effective therapy for SEUA with adequate safety profile in real-life conditions.
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Affiliation(s)
| | - Borja G Cosío
- Pneumology Service, Hospital Universitario Son Espases-IdISBa-Ciberes, Palma de Mallorca, Spain
- Correspondence: Borja G Cosío Department of Respiratory Medicine, Hospital Universitario Son ESPASES-IDISBA, Palma de Mallorca, Spain Email
| | | | - Gregorio Soto Campos
- Pneumology and Allergy Unit, University Hospital of Jerez, Jerez de la Frontera, Cádiz, Spain
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Switch from Omalizumab to Benralizumab in Allergic Patients with Severe Eosinophilic Asthma: A Real-Life Experience from Southern Italy. Biomedicines 2021; 9:biomedicines9121822. [PMID: 34944638 PMCID: PMC8698313 DOI: 10.3390/biomedicines9121822] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Background. The wide availability of monoclonal antibodies for the add-on therapy of severe asthma currently allows for the personalization of biologic treatment by selecting the most appropriate drug for each patient. However, subjects with overlapping allergic and eosinophilic phenotypes can be often eligible to more than one biologic, so that the first pharmacologic choice can be quite challenging for clinicians. Within such a context, the aim of our real-life investigation was to verify whether allergic patients with severe eosinophilic asthma, not adequately controlled by an initial biologic treatment with omalizumab, could experience better therapeutic results from a pharmacologic shift to benralizumab. Patients and methods. Twenty allergic patients with severe eosinophilic asthma, unsuccessfully treated with omalizumab and then switched to benralizumab, were assessed for at least 1 year in order to detect eventual changes in disease exacerbations, symptom control, oral corticosteroid intake, lung function, and blood eosinophils. Results. In comparison to the previous omalizumab therapy, after 1 year of treatment with benralizumab our patients experienced significant improvements in asthma exacerbation rate (p < 0.01), rescue medication need (p < 0.001), asthma control test (ACT) score (p < 0.05), forced expiratory volume in the first second (FEV1) (p < 0.05), and blood eosinophil count (p < 0.0001). Furthermore, with respect to the end of omalizumab treatment, the score of sino-nasal outcome test-22 (SNOT-22) significantly decreased after therapy with benralizumab (p < 0.05). Conclusion. The results of this real-life study suggest that the pharmacologic shift from omalizumab to benralizumab can be a valuable therapeutic approach for allergic patients with severe eosinophilic asthma, not adequately controlled by anti-IgE treatment.
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