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Cisneros-Serrano C, Rial MJ, Gómez-Bastero-Fernández A, Igea JM, Martínez-Meca A, Fernández-Lisón LC, López-Carrasco V, Villamañán-Bueno E, Plá-Martí MJ, Chiner E. Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration. Rev Clin Esp 2023; 223:154-164. [PMID: 36549642 DOI: 10.1016/j.rceng.2022.11.001] [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: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. MATERIALS AND METHODS This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. RESULTS One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. CONCLUSION Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.
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Affiliation(s)
- C Cisneros-Serrano
- Pulmonology Department, Hospital Universitario La Princesa, Madrid, Spain.
| | - M J Rial
- Allergy Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - J M Igea
- Clínica Alergoasma, Salamanca, Spain
| | - A Martínez-Meca
- Pulmonology Department Nurse, Hospital Universitario de La Princesa, Madrid, Spain
| | - L C Fernández-Lisón
- Hospital Pharmacy Department, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - V López-Carrasco
- Allergy Department Nurse, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | | | - M J Plá-Martí
- Allergy Department Nurse, Hospital Universitario La Fe, Valencia, Spain
| | - E Chiner
- Pulmonology Department, Hospital Universitario San Juan d'Alacant, Alicante, Spain
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2
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Cisneros-Serrano C, Rial M, Gómez-Bastero-Fernández A, Igea J, Martínez-Meca A, Fernández-Lisón L, López-Carrasco V, Villamañán-Bueno E, Plá-Martí M, Chiner E. Consenso multidisciplinar español sobre las características de los pacientes con asma grave en tratamiento con biológicos susceptibles de pasar a tratamiento domiciliario. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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3
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Bagnasco D, Canevari RF, Del Giacco S, Ferrucci S, Pigatto P, Castelnuovo P, Marseglia GL, Yalcin AD, Pelaia G, Canonica GW. Omalizumab and cancer risk: Current evidence in allergic asthma, chronic urticaria, and chronic rhinosinusitis with nasal polyps. World Allergy Organ J 2022; 15:100721. [DOI: 10.1016/j.waojou.2022.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022] Open
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4
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Hanania NA, Niven R, Chanez P, Antoine D, Pfister P, Garcia Conde L, Jaumont X. Long-term effectiveness and safety of omalizumab in pediatric and adult patients with moderate-to-severe inadequately controlled allergic asthma. World Allergy Organ J 2022; 15:100695. [PMID: 36254180 PMCID: PMC9519799 DOI: 10.1016/j.waojou.2022.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
- Corresponding author. Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030 USA
| | - Robert Niven
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Pascal Chanez
- Clinique des Bronches, de l'Allergie et du Sommeil, Department of Respiratory Diseases, APHM, Aix-Marseille University, France
| | - Deschildre Antoine
- CHU Lille, Université Nord de France, unité de pneumologie et allergologie pédiatriques, Hôpital Jeanne de Flandre, 59000 Lille, France
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5
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Al Ahmad M, Borboa Olivares LM, Cardoso AP, Djazmati W, Vinuesa MA, Domínguez MDJG, Neto AC, Gamboa LU, Lee JK, Pinho N, Tassinari P. Real-life Effectiveness of Omalizumab in Patients with Severe Allergic Asthma: RELIEF Study. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2206130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Patients with severe allergic asthma (SAA) are at risk of severe exacerbations. Omalizumab is recommended as an add-on treatment for patients with uncontrolled SAA, despite high-dose inhaled corticosteroids and long acting β2-agonist combination therapy (standard therapy).
RELIEF was a prospective, open label, multicenter study conducted to assess the real-life effectiveness of omalizumab co-administered with standard therapy in patients with SAA for 24 months.
Methods:
A total of 347 patients aged ≥ 6 years with SAA were enrolled, 285 of whom (8 pediatrics and 277 adolescents and adults) completed this 24-month study. Compared with the 12 months prior to baseline, the mean number of exacerbations was reduced in the overall population at any time interval during the study. Proportion of patients with no exacerbations increased to 77.7% at 24 months from 32.6% at 12 months prior to baseline. A reduction in healthcare resource utilization was also observed. The mean number of specialist visits reduced from baseline (5.8 visits) to 2.4 visits at Month 24.
Results:
The mean asthma control test score was >19 at every time-point during the study. The rate of Global Evaluation of Treatment Effectiveness (GETE) for asthma response significantly increased at Months 18 and 24 (P <0.05) compared to baseline. Pulmonary function remained relatively stable for the overall study population. There were no new or unexpected safety findings in the study.
Conclusion:
RELIEF study showed that add-on therapy with omalizumab is effective in reducing exacerbations, healthcare utilization, and improving GETE score in patients with SAA uncontrolled by standard therapy.
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Abstract
Severe asthma is a heterogeneous syndrome with several clinical variants and often represents a complex disease requiring a specialized and multidisciplinary approach, as well as the use of multiple drugs. The prevalence of severe asthma varies from one country to another, and it is estimated that 50% of these patients present a poor control of their disease. For the best management of the patient, it is necessary a correct diagnosis, an adequate follow-up and undoubtedly to offer the best available treatment, including biologic treatments with monoclonal antibodies. With this objective, this consensus process was born, which began in its first version in 2018, whose goal is to offer the patient the best possible management of their disease in order to minimize their symptomatology. For this 2020 consensus update, a literature review was conducted by the authors. Subsequently, through a two-round interactive Delphi process, a broad panel of asthma experts from SEPAR and the regional pulmonology societies proposed the recommendations and conclusions contained in this document.
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7
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Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:210278. [PMID: 35675922 PMCID: PMC9489006 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
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Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
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8
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Bernardini R, Toschi Vespasiani G, Giannetti A. An Overview of Off-Label Use of Humanized Monoclonal Antibodies in Paediatrics. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:625. [PMID: 35630042 PMCID: PMC9144580 DOI: 10.3390/medicina58050625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
In recent years, off-label and unlicensed drug use has extensively developed in the paediatric population. For a long time, clinical trials in the paediatric population were considered complicated to perform because of ethical problems, causing frequent off-label use. Off-label drug use remains an important public health issue, especially for children with rare conditions or with diseases not responsive to conventional treatments. The present paper is a narrative review of the literature of off-label drug use in children. The aim of our study is to summarize the main works dealing with the off-label use of biological drugs in paediatrics. Further studies analyzing their efficacy, safety, and cost-benefit ratios are needed to extend the use of biological therapies to the paediatric population.
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Affiliation(s)
- Roberto Bernardini
- Paediatrics and Neonatology Unit, San Giuseppe Hospital, 50053 Empoli, Italy
| | - Gaia Toschi Vespasiani
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Arianna Giannetti
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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9
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Omalizumab: An Optimal Choice for Patients with Severe Allergic Asthma. J Pers Med 2022; 12:jpm12020165. [PMID: 35207654 PMCID: PMC8878072 DOI: 10.3390/jpm12020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/28/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Omalizumab is the first monoclonal antibody that was globally approved as a personalized treatment option for patients with moderate-to-severe allergic asthma. This review summarizes the knowledge of almost two decades of use of omalizumab to answer some important everyday clinical practice questions, concerning its efficacy and safety and its association with other asthma-related and drug-related parameters. Evidence suggests that omalizumab improves asthma control and reduces the incidence and frequency of exacerbations in patients with severe allergic asthma. Omalizumab is also effective in those patients in reducing corticosteroid use and healthcare utilization, while it also seems to improve lung function. Several biomarkers have been recognized in predicting its efficacy in its target group of patients, while the optimal duration for evaluating its efficacy is between 16 and 32 weeks.
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10
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Czira A, Turner M, Martin A, Hinds D, Birch H, Gardiner F, Zhang S. A systematic literature review of burden of illness in adults with uncontrolled moderate/severe asthma. Respir Med 2021; 191:106670. [PMID: 34883444 DOI: 10.1016/j.rmed.2021.106670] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited published data on the burden of moderate/severe uncontrolled asthma. METHODS We conducted a systematic literature review to better understand the impact of moderate-to-severe asthma in the US, the UK, Germany, France, Italy, Spain, Canada, Japan, and Australia in terms of prevalence, clinical measures, health-related quality of life (HRQoL) and economic burden, for patients whose asthma is uncontrolled despite inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. RESULTS The prevalence of uncontrolled asthma among patients with moderate/severe disease varied but was as high as 100% in some subgroups. Patients with uncontrolled asthma generally had poor lung function (mean/median pre-bronchodilator forced expiratory volume in 1 second [FEV1]: 1.69-2.45 L; mean/median pre-bronchodilator percent predicted FEV1: 57.2-79.7). There was also a substantial but variable exacerbation burden associated with uncontrolled asthma, with the annualised rate of exacerbations ranging from 1.30 to 7.30 when considering various patient subgroups. Furthermore, the annualised rate of severe exacerbations ranged from 1.66 to 3.60. The HRQoL burden measured using disease-specific and generic instruments consistently demonstrated substantial impairment of HRQoL for those with uncontrolled asthma; Asthma Quality of Life Questionnaire scores ranged from 3.00 to 5.20, whilst EurQol-5 Dimensions index scores ranged from 0.53 to 0.59. Direct, indirect and total costs together with consumption of other healthcare resources associated with managing uncontrolled asthma were also substantial in the population studied; no caregiver burden was identified. CONCLUSIONS Our findings suggest that significant unmet needs exist for patients with uncontrolled asthma despite the availability of ICS/LABA therapy. Novel treatments are needed to help reduce the burden to patients, healthcare systems and society.
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Affiliation(s)
| | - Monica Turner
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - Amber Martin
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - David Hinds
- GSK, R&D Global Medical, Collegeville, PA, United States.
| | - Helen Birch
- GSK, R&D Global Medical, Brentford, Middlesex, UK.
| | | | - Shiyuan Zhang
- GSK, R&D Global Medical, Collegeville, PA, United States.
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11
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Bousquet J, Humbert M, Gibson PG, Kostikas K, Jaumont X, Pfister P, Nissen F. Real-World Effectiveness of Omalizumab in Severe Allergic Asthma: A Meta-Analysis of Observational Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2702-2714. [PMID: 33486142 DOI: 10.1016/j.jaip.2021.01.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessment of clinical outcomes in the real-world corroborates findings from randomized controlled trials (RCTs). OBJECTIVE This meta-analysis evaluated real-world data of omalizumab on treatment response, lung function, exacerbations, oral corticosteroid (OCS) use, patient-reported outcomes (PROs), health care resource utilization (HCRU), and school/work absenteeism at 4, 6, and 12 months after treatment. METHODS Observational studies in patients with severe allergic asthma (≥6 years) treated with omalizumab for ≥16 weeks, published from January 2005 to October 2018, were retrieved from PubMed, Embase, and Cochrane. A random-effects model was used to assess heterogeneity. RESULTS In total, 86 publications were included. Global evaluation of treatment effectiveness (GETE) was good/excellent in 77% patients at 16 weeks (risk difference: 0.77; 95% confidence interval [CI]: 0.70-0.84; I2 = 96%) and in 82% patients at 12 months (0.82, 0.73-0.91; 97%). The mean improvement in forced expiratory volume in 1 second was 160, 220, and 250 mL at 16 weeks, 6 months, and 12 months, respectively. There was a decrease in Asthma Control Questionnaire score at 16 weeks (-1.14), 6 months (-1.56), and 12 months (-1.13) after omalizumab therapy. Omalizumab significantly reduced annualized rate of severe exacerbations (risk ratio [RR]: 0.41, 95% CI: 0.30-0.56; I2 = 96%), proportion of patients receiving OCS (RR: 0.59, 95% CI: 0.47-0.75; I2 = 96%), and number of unscheduled physician visits (mean difference: -2.34, 95% CI: -3.54 to -1.13; I2 = 98%) at 12 months versus baseline. CONCLUSION The consistent improvements in GETE, lung function, and PROs, and reductions in asthma exacerbations, OCS use, and HCRU with add-on omalizumab in real-life confirm and complement the efficacy data of RCTs.
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Affiliation(s)
- Jean Bousquet
- Contre les Maladies Chroniques pour un VIeillissement Actif (MACVIA) en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; Centre Hospitalier Universitaire de Montpellier, Montpellier, France; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany.
| | - Marc Humbert
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Peter G Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia; Priority Research Centre for Asthma and Respiratory Disease, the University of Newcastle, Newcastle, NSW, Australia
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
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12
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Faulkner KM, MacDonald K, Abraham I, Alhossan A, Lee CS. 'Real-world' effectiveness of omalizumab in adults with severe allergic asthma: a meta-analysis. Expert Rev Clin Immunol 2020; 17:73-83. [PMID: 33307892 DOI: 10.1080/1744666x.2020.1856658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Severe asthma affects 5-10% of the 350 million people with asthma worldwide. Findings from the authors' previous meta-analysis supported omalizumab use as an adjuvant treatment for severe allergic asthma. The publication of fourteen new articles necessitates an update of the meta-analysis.Objective: To evaluate the 'real-world' effectiveness of omalizumab in the treatment of acute allergic asthma in adults by calculating pooled effects estimates from data in published articles.Methods: Articles on omalizumab effectiveness in 'real-world' settings were identified. Effect sizes, including point estimates of the proportion of patients who met a given criteria, mean improvements relative to baseline, and change in the proportion of patients requiring oral corticosteroids compared to baseline were extracted. Meta-analysis of proportions was conducted to pool effect sizes based on proportions. Standardized mean differences (Hedges' g) were calculated from means and standard deviations. Relative risk was calculated from changes in proportions. Variability within and between studies was evaluated.Results: Omalizumab increases the percentage of individuals rated 'good' or 'excellent' on the Global Evaluation of Treatment Effectiveness Scale. Omalizumab also improves respiratory function, quality-of-life, and asthma control while reducing medication usage, exacerbations, hospitalizations, and adverse events.Conclusion: 'Real-world' evidence continues to support the use of omalizumab as adjuvant treatment for severe allergic asthma.
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Affiliation(s)
- Kenneth M Faulkner
- Connell School of Nursing, Boston College William F, Chestnut Hill, MA, USA.,School of Nursing, Stony Brook University, Stony Brook, NY, USA
| | | | - Ivo Abraham
- Division of Research, Matrix45, Tucson, AZ, USA.,Health Outcomes and PharmacoEconomic Research, University of Arizona Center For, Tucson, AZ, USA.,Pharmacy and College of Medicine, University of Arizona College Of, Tucson, AZ, USA
| | | | - Christopher S Lee
- Connell School of Nursing, Boston College William F, Chestnut Hill, MA, USA
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13
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Kucharczyk A, Więsik-Szewczyk E, Poznańska A, Jahnz-Różyk K. Clinical Determinants of Successful Omalizumab Therapy in Severe Allergic Asthma Patients: 4-Year-Long, Real-Life Observation. J Asthma Allergy 2020; 13:659-668. [PMID: 33363390 PMCID: PMC7754267 DOI: 10.2147/jaa.s282203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Omalizumab is a high-cost therapy recommended for the treatment of severe allergic asthma. Objective To find clinical parameters that are related to the sustained response to omalizumab. Patients and Methods This retrospective, real-life, 4-year follow-up was provided in Poland between March 2013 and May 2019. The success of omalizumab was assessed based on composed subjective and objective criteria. Simple/multiple regression analyses were performed to search for predictors of the response to omalizumab. Results A total of 989 severe allergic asthma patients were referred for omalizumab therapy, of whom 854 patients were considered eligible for treatment. At weeks 16 and 52, omalizumab was successful in 84% and 91% of patients, respectively. Treatment effectiveness was maintained up to the 4-year follow-up. Four predictors of the response to omalizumab were found at week 16 and two at week 52. The results at week 16 may be used as predictors of success at week 52 based on the model including baseline FEV1% and change in ACQ-7 and miniAQLQ score at week 16: the area under the ROC curve equals 0.746 [95% CI: 0.672–0.820]. Conclusion Omalizumab therapy is very effective, with this efficacy sustained after 4 years of treatment. Success of the therapy can be predicted from the baseline FEV1% and clinical improvement (based on ACQ-7 and miniAQLQ scores) at week 16.
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Affiliation(s)
- Aleksandra Kucharczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
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14
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FitzGerald JM, Tran TN, Alacqua M, Altraja A, Backer V, Bjermer L, Bjornsdottir U, Bourdin A, Brusselle G, Bulathsinhala L, Busby J, Canonica GW, Carter V, Chaudhry I, Cho YS, Christoff G, Cosio BG, Costello RW, Eleangovan N, Gibson PG, Heaney LG, Heffler E, Hew M, Hosseini N, Iwanaga T, Jackson DJ, Jones R, Koh MS, Le T, Lehtimäki L, Ludviksdottir D, Maitland-van der Zee AH, Menzies-Gow A, Murray RB, Papadopoulos NG, Perez-de-Llano L, Peters M, Pfeffer PE, Popov TA, Porsbjerg CM, Price CA, Rhee CK, Sadatsafavi M, Tohda Y, Wang E, Wechsler ME, Zangrilli J, Price DB. International severe asthma registry (ISAR): protocol for a global registry. BMC Med Res Methodol 2020; 20:212. [PMID: 32819285 PMCID: PMC7439682 DOI: 10.1186/s12874-020-01065-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Severe asthma exerts a disproportionately heavy burden on patients and health care. Due to the heterogeneity of the severe asthma population, many patients need to be evaluated to understand the clinical features and outcomes of severe asthma in order to facilitate personalised and targeted care. The International Severe Asthma Registry (ISAR) is a multi-country registry project initiated to aid in this endeavour. Methods ISAR is a multi-disciplinary initiative benefitting from the combined experience of the ISAR Steering Committee (ISC; comprising 47 clinicians and researchers across 29 countries, who have a special interest and/or experience in severe asthma management or establishment and maintenance of severe asthma registries) in collaboration with scientists and experts in database management and communication. Patients (≥18 years old) receiving treatment according to the 2018 definitions of the Global Initiative for Asthma (GINA) Step 5 or uncontrolled on GINA Step 4 treatment will be included. Data will be collected on a core set of 95 variables identified using the Delphi method. Participating registries will agree to provide access to and share standardised anonymous patient-level data with ISAR. ISAR is a registered data source on the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance. ISAR’s collaborators include Optimum Patient Care, the Respiratory Effectiveness Group (REG) and AstraZeneca. ISAR is overseen by the ISC, REG, the Anonymised Data Ethics & Protocol Transparency Committee and the ISAR operational committee, ensuring the conduct of ethical, clinically relevant research that brings value to all key stakeholders. Conclusions ISAR aims to offer a rich source of real-life data for scientific research to understand and improve disease burden, treatment patterns and patient outcomes in severe asthma. Furthermore, the registry will provide an international platform for research collaboration in respiratory medicine, with the overarching aim of improving primary and secondary care of adults with severe asthma globally.
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Affiliation(s)
| | | | | | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Vibeke Backer
- Center of Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Leif Bjermer
- Department of Respiratory Medicine & Allergology, Skåne University Hospital, Lund, Sweden
| | | | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Hopital Arnaud de Villeneuve and PhyMed Exp (INSERM U 1046, CNRS UMR9214), Universite de Montpellier, Montpellier, France
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giorgio W Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy.,SANI-Severe Asthma Network Italy, Milan, Italy
| | | | | | - You Sook Cho
- Division of Allergy, Department of Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - George Christoff
- Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital and Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | | | - Peter G Gibson
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Enrico Heffler
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy.,SANI-Severe Asthma Network Italy, Milan, Italy
| | - Mark Hew
- Alfred Health & Monash University, Melbourne, Australia
| | | | - Takashi Iwanaga
- Department of Respiratory Medicine & Allergology, Faculty of Medicine, Kindai University Hospital, Ōsakasayama, Japan
| | - David J Jackson
- Guy's & St Thomas' NHS Trust and King's College London, London, UK
| | - Rupert Jones
- Faculty of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Mariko S Koh
- Department of Respiratory & Critical Care Medicine, Singapore General Hospital and Duke-National University Singapore Medical School, Singapore, Singapore
| | - Thao Le
- Optimum Patient Care, Cambridge, UK
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Dora Ludviksdottir
- Department of Respiratory Medicine, Faculty of Medicine, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | | | | | - Chin K Rhee
- The Catholic University of Korea, Seoul, South Korea
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Yuji Tohda
- Department of Respiratory Medicine & Allergology, Faculty of Medicine, Kindai University Hospital, Ōsakasayama, Japan
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health and Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Denver and Aurora, CO, USA
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, Asthma Program, National Jewish Health, Denver, USA
| | | | - David B Price
- Optimum Patient Care, Cambridge, UK. .,Observational and Pragmatic Research Institute, Singapore, Singapore. .,Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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15
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Álvarez-Gutiérrez FJ, Blanco-Aparicio M, Plaza V, Cisneros C, García-Rivero JL, Padilla A, Pérez-de Llano L, Perpiñá M, Soto-Campos G. Documento de consenso de asma grave en adultos. Actualización 2020. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Chorostowska-Wynimko J, Wencker M, Horváth I. The importance of effective registries in pulmonary diseases and how to optimize their output. Chron Respir Dis 2020; 16:1479973119881777. [PMID: 31645111 PMCID: PMC6811757 DOI: 10.1177/1479973119881777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Randomized controlled trials (RCTs) are essential for the approval of new
therapies; however, because of their design, they provide little insight
concerning disease epidemiology/etiology and current clinical practice.
Particularly, in lung disease, rigid inclusion/exclusion criteria can limit the
generalizability of pivotal trial data. Noninterventional studies (NIS),
conducted through the well-established mechanism of patient registries, are
undervalued as a means to close data gaps left by RCTs by providing essential
data that can guide patient care at different levels from clinical
decision-making to health-care policy. While NIS contribute valuable data in all
disease areas, their importance in rare diseases cannot be underestimated. In
respiratory disease, registries have been essential in understanding the natural
history and different phenotypes of rare conditions, such as alpha 1 antitrypsin
deficiency, cystic fibrosis, and idiopathic pulmonary fibrosis. Importantly,
additional therapeutic outcome data were generated. While measures for enhancing
data quality in RCTs have evolved significantly, the approach and effectiveness
of registries is variable. Within this article, we review the contribution of
registries to pulmonary disease and make recommendations for their effective
management. Additionally, we assess limitations of registry data as well as
challenges to registry operation, including the impact of the European Union
General Data Protection Regulation.
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Affiliation(s)
- Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Ildikó Horváth
- Department of XIV, National Koranyi Institute for Pulmonology, Budapest, Hungary.,Department of Public Health, Semmelweis University, Budapest, Hungary
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17
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Lee JK, Amin S, Erdmann M, Kukaswadia A, Ivanovic J, Fischer A, Gendron A. Real-World Observational Study on the Characteristics and Treatment Patterns of Allergic Asthma Patients Receiving Omalizumab in Canada. Patient Prefer Adherence 2020; 14:725-735. [PMID: 32308377 PMCID: PMC7152735 DOI: 10.2147/ppa.s248324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/10/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Omalizumab is a treatment option for pediatric and adult patients with moderate to severe allergic asthma poorly controlled with standard inhaled therapies. Clinical trials and observational studies have demonstrated the efficacy of omalizumab. There is limited real-world evidence on the characteristics and treatment patterns of Canadian asthma patients receiving omalizumab. OBJECTIVE We profiled Canadian omalizumab users to estimate time to omalizumab discontinuation and to assess changes in concurrent medication usage before, during, and after therapy. METHODS This was a retrospective, observational, cohort study that analyzed data from Canadian prescription claims databases. An algorithm was used to select naïve users of omalizumab with an inferred diagnosis of GINA 5-asthma who made a claim for omalizumab from February 1, 2007, to June 2, 2015. Demographic and baseline characteristics were assessed at index. Outcomes examined over the analysis period included (i) daily omalizumab dose per patient and per claim; (ii) omalizumab discontinuation (defined as ≥100-day gap in making omalizumab claims) and its potential predictors (ie, age, sex, province of residence, drug insurer; assessed by Cox Proportional Hazards Model); and (iii) for patients who discontinued omalizumab, changes in concurrent medication usage before, during, and 6 months after omalizumab usage. RESULTS The final study cohort consisted of 1160 patients (mean age: 45.8 ± 15.2 years; 64.7% female). During the first year of omalizumab therapy, 29.5% of patients discontinued treatment. The singular characteristic that predicted omalizumab discontinuation with statistical significance was age group (20‒34 years vs 12‒19 years; hazard ratio 1.75, 95% confidence interval 1.11-2.76; P<0.05). There were significant reductions in the use of some concurrent inhaled and oral asthma medications during and/or after omalizumab use (P<0.05). CONCLUSION Nearly one-third of patients who initiated omalizumab in Canada for refractory, moderate to severe allergic asthma discontinued treatment during the first year.
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Affiliation(s)
- Jason K Lee
- Clinical Immunology and Allergy, Internal Medicine, Evidence Based Medical Educator Inc. and Urticaria Canada, Toronto, ON, Canada
| | | | | | | | | | | | - Alain Gendron
- AstraZeneca, Mississauga, Ontario, Canada and Department of Medicine, Université de Montréal, Montreal, QC, Canada
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18
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Wang E, Wechsler ME, Tran TN, Heaney LG, Jones RC, Menzies-Gow AN, Busby J, Jackson DJ, Pfeffer PE, Rhee CK, Cho YS, Canonica GW, Heffler E, Gibson PG, Hew M, Peters M, Harvey ES, Alacqua M, Zangrilli J, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Hosseini N, Murray RB, Price DB. Characterization of Severe Asthma Worldwide: Data From the International Severe Asthma Registry. Chest 2019; 157:790-804. [PMID: 31785254 DOI: 10.1016/j.chest.2019.10.053] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/01/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical characteristics of the international population with severe asthma are unknown. Intercountry comparisons are hindered by variable data collection within regional and national severe asthma registries. We aimed to describe demographic and clinical characteristics of patients treated in severe asthma services in the United States, Europe, and the Asia-Pacific region. METHODS The International Severe Asthma Registry retrospectively and prospectively collected data in patients with severe asthma (≥ 18 years old), receiving Global Initiative for Asthma (GINA) Step 5 treatment or with severe asthma remaining uncontrolled at GINA Step 4. Baseline demographic and clinical data were collected from the United States, United Kingdom, South Korea, Italy, and the Severe Asthma Web-based Database registry (including Australia, Singapore, and New Zealand) from December 2014 to December 2017. RESULTS We included 4,990 patients. Mean (SD) age was 55.0 (15.9) years, and mean (SD) age at asthma onset was 30.7 (17.7) years. Patients were predominantly female (59.3%) and white (72.6%), had never smoked (60.5%), and were overweight or obese (70.4%); 34.9% were at GINA Step 5; and 57.2% had poorly controlled disease. A total of 51.1% of patients were receiving regular intermittent oral corticosteroids, and 25.4% were receiving biologics (72.6% for those at GINA Step 5). Mean (SD) exacerbation rate was 1.7 (2.7) per year. Intercountry variation was observed in clinical characteristics, prescribed treatments, and biomarker profiles. CONCLUSIONS Using a common data set and definitions, this study describes severe asthma characteristics of a large patient cohort included in multiple severe asthma registries and identifies country differences. Whether these are related to underlying epidemiological factors, environmental factors, phenotypes, asthma management systems, treatment access, and/or cultural factors requires further study.
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Affiliation(s)
- Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, and Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO
| | | | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Rupert C Jones
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, United Kingdom
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom
| | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - You Sook Cho
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy and SANI-Severe Asthma Network Italy, Italy
| | - Enrico Heffler
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy and SANI-Severe Asthma Network Italy, Italy
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
| | - Erin S Harvey
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
| | | | | | | | | | | | | | | | | | - David B Price
- Optimum Patient Care Global Ltd, Cambridge, England; Observational and Pragmatic Research Institute, Singapore, Republic of Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
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19
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Varricchi G, Marone G, Spadaro G, Russo M, Granata F, Genovese A, Marone G. Novel Biological Therapies in Severe Asthma: Targeting the Right Trait. Curr Med Chem 2019; 26:2801-2822. [PMID: 29318959 DOI: 10.2174/0929867325666180110094542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/23/2022]
Abstract
Asthma is a heterogeneous disease characterized by chronic airway inflammation that results in a wide spectrum of clinical manifestations. Patients with severe asthma represent a substantial share of consumption of healthcare resources and hospitalization. Moreover, these patients are at risk of increased morbidity and mortality. Recently, several phenotypes and endotypes of asthma have been identified. The identification of specific subtypes of asthma is fundamental for optimizing the clinical benefit of novel treatments. Although in most patients the disease can be controlled by some combination of pharmacologic agents, in some 5-10% of patients the disease remains uncontrolled. Several monoclonal antibodies (mAbs) targeting pathogenetic molecules (e.g., IgE, IL-5, IL- 5Rα, IL-4, IL-13, TSLP) are currently available or under development for the treatment of different forms of severe type 2 asthma. The identification of diagnostic and predictive biomarkers (e.g., IgE, blood eosinophil count, FeNO, periostin, etc.) has revolutioned the field of targeted therapy in severe asthma. Monoclonal antibodies targeting Th2-driven inflammation are generally safe in adult patients with moderate-to-severe asthma. The long-term safety of these biologics is a relevant issue that should be addressed. Unfortunately, little is known about non-type 2 asthma. Further studies are needed to identify biomarkers to guide targeted therapies of different forms of non-type 2 asthma.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Giancarlo Marone
- Department of Public Health, University of Naples Federico II, Naples, Italy.,Monaldi Hospital, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Michele Russo
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy
| | - Francescopaolo Granata
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Arturo Genovese
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore", National Research Council (CNR), Naples, Italy
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20
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Caminati M, Polk B, Rosenwasser LJ. What have recent advances in therapy taught us about severe asthma disease mechanisms? Expert Rev Clin Immunol 2019; 15:1145-1153. [PMID: 31549894 DOI: 10.1080/1744666x.2020.1672536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Severe asthma still represents a worldwide challenge. The need for further treatment options has stimulated basic and pharmacological research to focus on the immune and inflammatory background of asthma. The new biologic drugs express the considerable advances in the field and besides providing a revolutionary treatment option for severe asthma, contribute themselves to better understand the pathophysiologic mechanisms they address, paving the way to new potential targets.Areas covered: A selective search on PubMed and Medline was performed, including the evidence on immunology of severe asthma published up to May 2019 by focusing on the immunological effects of biologic drugs underlying their clinical outcomes.Expert opinion: The recent pharmacological research in the field of biologics has represented an exceptional opportunity for exploring severe asthma mechanisms. However, some points deserve to be addressed by further investigation. Although in the absence of safety warnings so far, interfering with the immune system may raise some safety concerns, especially in the long-term use. Particularly when interacting with epithelial and innate immunity the selection of candidates probably deserves special caution. Also, whether biologics exert a true disease-modifying effect is not completely clear. As a direct practical implication, the optimal treatment duration is still controversial.
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Affiliation(s)
- Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy.,Department of Medicine, University of Verona, Verona, Italy
| | - Brooke Polk
- Wash U School of Medicine, St Louis, MO, USA
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21
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Quirce S, Melero C, Huerta A, Uría E, Cuesta M. Economic impact of severe asthma exacerbations in Spain: multicentre observational study. J Asthma 2019; 58:207-212. [PMID: 31621441 DOI: 10.1080/02770903.2019.1674330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To describe resource use and costs of severe exacerbations in patients with severe asthma.Method: Secondary analysis of an observational, longitudinal, retrospective study that estimated the economic impact of severe asthma. The study was carried out in severe asthma units of the pulmonology and allergy services of 20 public hospitals (inclusion period: June to November 2016). The study included adult patients diagnosed with severe asthma according to the European Respiratory Society/American Thoracic Society consensus in the stable phase (no exacerbation during the last 2 months), and with at least one severe exacerbation during the study period (12 months). Healthcare resource use due to severe exacerbations (emergency visits, hospitalizations and pharmacological treatment) was recorded. The direct health costs associated with severe exacerbations were calculated by multiplying the resources used by the corresponding unit cost (in 2018 euros).Results: 134 patients with ≥1 severe exacerbation were included: 63% were female and the mean age was 54 years. 249 severe exacerbations were registered. There were 1.5 physician visits at primary care, hospital care and/or emergency room per episode, 13% of episodes required hospitalization, with a mean hospital stay of 7.2 days. Systemic corticosteroids were prescribed in 92% of exacerbations. The mean direct cost was €758.7/exacerbation (95% confidence interval: 556.8-1,011.1), of which 82% was due to hospitalizations (€623.3/episode). Considering only episodes requiring hospital admission, the mean cost increased by €4,997/exacerbation.Conclusions: It was estimated that the economic impact of a severe exacerbation in Spanish patients with severe asthma was €758.7/exacerbation.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, and CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain
| | - Carlos Melero
- Instituto de Investigación (i + 12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alicia Huerta
- Departamento de Market Access, GlaxoSmithKline, Madrid, Spain
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22
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Entrenas Costa LM, Casas-Maldonado F, Soto Campos JG, Padilla-Galo A, Levy A, Álvarez Gutiérrez FJ, Gómez-Bastero Fernández AP, Morales-García C, Gallego Domínguez R, Villegas Sánchez G, Mateos Caballero L, Pereira-Vega A, García Polo C, Pérez Chica G, Martín Villasclaras JJ. Economic Impact and Clinical Outcomes of Omalizumab Add-On Therapy for Patients with Severe Persistent Asthma: A Real-World Study. PHARMACOECONOMICS - OPEN 2019; 3:333-342. [PMID: 30684255 PMCID: PMC6710309 DOI: 10.1007/s41669-019-0117-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Omalizumab is a fully humanized monoclonal antibody indicated as add-on therapy to improve asthma control in patients with severe persistent allergic asthma. AIMS The aim of this study was to evaluate social, healthcare expenditure and clinical outcomes changes after incorporating omalizumab into standard treatment in the control of severe asthma. METHODS In this multicentre retrospective study, a total of 220 patients were included from 15 respiratory medicine departments in the regions of Andalusia and Extremadura (Spain). Effectiveness was calculated as a 3-point increase in the Asthma Control Test (ACT) and a reduction in the annual number of exacerbations. The economic evaluation included both direct and indirect costs. Incremental cost-effectiveness ratio (ICER) was calculated. Results from the year before and the year after incorporation of omalizumab were compared. RESULTS After adding omalizumab, improvement of lung function, asthma and rhinitis according to patient perception, as well as the number of exacerbations and asthma control measured by the ACT score were observed. Globally, both healthcare resources and pharmacological costs decreased after omalizumab treatment, excluding omalizumab cost. When only direct costs were considered, the ICER was €1712 (95% CI 1487-1995) per avoided exacerbation and €3859 (95% CI 3327-4418) for every 3-point increase in the ACT score. When both direct and indirect costs were considered, the ICER was €1607 (95% CI 1385-1885) for every avoided exacerbation and €3555 (95% CI 3012-4125) for every 3-point increase. CONCLUSIONS Omalizumab was shown to be an effective add-on therapy for patients with persistent severe asthma and allowed reducing key drivers of asthma-related costs.
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Affiliation(s)
- Luis Manuel Entrenas Costa
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Avda. de las Ollerías 1, portal 10 4-2, 14001, Córdoba, Spain.
| | | | - José Gregorio Soto Campos
- Unidad de Gestión Clínica de Neumología y Alergia, Hospital de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - Alicia Padilla-Galo
- Agencia Sanitaria Costa del Sol, Unidad de Neumología, Marbella, Málaga, Spain
| | - Alberto Levy
- Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | | | | | - Concepción Morales-García
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | - Antonio Pereira-Vega
- Unidad de Gestión Clínica de Neumología y Alergia, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Cayo García Polo
- Unidad de Gestión Clínica de Neumología, Alergia y Cirugía Torácica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Gerardo Pérez Chica
- Unidad de Gestión Clínica de Aparato Respiratorio, Hospital Médico Quirúrgico, Jaén, Spain
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23
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MacDonald KM, Kavati A, Ortiz B, Alhossan A, Lee CS, Abraham I. Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018. Expert Rev Clin Immunol 2019; 15:553-569. [PMID: 30763137 DOI: 10.1080/1744666x.2019.1574571] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Omalizumab is a recombinant monoclonal anti-IgE antibody approved in the US as add-on treatment in moderate-to-severe allergic asthma (in severe allergic asthma [SAA] in Europe). A 2016 review of 24 real-world effectiveness studies in SAA published between 2008-2015 concluded that omalizumab was associated with significant improvements in objective and subjective outcomes with benefits extending beyond 2 years. Several new real-world studies have been published since, bringing the total to 42 studies. Areas covered: This systematic review of 42 studies published since 2008 updates and extends the 2016 review on the real-word evidence on omalizumab in SAA. It offers greater granularity as to time windows within which outcomes are reported and includes studies extending well beyond 4 years post omalizumab initiation. Expert commentary: This review firmly establishes the short-term effectiveness of omalizumab in adolescent and adult patients with SAA at 1 year, and provides strong evidence of long-term effectiveness up to 4 years and emergent evidence of effectiveness beyond 4 years. In the aggregate, these 42 studies underscore the long-term effectiveness of omalizumab in terms of: reducing exacerbations and symptoms, achieving asthma control, improving lung function, enhancing quality of life, decreasing emergency department visits and hospitalizations, and promoting concomitant medication-sparing.
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Affiliation(s)
| | - Abhishek Kavati
- b Health Economics & Outcomes Research , Novartis , East Hanover , NJ , USA
| | - Benjamin Ortiz
- c Clinical Development & Medical Affairs , Novartis , East Hanover , NJ , USA
| | | | - Christopher S Lee
- a Division of Research , Matrix45 , Tucson , AZ , USA.,e Boston College , Connell School of Nursing , Boston , MA , USA
| | - Ivo Abraham
- a Division of Research , Matrix45 , Tucson , AZ , USA.,f Center for Health Outcomes and Pharmacoeconomic Research , University of Arizona , Tucson , AZ , USA.,g Department of Pharmacy Practice and Science, College of Pharmacy , University of Arizona , Tucson , AZ , USA.,h Department of Family and Community Medicine , College of Medicine - Tucson, University of Arizona , Tucson , AZ , USA
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24
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Pérez de Llano LA, Cosío BG, Domingo C, Urrutia I, Bobolea I, Valero A, Entrenas Costa LM, Quirce S, Barranco P, Marina Malanda N, Andrés LP, Alvarez-Gutiérrez FJ. Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2277-2283.e2. [PMID: 30677539 DOI: 10.1016/j.jaip.2019.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies. OBJECTIVE To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab. METHODS We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period. RESULTS Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab. CONCLUSION Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.
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Affiliation(s)
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Domingo
- Department of Pulmonary Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Isabel Urrutia
- Asthma Unit, Department of Pulmonary Medicine, Hospital Galdakao, Bizkaia, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Allergy Section, Department of Pulmonology and Allergy, Hospital Clinic Barcelona-Institute for Health Research (IdiBAPS), Madrid, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Allergy Section, Department of Pulmonology and Allergy, Hospital Clinic Barcelona-Institute for Health Research (IdiBAPS), Madrid, Spain
| | - Luis M Entrenas Costa
- Pneumology Service, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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Chen S, Golam S, Myers J, Bly C, Smolen H, Xu X. Systematic literature review of the clinical, humanistic, and economic burden associated with asthma uncontrolled by GINA Steps 4 or 5 treatment. Curr Med Res Opin 2018; 34:2075-2088. [PMID: 30047292 DOI: 10.1080/03007995.2018.1505352] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study sought to characterize the epidemiologic, clinical, humanistic, and economic burden of patients with asthma uncontrolled by GINA Steps 4 or 5 treatment (severe, uncontrolled asthma [SUA]). METHODS A systematic literature review adhering to PRISMA guidelines was performed. Relevant publications were searched for in MEDLINE and EMBASE from January 2004 to September 2016 and in a conference proceedings database from January 2012 to October 2016. Studies were screened using the Population, Intervention, Comparator, Outcomes, Study Design, and Time (PICOS-T) framework. Studies of SUA with observational (prospective and retrospective), randomized, or nonrandomized study designs; adult patient populations; sample sizes ≥20 patients; epidemiologic or clinical outcomes, patient-reported outcomes (PROs), or economic outcomes were included. For our analysis, SUA was defined as inadequate control of asthma, despite the use of medium- to high-dosage inhaled corticosteroids and at least one additional treatment. RESULTS A total of 195 articles reporting unique study populations were included. Prevalence of SUA was as great as 87.4% for patients with severe asthma, although values varied depending on the criteria used to define asthma control. Compared with patients with severe asthma who were controlled, patients with SUA experienced more symptoms, night-time awakenings, rescue medication use, and worse PROs. SUA-associated costs were 3-times greater than costs for patients with severe, controlled disease. CONCLUSION Despite the availability of approved asthma treatments, this literature analysis confirms that SUA poses a substantial epidemiologic, clinical, humanistic, and economic burden. Published data are limited for certain aspects of SUA, highlighting a need for further research.
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Affiliation(s)
| | | | - Julie Myers
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Chris Bly
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Harry Smolen
- c Medical Decision Modeling Inc. , Indianapolis , IN, USA
| | - Xiao Xu
- a AstraZeneca , Gaithersburg , MD, USA
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Sá-Sousa A, Fonseca JA, Pereira AM, Ferreira A, Arrobas A, Mendes A, Drummond M, Videira W, Costa T, Farinha P, Soares J, Rocha P, Todo-Bom A, Sokolova A, Costa A, Fernandes B, Chaves Loureiro C, Longo C, Pardal C, Costa C, Cruz C, Loureiro CC, Lopes C, Mesquita D, Faria E, Magalhães E, Menezes F, Todo-Bom F, Carvalho F, Regateiro FS, Falcão H, Fernandes I, Gaspar-Marques J, Viana J, Ferreira J, Silva JM, Simão L, Almeida L, Fernandes L, Ferreira L, van Zeller M, Quaresma M, Castanho M, André N, Cortesão N, Leiria-Pinto P, Pinto P, Rosa P, Carreiro-Martins P, Gerardo R, Silva R, Lucas S, Almeida T, Calvo T. The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1495039. [PMID: 30584531 PMCID: PMC6280304 DOI: 10.1155/2018/1495039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022]
Abstract
The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.
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Affiliation(s)
- Ana Sá-Sousa
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Ferreira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Arrobas
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Mendes
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- Pulmonology Department, Faculty of Medicine University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Wanda Videira
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | | | | | | | | | - Ana Todo-Bom
- Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Immunoallergology Department, Faculdade de Medicina, Universidade do Coimbra, Coimbra, Portugal
| | - Anna Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - António Costa
- Pulmonology Department, Hospital da Senhora da Oliveira, Guimarães EPE, Guimarães, Portugal
| | | | - Carla Chaves Loureiro
- Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cecília Longo
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Cecília Pardal
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Célia Costa
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Cíntia Cruz
- Immunology and Allergy Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal
- Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Immunology and Allergy Department, Hospital Pedro Hispano Unidade Local de Saúde Matosinhos, EPE, Matosinhos, Portugal
- Immunology Dpeartment, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Duarte Mesquita
- Novartis Farma-Produtos Farmacêuticos, S.A., Porto Salvo, Portugal
| | - Emília Faria
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eunice Magalhães
- Pulmonology Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Fernando Menezes
- Pulmonology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Filipa Todo-Bom
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Francisca Carvalho
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Frederico S. Regateiro
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Helena Falcão
- Immunology and Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Ivone Fernandes
- Pulmonology Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - João Gaspar-Marques
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Jorge Viana
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Immunology and Allergy Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - José Manuel Silva
- Pulmonology Department, Unidade Local de Saúde da Guarda, EPE, Guarda, Portugal
| | - Laura Simão
- Pulmonology Department, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, Portugal
| | - Leonor Almeida
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
| | - Lígia Fernandes
- Pulmonology Department, Hospital Distrital Figueira da Foz, EPE, Figueira da Foz, Portugal
| | | | - Mafalda van Zeller
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Pulmonology Department, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Márcia Quaresma
- Department of Pediatrics, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | | | - Natália André
- Pulmonology Department, Centro Hospitalar do Oeste, Torres Vedras, Portugal
| | - Nuno Cortesão
- Pulmonology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Paula Leiria-Pinto
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Paula Pinto
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
- ISAMB, Instituto de Saúde Ambiental Faculdade de Medicina de Lisboa. Lisboa, Portugal
| | - Paula Rosa
- Pulmonology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Pedro Carreiro-Martins
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Rita Gerardo
- Pulmonology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
| | - Rui Silva
- Immunology and Allergy Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Susana Lucas
- Pulmonology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Teresa Almeida
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Calvo
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
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Abstract
Among the monoclonal antibodies (mAbs) developed for severe asthma treatment, three have already been marketed. Omalizumab was the first, more than 10 years ago; today, mepolizumab and reslizumab are also available in the European Union and the US. Omalizumab blocks free immunoglobulin E (IgE), mepolizumab and reslizumab block an interleukin (IL-5). In the near future, dupilumab and benralizumab are expected to emerge as two new alternatives. Benralizumab blocks the receptor for IL-5 (IL5-Rα) and has a direct cytotoxic effect on eosinophils, and dupilumab blocks the α-unit of the heterodimeric receptor for IL-4 and IL-13 (IL-4Rα); as a result, dupilumab can block both IL-4 and IL-13. The purpose of this manuscript is to present the pathophysiology of some immunological aspects of severe asthma, describe the adaptive and innate immunity arms as well as their interrelations (stressing the subordination of the adaptive arm to the innate arm), outline the pharmacologic effects of these mAbs, clarify the overlapping effects of the different mAbs, and discuss the differences between mAbs based on their target molecules. Based on the data presented, I propose omalizumab for patients with an allergic phenotype regardless of their peripheral eosinophilic count, and anti-IL-5 as an alternative in allergic patients with blood eosinophilia in which omalizumab has failed; anti-IL5 for patients with an eosinophilic phenotype and omalizumab as an alternative in patients in whom anti-IL5 fails and IgE ≥30 IU/mL (compassionate use). Omalizumab is also proposed for patients with severe chronic asthma allergic to seasonal allergens.
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Canonica GW, Rottoli P, Bucca C, Zappa MC, Michetti G, Macciocchi B, Caruso C, Santus P, Bartezaghi M, Rigoni L. Improvement of patient-reported outcomes in severe allergic asthma by omalizumab treatment: the real life observational PROXIMA study. World Allergy Organ J 2018; 11:33. [PMID: 30410639 PMCID: PMC6214174 DOI: 10.1186/s40413-018-0214-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background Data on the prevalence of perennial versus seasonal allergic asthma in Italy are lacking; moreover, there is limited evidence on the effect of omalizumab on patient-reported outcomes in Italian patients with severe allergic asthma. PROXIMA, an observational, multicenter study, was designed to assess the prevalence of perennial versus seasonal allergic asthma (cross-sectional phase) and the effect of omalizumab on improving illness perception, quality of life (QoL) and asthma control of Italian patients with severe allergic asthma (longitudinal phase). Methods The study included a cross-sectional phase (n = 357) and a longitudinal phase (n = 123): during the longitudinal phase, patients received omalizumab (75–600 mg subcutaneously every month) and were followed-up for 12 months. The primary parameter of cross-sectional phase was prevalence of perennial allergic asthma and that of longitudinal phase was proportion of patients with asthma control (assessed using asthma control questionnaire [ACQ]). Secondary parameters assessed were patients’ disease perception, level of asthma control, exacerbation rate during both cross-sectional and longitudinal phases, and patients' compliance to and persistence with omalizumab, and patients' QoL during the longitudinal phase. Results Most patients (95.8%) had perennial allergies; 81% had polysensitization. Of 99 patients in the per-protocol set, 95 (95.96% [95% CI: 89.98–98.89%]) achieved asthma control (ACQ < 4) at both 6 and 12 months of omalizumab treatment; ACQ score decreased after 6 and 12 months (P < 0.0001). Omalizumab treatment resulted in a significant improvement in QoL and patients’ illness perception and 87% decrease in exacerbation rate. The compliance rate with omalizumab was high (73.2%). No new safety signals were identified during treatment. Conclusion This study demonstrated that in severe allergic asthma, omalizumab improves patient-reported outcomes such as patients’ illness perception and QoL, while confirming improvement of asthma control and exacerbation rate reduction in Italian patients.
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Affiliation(s)
- Giorgio Walter Canonica
- 1Department of Biomedical Sciences, Personalised Medicine Clinic Asthma & Allergy, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paola Rottoli
- 2Respiratory Diseases and Lung Transplantation Unit, Department of Medical, Surgical and Neuro Sciences, University of Siena, Siena, Italy
| | - Caterina Bucca
- 3Pneumology Unit, AOU Molinette, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | | | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico Gemelli, Presidio Columbus, Rome, Italy
| | - Pierachille Santus
- 8Division of Respiratory Diseases, "L.Sacco" University Hospital, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences (DIBIC), University of Milan, Milan, Italy
| | - Marta Bartezaghi
- 9Novartis Farma SpA, Largo U. Boccioni 1, 21040 Origgio, VA Italy
| | - Laura Rigoni
- 9Novartis Farma SpA, Largo U. Boccioni 1, 21040 Origgio, VA Italy
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Heffler E, Blasi F, Latorre M, Menzella F, Paggiaro P, Pelaia G, Senna G, Canonica GW. The Severe Asthma Network in Italy: Findings and Perspectives. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1462-1468. [PMID: 30368004 DOI: 10.1016/j.jaip.2018.10.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Severe Asthma Network in Italy (SANI) is a registry of patients recruited by accredited centers on severe asthma. OBJECTIVE To analyze epidemiological, clinical, inflammatory, functional, and treatment characteristics of severe asthmatics from the SANI registry. METHODS All consecutive patients with severe asthma were included into the registry, without exclusion criteria to have real-life data on demographics, asthma control, treatments (including biologics), inflammatory biomarkers, and comorbidities. RESULTS A total of 437 patients (mean age: 54.1 years, 57.2% females, 70.7% atopics, 94.5% in Global Initiative for Asthma severity step V) were enrolled into the study. The mean annual exacerbation rate was 3.75. The mean blood eosinophil level was 536.7 cells/mcL, and the average serum total IgE was 470.3 kU/L. Approximately 64% of patients were on regular oral corticosteroid treatment, 57% with omalizumab and 11.2% with mepolizumab. Most common comorbidities were rhinitis, nasal polyposis, and bronchiectasis. Patients with nasal polyposis had higher age of disease onset, higher blood eosinophil count, and lower frequency of atopy and atopic eczema. Bronchiectasis was associated with more frequent severe exacerbations, higher blood eosinophils, and total IgE. Stratifying patients, those with late-onset asthma were less frequently atopic (with less frequent allergic rhinitis and food allergy), and more frequently with nasal polyposis and higher serum total IgE levels. CONCLUSIONS This study revealed a high frequency of relevant comorbidities and that a substantial proportion of patients have late-onset asthma; all these features define specific different disease phenotypes. Severe asthma complexity and comorbidities require multidisciplinary approaches, led by specifically trained pulmonologists and allergists.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Al-Ahmad M, Nurkic J, Maher A, Arifhodzic N, Jusufovic E. Tolerability of Omalizumab in Asthma as a Major Compliance Factor: 10-Year Follow Up. Open Access Maced J Med Sci 2018; 6:1839-1844. [PMID: 30455759 PMCID: PMC6236047 DOI: 10.3889/oamjms.2018.394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/08/2018] [Accepted: 09/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a lack of data related to real life, long-term safety, tolerability and compliance of omalizumab treatment in asthma patients beyond 6 years. AIM Study aimed to assess safety, tolerability, compliance and all reasons for treatment discontinuation during 10 years on omalizumab. SUBJECT AND METHODS This is a retrospective, observational study of uncontrolled asthma patients receiving omalizumab for the last 10 years. All data were collected from patients' files (demographics, adverse events, comorbidities, compliance index, reasons for discontinuation of omalizumab). Reactions to omalizumab were classified as local and systemic, and their severity as mild, moderate or severe. Reactions were either immediate (minutes to hours after drug administration) or delayed (after days). Compliance to omalizumab, defined as Compliance index (CI), was calculated by comparing milligrams of given to milligrams of prescribed dose/ per year. RESULTS Out of 35 patients receiving omalizumab, 15 drop out at different time points mostly due to treatment efficacy or appearance of new comorbidities. Patients who continue for the next ten years had mild to moderate adverse events related to omalizumab. There was no increased risk of severe adverse events during 10 years on omalizumab. Patient's treatment tolerability, despite mild to moderate adverse events, is in favour of compliance. CONCLUSION Compliance with omalizumab mildly decreased over 10 years but was not affected by severe adverse events of treatment or new comorbidities. Although, omalizumab is safe medicine appearance of new comorbidities has to be closely followed up.
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Affiliation(s)
- Mona Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.,Al-Rashed Allergy Center, Ministry of Health, Kuwait
| | | | - Ahmed Maher
- Al-Rashed Allergy Center, Ministry of Health, Kuwait
| | | | - Edin Jusufovic
- Cathedra for Internal Medicine Department, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
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31
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Melero Moreno C, Quirce S, Huerta A, Uría E, Cuesta M. Economic impact of severe asthma in Spain: multicentre observational longitudinal study. J Asthma 2018; 56:861-871. [PMID: 30003827 DOI: 10.1080/02770903.2018.1499035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Estimate the economic impact of severe asthma from the Spanish social perspective through the estimation of the associated annual direct and indirect costs. Methods: Observational, longitudinal, retrospective study carried out in 20 Spanish secondary settings (Pulmonology and Allergy Services) among patients aged ≥18, diagnosed with severe asthma according to European Respiratory Society/American Thoracic Society consensus and who have not experienced an exacerbation in the previous 2 months. Asthma-related healthcare resource utilization as well as asthma-related days off work were collected over a retrospective 12-month period from medical records review (inclusion period: June to November 2016). Total costs were calculated by multiplying the natural resource units used within 1 year by the corresponding unit cost. Costs were expressed in Euros for 2018. Results: A total of 303 patients were included, mean age was 54 years old and 67% were women. There were 5.7 physician visits per patient (3.3 in secondary care). The most common pharmacologic treatment was fixed dose combination of inhaled corticosteroids/long-acting β2-adrenergic agonists (96.7%), followed by leukotriene receptor antagonists (57.1%). 134 patients (44.2%) had at least one severe asthma exacerbation (mean: 1.9 exacerbation/patient), of whom 22 patients required hospitalization, with a mean hospital stay of 10.9 days/patient. Mean sick leave due to severe asthma was 9.1 days per patient per year. Mean annual direct cost (confidence interval 95%) was €7472/patient (€6578-8612). The cost per exacerbation was €1410/patient. When indirect costs were added (€1082/patient [€564-1987]), the total annual mean cost rose to €8554/patient (€7411-10199). Conclusions: Taking the social perspective, the economic impact of severe asthma in Spain was estimated to be €8554/patient/year.
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Affiliation(s)
- Carlos Melero Moreno
- a Instituto de Investigación (i + 12), Hospital Universitario 12 Octubre , Madrid , Spain
| | - Santiago Quirce
- b Servicio de Alergología, Hospital Universitario La Paz, and CIBER de Enfermedades Respiratorias CIBERES , Madrid , Spain
| | - Alicia Huerta
- c Departamento de Evaluación de Medicamentos, GlaxoSmithKline , Madrid , Spain
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Caminati M, Pham DL, Bagnasco D, Canonica GW. Type 2 immunity in asthma. World Allergy Organ J 2018; 11:13. [PMID: 29988331 PMCID: PMC6020328 DOI: 10.1186/s40413-018-0192-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022] Open
Abstract
Type 2-immunity represents the typical adaptive response to allergen exposure in atopic individuals. It mainly involves Th2 cells and immunoglobulin E, as the main orchestrators of type 2-inflammation. Recently, it has been highlighted that allergens may be responsible for a Th2 response beside specific IgE activation and that a number of other environmental stimuli, such as viruses and pollutants, can trigger the same pattern of inflammation beyond atopy. Emerging data sustain a substantial role of the so-called epithelial dysfunction in asthma pathogenesis, both from anatomic and functional point of view. Furthermore an increasing amount of evidence demonstrates the relevance of innate immunity in polarizing a Th2 impaired response in asthmatic patients. Under this perspective, the complex cross-talking between airway epithelium, innate and adaptive immunity is emerging as a major determinant of type 2-inflammation beyond allergens. This review will include an update on the relevance of dysregulation of innate and adaptive type 2-immunity in asthma pathogenesis, particularly severe asthma, and on the role of the allergens that are associated with severe asthma. Type 2-immunity also will be reviewed in the light of the current and upcoming targeted treatments for severe asthma.
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Affiliation(s)
- Marco Caminati
- 1Asthma Center and Allergy Unit, Verona University Hospital, Piazzale Scuro10, 37134 Verona, Italy
| | - Duy Le Pham
- 2Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Diego Bagnasco
- University of Genoa Allergy and Respiratory Diseases, IRCCS San Martino Hospital, IST, University of Genoa, Genoa, Italy
| | - Giorgio Walter Canonica
- 4Personalized Medicine Clinic, Asthma & Allergy, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
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Yorgancıoğlu A, Öner Erkekol F, Mungan D, Erdinç M, Gemicioğlu B, Özşeker ZF, Bayrak Değirmenci P, Naycı S, Çilli A, Erdenen F, Kırmaz C, Ediger D, Yalçın AD, Büyüköztürk S, Öztürk S, Güleç M, Işık SR, Kalyoncu AF, Göksel Ö, Aydın Ö, Havlucu Y, Baloğlu Ar İ, Erdoğdu A. Long-Term Omalizumab Treatment: A Multicenter, Real-Life, 5-Year Trial. Int Arch Allergy Immunol 2018; 176:225-233. [PMID: 29772578 DOI: 10.1159/000488349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years. METHODS A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point. RESULTS Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%. CONCLUSION Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good.
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Affiliation(s)
- Arzu Yorgancıoğlu
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ferda Öner Erkekol
- Department of Allergy and Immunology, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
| | - Dilşad Mungan
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Münevver Erdinç
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bilun Gemicioğlu
- Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Ferhan Özşeker
- Division of Allergy and Immunology, Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Sibel Naycı
- Department of Chest Diseases, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Aykut Çilli
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Füsun Erdenen
- Department of Internal Medicine, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Cengiz Kırmaz
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Dane Ediger
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Arzu Didem Yalçın
- Department of Internal Medicine, Antalya Research and Training Hospital, Antalya, Turkey
| | - Suna Büyüköztürk
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Sami Öztürk
- Division of Allergy and Immunology, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School (Haydarpaşa), Istanbul, Turkey
| | - Mustafa Güleç
- Division of Allergy and Immunology, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Sacide Rana Işık
- Department of Allergy and Immunology, Yedikule Chest Diseases and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özlem Göksel
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ömür Aydın
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yavuz Havlucu
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | | | - Ahmet Erdoğdu
- Medical Department, Novartis Pharmaceuticals, Istanbul, Turkey
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Zervas E, Samitas K, Papaioannou AI, Bakakos P, Loukides S, Gaga M. An algorithmic approach for the treatment of severe uncontrolled asthma. ERJ Open Res 2018. [PMID: 29531957 PMCID: PMC5838355 DOI: 10.1183/23120541.00125-2017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options. Stepwise approach for the treatment of severe asthmahttp://ow.ly/rLPl30i0TyZ
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Affiliation(s)
- Eleftherios Zervas
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Konstantinos Samitas
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece
| | | | - Petros Bakakos
- 1st Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", University of Athens, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Dept, Attikon Hospital, University of Athens, Athens, Greece
| | - Mina Gaga
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece
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Omalizumab therapy in a patient with severe asthma and co-existing chronic obstructive pulmonary disease. Postepy Dermatol Alergol 2018; 36:239-241. [PMID: 31320863 PMCID: PMC6627253 DOI: 10.5114/ada.2018.73140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 01/15/2023] Open
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Paganin F, Mangiapan G, Proust A, Prudhomme A, Attia J, Marchand-Adam S, Pellet F, Milhe F, Melloni B, Bernady A, Raspaud C, Nocent C, Berger P, Guilleminault L. Lung function parameters in omalizumab responder patients: An interesting tool? Allergy 2017; 72:1953-1961. [PMID: 28517027 DOI: 10.1111/all.13202] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Omalizumab, an anti-IgE antibody, is used to treat patients with severe allergic asthma. The evolution of lung function parameters over time and the difference between omalizumab responder and nonresponder patients remain inconclusive. The objective of this real-life study was to compare the changes in forced expiratory volume in 1 second (FEV1) of omalizumab responders and nonresponders at 6 months. METHODS A multicenter analysis was performed in 10 secondary and tertiary institutions. Lung function parameters (forced vital capacity (FVC), pre- and postbronchodilator FEV1, residual volume (RV), and total lung capacity (TLC) were determined at baseline and at 6 months. Omalizumab response was assessed at the 6-month visit. In the omalizumab responder patients, lung function parameters were also obtained at 12, 18, and 24 months. RESULTS Mean prebronchodilator FEV1 showed improvement in responders at 6 months, while a decrease was observed in nonresponders (+0.2±0.4 L and -0.1±0.4 L, respectively, P<.01). After an improvement at 6 months, pre- and postbronchodilator FEV1 remained stable at 12, 18, and 24 months. The FEV1/FVC remained unchanged over time, but the proportion of patients with an FEV1/FVC ratio <0.7 decreased at 6, 12, 18, and 24 months (55.2%, 54.0%, 54.0%, and 44.8%, respectively, P<.05). Mean RV values decreased at 6 months but increased at 12 months and 24 months (P<.05). Residual volume/total lung capacity (RV/TLC) ratio decreased at 6 months and remained unchanged at 24 months. CONCLUSION After omalizumab initiation, FEV1 improved at 6 months in responder patients and then remained stable for 2 years. RV and RV/TLC improved at 6 months.
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Affiliation(s)
- F. Paganin
- INSERM U 600, UMR 6212; Université de la Méditerranée.; Marseille France
- Université de la Réunion; St Denis France
| | - G. Mangiapan
- Service de Pneumologie; CHIC de Créteil; Créteil France
| | - A. Proust
- Service de Pneumologie; CHU de Nimes; Tarbes France
| | - A. Prudhomme
- Service de Pneumologie; CHG de Bigorre; Tarbes France
| | - J. Attia
- Cabinet de Pneumologie; Bastia France
| | | | - F. Pellet
- Cabinet de Pneumologie; Bordeaux France
| | - F. Milhe
- Service de Pneumologie; Polyclinique des Fleurs; Ollioules France
| | - B. Melloni
- Service de Pneumologie; CHU de Limoges; Limoges France
| | - A. Bernady
- Service de Pneumologie; Centre médical Toki Eder; Cambo les Bains France
| | - C. Raspaud
- Service de Pneumologie; Clinique Pasteur; Toulouse France
| | - C. Nocent
- Service de Pneumologie et d'allergologie; CH de la côte Basque; Bayonne France
| | - P. Berger
- Centre de Recherche Cardio-thoracique de Bordeaux; Univ. Bordeaux, U1045, CIC1401; Bordeaux France
- Centre de Recherche Cardio-thoracique de Bordeaux; INSERM, U1045, CIC1401; Bordeaux France
- Service d'Exploration Fonctionnelle Respiratoire; CHU de Bordeaux, CIC1401; Pessac France
| | - L. Guilleminault
- Université de la Réunion; St Denis France
- Service de Pneumologie; CHU Reunion/GHSR; Saint-Pierre France
- INSERM; UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI); Sainte-Clotilde France
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Domingo C, Pomares X, Navarro A, Amengual MJ, Montón C, Sogo A, Mirapeix RM. A step-down protocol for omalizumab treatment in oral corticosteroid-dependent allergic asthma patients. Br J Clin Pharmacol 2017; 84:339-348. [PMID: 29044640 DOI: 10.1111/bcp.13453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022] Open
Abstract
AIMS There are no specific criteria for a step-down or withdrawal dose of omalizumab (OMA). Our purpose was to evaluate the viability of a protocol for OMAlizumab DOse REduction (the OMADORE study) in severe allergic asthma (SAA). METHODS The study population included 35 SAA patients treated during a minimum period of 1 year with oral corticosteroids (OC) equivalent to a mean daily dose of 4 mg of methyl-prednisolone. To qualify for the protocol, the patients had to have received treatment with OMA for at least one and a half years, OC dose had to have reached the lowest tolerated dose and spirometry had to be greater than or equal to that at entry. The interventions were (a) OMA dose was reduced by half; (b) if patients were clinically stable after 6 months, the dose was halved again; (c) if repeated OC boosters were needed and/or spirometry worsened by more than 10%, OMA dose was raised to the previous figure until stabilization. RESULTS Mean age was 52.5 (17) years, median monthly OC dose was 120 (IQR: 225) mg. Pulmonary function: FVC: 79.7 (20.2)%; FEV1 : 64.8 (21.7)%; FEV1 / FVC: 61.7(13.8)%. OMA could be withdrawn in 34.3% of the patients; 22.9% tolerated a reduction, and in 42.9% the dose could not be modified. Follow-up time after reduction or withdrawal ranged from 12 to 30 months. There were no severe exacerbations requiring emergency assistance or admission. CONCLUSIONS The OMADORE study found that in more than 50% of SAA patients on OC, OMA dose can be safely reduced or withdrawn based on a progressive dose reduction protocol.
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Affiliation(s)
- Christian Domingo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Xavier Pomares
- Pulmonary Service, Corporació Sanitària Parc Taulí, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Albert Navarro
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - María José Amengual
- Laboratory Department, Immunology unit, UDIAT, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Concepción Montón
- Pulmonary Service, Corporació Sanitària Parc Taulí, Barcelona, Spain.,Health Services Research on Chronic Diseases Network-REDISSEC, Galdakao, Spain
| | - Ana Sogo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Rosa M Mirapeix
- Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Vennera MDC, Sabadell C, Picado C. Duration of the efficacy of omalizumab after treatment discontinuation in 'real life' severe asthma. Thorax 2017; 73:782-784. [PMID: 29079610 DOI: 10.1136/thoraxjnl-2017-210017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/04/2022]
Abstract
Efficacy of omalizumab in severe asthma is well documented; however, the optimal duration of the treatment remains unclear. In an open prospective study, we sought to assess the persistence of response in subjects withdrawing from omalizumab treatment. We evaluated 49 patients who voluntarily accepted to discontinue omalizumab treatment after 6 years of therapy. Asthma relapse was defined as any severe asthma exacerbation associated with loss of asthma control. Twelve patients relapsed in the first year of follow-up, and 7 within 13 and 48 months. These results suggest that the effects of 6 years of omalizumab may persist after discontinuation of therapy in 60% of patients for at least 4 years.
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Affiliation(s)
- Maria Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Carlos Sabadell
- Department of Pneumology, Hospital de Figueres, Figueres, Catalunya, Spain
| | - Cesar Picado
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Tadrous M, Khuu W, Lebovic G, Stanbrook MB, Martins D, Paterson JM, Mamdani MM, Juurlink DN, Gomes T. Real-world health care utilization and effectiveness of omalizumab for the treatment of severe asthma. Ann Allergy Asthma Immunol 2017; 120:59-65.e2. [PMID: 28986124 DOI: 10.1016/j.anai.2017.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Omalizumab is indicated for the treatment of moderate to severe asthma. There is limited observational evidence on the costs and effectiveness of omalizumab. OBJECTIVE To examine the costs and effectiveness of omalizumab for treatment of severe asthma relative to nonusers. METHODS We conducted a within-person repeated-measures matched cohort study in Ontario, Canada from April 1, 2012 to March 31, 2014. Continuous users of omalizumab were matched with up to 4 nonusers according to age, sex, recent specialist visits, oral corticosteroid use, asthma severity, and Charlson comorbidity score. The primary outcome was direct health care costs. Secondary outcomes were asthma-related hospitalizations or emergency department visits and oral corticosteroid use. The association between omalizumab use and each outcome was assessed using mixed-effects models adjusting for confounders. RESULTS Ninety-five omalizumab users and 352 nonusers were matched. Among users, there was a significant increase in health care costs of $1,796 per person owing to the cost of the medication at treatment initiation (P < .0001). Costs did not change significantly among nonusers ($85 increase in average monthly costs per person; P = .59). We found no significant changes in the rates of asthma-related hospitalizations or emergency department visits among omalizumab users (P = .44) or nonusers (P = .99) between pre- and postintervention periods. CONCLUSION The use of omalizumab was associated with increased costs but no evidence of lower rates of clinically important outcomes. These results suggest omalizumab had limited effectiveness in our study population. Future studies should further explore subsets of patients most likely to benefit from omalizumab therapy.
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Affiliation(s)
- Mina Tadrous
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Wayne Khuu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew B Stanbrook
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Diana Martins
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Centre for Health care Analytics Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David N Juurlink
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tara Gomes
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Di Bona D, Fiorino I, Taurino M, Frisenda F, Minenna E, Pasculli C, Kourtis G, Rucco AS, Nico A, Albanesi M, Giliberti L, D'Elia L, Caiaffa MF, Macchia L. Long-term "real-life" safety of omalizumab in patients with severe uncontrolled asthma: A nine-year study. Respir Med 2017; 130:55-60. [PMID: 29206634 DOI: 10.1016/j.rmed.2017.07.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Randomized Controlled Trials showed that omalizumab exhibited a good safety and tolerability profile in patients with moderate-to-severe asthma. However, safety data of long-term treatment with omalizumab are scarce. Our aim was to assess the safety of omalizumab in patients under long-term treatment in a real-life setting. METHODS Difficult-to-control asthmatic patients treated with omalizumab up to 9 years were retrospectively evaluated. Mild to severe adverse events any and reasons for discontinuation were recorded. RESULTS Ninety-one patients (26.4% males, mean age 49.9 ± 14.9 years) were included: mean treatment length, 3.8 ± 2.6 years; mean individual monthly dose, 514.5 ± 345.7 mg (range, 150-1200 mg). A total of 10,472 single injections were given cumulatively to the 91 patients (115 single injections per patients, on average, over a treatment period up to 9 years). Fifty-nine patients (64.8%) were treated for a period of time from 3 to 9 years, 14 of whom from 6 to 9 years. A high proportion of patients who discontinued treatment dropped out within the first year (18, 39.1%), mainly for reasons unrelated to treatment. Six patients (6.6%) discontinued omalizumab for treatment-related adverse events: arthralgia/myalgia (3 patients); urticaria, angioedema (1 patients); metrorrhagia (1 patient); relapsing herpes labialis (1 patient). Four other patients complained of mild adverse events (rhinitis/conjunctivitis, injection site reaction, fatigue, thrombosis) but continued the treatment. Anaphylaxis was not reported. CONCLUSIONS Long-term treatment with omalizumab appears remarkably safe and well tolerated in real-life setting. Prolonged omalizumab treatment for many consecutive years did not increase the risk of side effects, particularly anaphylaxis.
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Affiliation(s)
- Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy.
| | - Irene Fiorino
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Marialuisa Taurino
- School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Flavia Frisenda
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Elena Minenna
- School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Carlo Pasculli
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Georgios Kourtis
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Anna Simona Rucco
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Andrea Nico
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Marcello Albanesi
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Lucia Giliberti
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
| | - Luciana D'Elia
- School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Maria Filomena Caiaffa
- School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Luigi Macchia
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy
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Senna G, Guerriero M, Paggiaro PL, Blasi F, Caminati M, Heffler E, Latorre M, Canonica GW. SANI-Severe Asthma Network in Italy: a way forward to monitor severe asthma. Clin Mol Allergy 2017; 15:9. [PMID: 28400707 PMCID: PMC5385599 DOI: 10.1186/s12948-017-0065-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/27/2017] [Indexed: 12/27/2022] Open
Abstract
Even if severe asthma (SA) accounts for 5-10% of all cases of the disease, it is currently a crucial unmet need, owing its difficult clinical management and its high social costs. For this reason several networks, focused on SA have been organized in some countries, in order to select these patients, to recognize their clinical features, to evaluate their adherence, to classify their biological/clinical phenotypes, to identify their eligibility to the new biologic therapies and to quantify the costs of the disease. Aim of the present paper is to describe the ongoing Italian Severe Asthma Network (SANI). Up today 49 centres have been selected, widespread on the national territory. Sharing the same diagnostic protocol, data regarding patients with SA will be collected and processed in a web platform. After their recruitment, SA patients will be followed in the long term in order to investigate the natural history of the disease. Besides clinical data, the cost/benefit evaluation of the new biologics will be verified as well as the search of peculiar biomarker(s) of the disease.
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Affiliation(s)
- G. Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy
| | - M. Guerriero
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, 37134 Verona, Italy
| | - P. L. Paggiaro
- Cardio-Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - F. Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
| | - M. Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy
| | - E. Heffler
- Respiratory Diseases and Allergy – Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
| | - M. Latorre
- Cardio-Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - G. W. Canonica
- Allergy & Respiratory Disease, DIMI-University of Genova, Largo Rosanna Benzi, 10, 16132 Genova, Italy
- Asthma & Allergy Clinic, Humanitas University, Via manzoni 56, 20089 Rozzano, Milano Italy
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Alhossan A, Lee CS, MacDonald K, Abraham I. "Real-life" Effectiveness Studies of Omalizumab in Adult Patients with Severe Allergic Asthma: Meta-analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1362-1370.e2. [PMID: 28351783 DOI: 10.1016/j.jaip.2017.02.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 01/19/2017] [Accepted: 02/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND After the approval of omalizumab for severe allergic asthma, a total of 25 studies have evaluated the effectiveness of omalizumab under "real-life" conditions of heterogeneity in patients, clinicians, sites, and treatment patterns. OBJECTIVE We conducted a meta-analysis to evaluate the effectiveness of omalizumab focusing on treatment response, lung function, quality of life, symptom control, corticosteroid use, and exacerbations and hospitalizations at 4-6, 12, and 24 months. METHODS We searched PubMed and Embase for real-life studies on omalizumab in severe asthma published up to 2015. Three effect size types were extracted: single-point proportions; mean ± SD of change relative to baseline as raw numbers and standardized as Cohen's d; and changes in proportions of patients as relative risk. Random-effects meta-analyses were performed to account for within- and between-study heterogeneity. Studies were weighted by the DerSimonian and Laird method. RESULTS Per data available at the 3 time points, omalizumab therapy was consistently associated with large proportions of patients classified as "good" to "excellent" treatment responders (Global Evaluation of Treatment Effectiveness scale); improvements in forced expiratory volume in 1 second, quality of life (Asthma-related Quality-of-Life Questionnaire scale), and asthma symptom control (Asthma Control Test scale); reductions in oral and inhaled corticosteroid (ICS) use; and reductions in exacerbations and hospitalizations. CONCLUSIONS This meta-analysis of noncontrolled studies documents the real-life pharmacotherapeutic effectiveness of omalizumab, as add-on treatment to ICS ± long-acting β2-agonists agents, in improving outcomes in patients with severe allergic asthma under conditions of heterogeneity in patients, clinicians, sites, and treatment patterns. The results mirror, complement, and extend the efficacy data from randomized controlled trials.
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Affiliation(s)
- Abdulaziz Alhossan
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Ariz
| | - Christopher S Lee
- Schools of Nursing and Medicine, Oregon Health and Science University, Portland, Ore
| | | | - Ivo Abraham
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Matrix45, Tucson, Ariz; College of Pharmacy and College of Medicine, University of Arizona, Tucson, Ariz.
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Can the response to Omalizumab be influenced by treatment duration? A real-life study. Pulm Pharmacol Ther 2017; 44:38-45. [PMID: 28302544 DOI: 10.1016/j.pupt.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE It is unknown whether Omalizumab effectiveness changes over the course of time. Our retrospective real-life study tried to analyze whether Omalizumab response may be influenced by treatment duration. METHODS 340 severe asthmatics treated with Omalizumab for different periods of time were recruited. They were subdivided into 4 groups according to the Omalizumab treatment length: <12, between 12 and 24, between 24 and 60 and >60 months. Omalizumab treatment results (FEV1, exacerbations, ACT, SABA use, asthma control levels, medications used e and ICS doses) were compared. RESULTS ACT, exacerbations, GINA control levels, ICS doses and SABA use were similar in all groups with different Omalizumab treatment durations. Using a linear regression model, corrected for all confounding variables, a higher significant positive increase in FEV1% in subjects treated for 12-24 (β = 9.49; p = 0.034) or 24-60 months (β = 8.56; p = 0.043) was found when compared with subjects treated for a shorter period. Treatment duration was positively associated with a step down of the other associated therapies (OR: 1.013; p = 0.019). This association was more relevant (OR: 4.167; p = 0.005) when we considered Omalizumab treatment duration >60 months compared to the shorter therapy. In particular, the percentage of subjects that were taking Montelukast, LABAs and oral corticosteroids was lower in the group treated with Omalizumab for a longer period of time. CONCLUSION In real-life, the positive Omalizumab response remained stable for over 60 months. Long term Omalizumab treatment may lead to a discontinuation of some associated medications and to a slowing down of FEV1 decline.
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Domingo C, Pomares X, Navarro A, Rudi N, Sogo A, Dávila I, Mirapeix RM. Omalizumab Is Equally Effective in Persistent Allergic Oral Corticosteroid-Dependent Asthma Caused by Either Seasonal or Perennial Allergens: A Pilot Study. Int J Mol Sci 2017; 18:ijms18030521. [PMID: 28264494 PMCID: PMC5372537 DOI: 10.3390/ijms18030521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/23/2017] [Accepted: 02/14/2017] [Indexed: 11/25/2022] Open
Abstract
Omalizumab is marketed for chronic severe asthma patients who are allergic to perennial allergens. Our purpose was to investigate whether omalizumab is also effective in persistent severe asthma due to seasonal allergens. Thirty patients with oral corticosteroid-dependent asthma were treated with Omalizumab according to the dosing table. For each patient with asthma due to seasonal allergens, we recruited the next two consecutive patients with asthma due to perennial allergens. The dose of oral methyl prednisolone (MP) was tapered at a rate of 2 mg every two weeks after the start of treatment with omalizumab depending on tolerance. At each monthly visit, a forced spirometry and fractional exhaled nitric oxide (FeNO) measurement were performed and the accumulated monthly MP dose was calculated. At entry, there were no differences between groups in terms of gender, body mass index or obesity, year exacerbation rate, monthly dose of MP, FeNO and blood immunoglobuline E (IgE) values, or spirometry (perennial: FVC: 76%; FEV1: 62%; seasonal: FVC: 79%; FEV1: 70%). The follow-up lasted 76 weeks. One patient in each group was considered a non-responder. Spirometry did not worsen in either group. There was a significant intragroup reduction in annual exacerbation rate and MP consumption but no differences were detected in the intergroup comparison. Omalizumab offered the same clinical benefits in the two cohorts regardless of whether the asthma was caused by a seasonal or a perennial allergen. These results strongly suggest that allergens are the trigger in chronic asthma but that it is the persistent exposure to IgE that causes the chronicity.
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Affiliation(s)
- Christian Domingo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Av. Can Domènech s/n, 08193 Bellaterra, Barcelona, Spain.
| | - Xavier Pomares
- Pulmonary Service, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Av. Can Domènech s/n, 08193 Bellaterra, Barcelona, Spain.
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
| | - Albert Navarro
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Av. Can Domènech s/n, 08193 Bellaterra, Barcelona, Spain.
| | - Núria Rudi
- Department of Pharmacy, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.
| | - Ana Sogo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Av. Can Domènech s/n, 08193 Bellaterra, Barcelona, Spain.
| | - Ignacio Dávila
- Allergy Service, University Hospital of Salamanca, Biomedical and diagnostics sciences, Universidad de Salamanca, 37008 Salamanca, Spain.
| | - Rosa M Mirapeix
- Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Av. Can Domènech s/n, 08193 Bellaterra, Barcelona, Spain.
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Vennera MDC, Valero A, Uría E, Forné C, Picado C. Cost-Effectiveness Analysis of Omalizumab for the Treatment of Severe Persistent Asthma in Real Clinical Practice in Spain. Clin Drug Investig 2016; 36:567-78. [PMID: 27142072 DOI: 10.1007/s40261-016-0402-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Omalizumab is a humanized monoclonal antibody that targets circulating immunoglobulin E molecules to treat severe uncontrolled asthma. The aim of this study was to determine the cost effectiveness of omalizumab compared with standard treatment for the control of severe persistent asthma according to data from patients treated in a specialized asthma unit. METHODS This was an observational, retrospective, single-center study in the setting of the Pulmonology and Respiratory Allergy Service, Thorax Institute, Hospital Clínic de Barcelona, Barcelona, Spain. Data were collected by review of medical records of 86 uncontrolled severe persistent asthma patients treated with omalizumab from January 2005 to April 2014. Effectiveness was assessed by the reduction in asthma exacerbations and 3-point increases in the Asthma Control Test (ACT) score. The economic evaluation was performed from the societal perspective, including direct health costs (resource use and drug treatments) and indirect costs (disease impact on labor productivity) in 2016 Euros. The time horizon was 12 months before and after the initiation of treatment with omalizumab. Results were expressed using the incremental cost-effectiveness ratio (ICER). RESULTS Taking into account only direct costs, the ICERs were €1487.46 (95 % confidence interval [CI] 1241.21-1778.34) per exacerbation avoided and €5425.13 (95 % CI 4539.30-6551.03) per 3-point increase in the ACT. When indirect costs were included, the ICERs were €1130.93 (95 % CI 909.08-1392.86) per exacerbation avoided, and €4124.79 (95 % CI 3281.69-5186.73) per 3-point increase in the ACT. CONCLUSIONS The results of this study confirm the effectiveness of the addition of omalizumab to standard therapy in patients with uncontrolled severe persistent asthma.
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Affiliation(s)
- María Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antonio Valero
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Estefany Uría
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - Carles Forné
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - César Picado
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Papathanassiou E, Loukides S, Bakakos P. Severe asthma: anti-IgE or anti-IL-5? Eur Clin Respir J 2016; 3:31813. [PMID: 27834175 PMCID: PMC5102127 DOI: 10.3402/ecrj.v3.31813] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/03/2016] [Indexed: 12/19/2022] Open
Abstract
Severe asthma is a discrete clinical entity characterised by recurrent exacerbations, reduced quality of life and poor asthma control as ordinary treatment regimens remain inadequate. Difficulty in managing severe asthma derives partly from the multiple existing phenotypes and our inability to recognise them. Though the exact pathogenetic pathway of severe allergic asthma remains unclear, it is known that numerous inflammatory cells and cytokines are involved, and eosinophils represent a key inflammatory cell mediator. Anti-IgE (omalizumab) and anti-IL-5 (mepolizumab) antibodies are biological agents that interfere in different steps of the Th2 inflammatory cascade and are licensed in severe asthma. Both exhibit a favourable clinical outcome as they reduce exacerbation rate and improve asthma control and quality of life, while mepolizumab also induces an oral steroid sparing effect. Nevertheless, it is still questionable which agent is more suitable in the management of severe allergic asthma since no comparable studies have been conducted. Omalizumab's established effectiveness in clinical practice over a long period is complemented by a beneficial effect on airway remodelling process mediated mainly through its impact on eosinophils and other parameters strongly related to eosinophilic inflammation. However, it is possible that mepolizumab through nearly depleting eosinophils could have a similar effect on airway remodelling. Moreover, to date, markers indicative of the patient population responding to each treatment are unavailable although baseline eosinophils and exacerbation rate in the previous year demonstrate a predictive value regarding anti-IL-5 therapy effectiveness. On the other hand, a better therapeutic response for omalizumab has been observed when low forced expiratory volume in 1 sec, high-dose inhaled corticosteroids and increased IgE concentrations are present. Consequently, conclusions are not yet safe to be drawn based on existing knowledge, and additional research is necessary to unravel the remaining issues for the severe asthmatic population.
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Affiliation(s)
- Evgenia Papathanassiou
- 2nd Department of Respiratory Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, 'Sotiria' Hospital of Chest Diseases, Medical School, National and Kapodistrian University of Athens, Athens, Greece;
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Luu M, Bardou M, Bonniaud P, Goirand F. Pharmacokinetics, pharmacodynamics and clinical efficacy of omalizumab for the treatment of asthma. Expert Opin Drug Metab Toxicol 2016; 12:1503-1511. [PMID: 27748630 DOI: 10.1080/17425255.2016.1248403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Omalizumab is a subcutaneously administrated monoclonal anti-IgE antibody indicated in adults, adolescents and children 6 years of age and older with moderate to severe allergic asthma uncontrolled by conventional pharmacological treatments and sensitization to at least one perennial allergen. Area covered: This drug evaluation summarizes published data on pharmacokinetic and pharmacodynamic properties of omalizumab, on clinical efficacy and safety, including real-world evidence, and provides a medico-economic evaluation of the drug. Expert opinion: Omalizumab represents an efficient therapeutic option for the management of patients with uncontrolled moderate/severe allergic asthma. It provides a significant reduction in the asthma exacerbation rate with a steroid-sparing effect, an improvement in quality of life in adults and adolescents, despite a lack of evidence about its efficacy specifically in severe allergic asthma. Clinical trials have demonstrated its efficacy in the pediatric population but further real-life evidence is expected to better characterize long-term effects in this population. There is still some debate about the optimal treatment duration but, to date, it is recommended not to stop the treatment as cessation has resulted in symptom recurrence. Omalizumab is an expensive treatment, but a key therapeutic option when used for uncontrolled severe allergic asthma.
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Affiliation(s)
- Maxime Luu
- a Centre d'Investigations Cliniques 1432, module plurithématique (INSERM 1442) , CHU Dijon Bourgogne , Dijon , France.,b CRI U866, INSERM (Institut National de la Santé et de la Recherche Médicale) , Dijon , France.,c Université de Bourgogne , Dijon , France
| | - Marc Bardou
- a Centre d'Investigations Cliniques 1432, module plurithématique (INSERM 1442) , CHU Dijon Bourgogne , Dijon , France.,b CRI U866, INSERM (Institut National de la Santé et de la Recherche Médicale) , Dijon , France.,c Université de Bourgogne , Dijon , France.,d Service d'hépato-gastroentérologie , CHU Dijon Bourgogne , Dijon , France
| | - Philippe Bonniaud
- b CRI U866, INSERM (Institut National de la Santé et de la Recherche Médicale) , Dijon , France.,c Université de Bourgogne , Dijon , France.,e Service de Pneumologie , CHU Dijon Bourgogne , France
| | - Françoise Goirand
- b CRI U866, INSERM (Institut National de la Santé et de la Recherche Médicale) , Dijon , France.,c Université de Bourgogne , Dijon , France.,f Laboratoire de Pharmacologie , CHU de Dijon , Dijon , France
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Caminati M, Senna G, Stefanizzi G, Bellamoli R, Longhi S, Chieco-Bianchi F, Guarnieri G, Tognella S, Olivieri M, Micheletto C, Festi G, Bertocco E, Mazza M, Rossi A, Vianello A. Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience. BMC Pulm Med 2016; 16:128. [PMID: 27562427 PMCID: PMC5000547 DOI: 10.1186/s12890-016-0290-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/18/2016] [Indexed: 11/29/2022] Open
Abstract
Background In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database. Results In RCTs the drop-out rate ranged from 7.1 to 19.4 %. Although the reasons for withdrawal were only occasionally reported, patient decision and adverse events were the most frequently reported causes. In real-life studies the drop-out rate ranged from 0 to 45.5 %. In most cases lack of efficacy was responsible for treatment discontinuation. According to NEONet data, 32 % of treated patients dropped out, with an increasing number of drop outs observed over time. Patient decision and lack of efficacy accounted for most treatment withdrawals. Conclusions Treatment adherence is particularly crucial in patients with severe asthma considering the clinical impact of the disease and the cost of non-adherence. The risk of treatment discontinuation has to be carefully considered both in the experimental and real-life settings. Increased knowledge regarding the main reasons for patient withdrawal is important to improve adherence in clinical practice.
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Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy.
| | - G Senna
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - G Stefanizzi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - R Bellamoli
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - S Longhi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - F Chieco-Bianchi
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - G Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - S Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - M Olivieri
- Unit of Occupational Medicine, Verona General and University Hospital, Verona, Italy
| | - C Micheletto
- Respiratory Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - G Festi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - E Bertocco
- Respiratory pathology Unit, Arzignano General Hospital, Vicenza, Italy
| | - M Mazza
- Pulmonary Unit, Pordenone General Hospital, Pordenone, Italy
| | - A Rossi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
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Abraham I, Alhossan A, Lee CS, Kutbi H, MacDonald K. 'Real-life' effectiveness studies of omalizumab in adult patients with severe allergic asthma: systematic review. Allergy 2016; 71:593-610. [PMID: 26644231 DOI: 10.1111/all.12815] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 01/21/2023]
Abstract
We reviewed 24 'real-life' effectiveness studies of omalizumab in the treatment of severe allergic asthma that included 4117 unique patients from 32 countries with significant heterogeneity in patients, clinicians and settings. The evidence underscores the short- and long-term benefit of anti-IgE therapy in terms of the following: improving lung function; achieving asthma control and reducing symptomatology, severe exacerbations and associated work/school days lost; reducing healthcare resource utilizations, in particular hospitalizations, hospital lengths of stay and accident specialist or emergency department visits; reducing or discontinuing other asthma medications; and improving quality of life - thus confirming, complementing and extending evidence from randomized trials. Thus, omalizumab therapy is associated with signal improvements across the full objective and subjective burden of illness chain of severe allergic asthma. Benefits of omalizumab may extend up to 2-4 years, and the majority of omalizumab-treated patients may benefit for many years. Omalizumab has positive short- and long-term safety profiles similar to what is known from randomized clinical trials. Initiated patients should be monitored for treatment response at 16 weeks. Those showing positive response at that time are highly likely to show sustained treatment response and benefit in terms of clinical, quality of life and health resource utilization outcomes.
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Affiliation(s)
- I. Abraham
- Center for Health Outcomes and PharmacoEconomic Research; University of Arizona; Tucson AZ USA
- College of Pharmacy and College of Medicine; University of Arizona; Tucson AZ USA
- Matrix45; Tucson AZ USA
| | - A. Alhossan
- Center for Health Outcomes and PharmacoEconomic Research; University of Arizona; Tucson AZ USA
- College of Pharmacy; King Saud University; Riyadh Saudi Arabia
| | - C. S. Lee
- School of Nursing; Oregon Health & Science University; Portland OR USA
| | - H. Kutbi
- Center for Health Outcomes and PharmacoEconomic Research; University of Arizona; Tucson AZ USA
- College of Pharmacy; King Abdulaziz University; Jeddah Saudi Arabia
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Kupryś-Lipińska I, Majak P, Molinska J, Kuna P. Effectiveness of the Polish program for the treatment of severe allergic asthma with omalizumab: a single-center experience. BMC Pulm Med 2016; 16:61. [PMID: 27117315 PMCID: PMC4847261 DOI: 10.1186/s12890-016-0224-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A national program for the treatment of severe allergic (IgE-dependent) asthma with omalizumab (OMA) was implemented in Poland in 2013. This observational study evaluated the effectiveness of the Polish OMA program and monitored asthma control after treatment discontinuation. METHODS In the first year of the program, 53 patients (23 new/30 continuing treatment) received OMA in the Barlicki Hospital, Poland. Patients were evaluated at baseline and after 16 weeks of OMA treatment by spirometry, mean dose of inhaled corticosteroids (ICS) and oral corticosteroids (OCS), number of asthma exacerbations, the Asthma Control Questionnaire (ACQ), and the Asthma Quality of Life Questionnaire (AQLQ). OMA treatment responses were determined using the global effectiveness of treatment evaluation scale. Fourteen patients ceased OMA treatment following ≥36 months of therapy and entered follow up. RESULTS All patients treated with OMA de novo for at least 16 weeks had a decrease in asthma exacerbations and showed a good (15/16, 94 %) or an excellent (1/16, 6 %) response to treatment. We observed a reduction in OCS dose (≥5 mg/day) in 14/16 (88 %) patients. ACQ and AQLQ scores improved by ≥0.5 points in 15/16 (94 %) and 14/16 (88 %) patients, respectively. After OMA cessation, 11/14 (79 %) patients showed worsening of asthma control and severe exacerbations. CONCLUSIONS Patients in the OMA program show significant benefits, including reduced use of OCS, improved asthma control and quality of life. After OMA discontinuation, frequent severe exacerbations were observed primarily in patients whose asthma was previously uncontrolled by high OCS doses.
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Affiliation(s)
- Izabela Kupryś-Lipińska
- Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, 90-153, Łódź, Poland.
| | - Paweł Majak
- Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Joanna Molinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, 90-153, Łódź, Poland
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