1
|
Padró C, Gutiérrez D, Moreno F, Parra A, Rial MJ, Lleonart R, Torán‐Barona C, Justicia JL, Roger A. Effectiveness and safety of a microcrystalline tyrosine‐adjuvanted
Dermatophagoides pteronyssinus
allergoid immunotherapy in adult patients with allergic asthma and rhinitis: A real‐life prospective observational study. Immun Inflamm Dis 2022; 10:e585. [PMID: 35478444 PMCID: PMC9017636 DOI: 10.1002/iid3.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Although clinical trials have shown the efficacy and safety of allergen‐specific immunotherapy (AIT) in the treatment of allergic asthma, there is a need for real‐life studies. We aimed to assess the effectiveness and safety of a microcrystalline tyrosine‐adjuvanted Dermatophagoides pteronyssinus allergoid (Acarovac Plus®) in patients with house dust mite (HDM)‐induced allergic asthma in a real‐life study. Methods A subanalysis of a multicenter, prospective, observational, real‐life study. Patients with rhinitis and allergic asthma caused by HDMs were assessed before AIT with Acarovac Plus® and at 6 and 12 months after this treatment. Assessment parameters were percentage of days with asthma symptoms, percentage of days on asthma medication, classification of asthma according to Spanish guidelines for the management of asthma, asthma‐related quality of life (quality of life in adults with asthma questionnaire [QLAAQ]), perception of symptoms (visual analog scale [VAS]), and treatment satisfaction (treatment satisfaction questionnaire for medication [TSQM]). Safety was assessed by the number and severity of adverse reactions. Results This subanalysis included 55 patients. Treatment with Acarovac Plus® showed significant differences in the analyzed variables when the baseline visit was compared with the 12‐month visit: reduction of the mean (SD) percentage of days with asthma symptoms (23.9 [9.2] vs. 5.1 [12.8]; p = .002), of the mean [SD] percentage of days on asthma medication (67.6 [42.9] vs. 45.1 [46.8]; p = .002), and of the percentage of patients with persistent asthma (78.2% vs. 38.9%; p = .009). Acarovac Plus® significantly improved asthma‐related quality of life, as shown by a decrease of 1.39 points in QLAAQ score at 12 months (p < .001), and in the subjective perception of symptoms on the VAS (−3.50, p < .0001). Patients showed high treatment satisfaction according to the TSQM, and it was well tolerated. No serious adverse events were reported. Conclusions Acarovac Plus® was effective and safe for the treatment of patients with HDM‐induced allergic asthma in a real‐life study.
Collapse
Affiliation(s)
- Clara Padró
- Allergy Section Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Diego Gutiérrez
- Clínica Médico Asistencial Virgen del Rosario Algeciras Spain
| | | | - Antonio Parra
- Allergy Department Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Manuel J. Rial
- Allergy Department Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Ramón Lleonart
- Allergy Unit Hospital Universitari de Bellvitge L'Hospitalet de Llobregat Spain
| | | | | | - Albert Roger
- Allergy Section Hospital Universitari Germans Trias i Pujol Badalona Spain
| |
Collapse
|
2
|
Evaristo KB, Mendes FAR, Saccomani MG, Cukier A, Carvalho-Pinto RM, Rodrigues MR, Santaella DF, Saraiva-Romanholo BM, Martins MA, Carvalho CRF. Effects of Aerobic Training Versus Breathing Exercises on Asthma Control: A Randomized Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2989-2996.e4. [PMID: 32773365 DOI: 10.1016/j.jaip.2020.06.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aerobic training and breathing exercises are interventions that improve asthma control. However, the outcomes of these 2 interventions have not been compared. OBJECTIVE To compare the effects of aerobic training versus breathing exercises on clinical control (primary outcome), quality of life, exercise capacity, and airway inflammation in outpatients with moderate-to-severe asthma. METHODS Fifty-four asthmatics were randomized into either the aerobic training group (AG, n = 29) or the breathing exercise group (BG, n = 25). Both interventions lasted for 24 sessions (2/week, 40 minutes/session). Asthma clinical control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), asthma symptom-free days (ASFD), airway inflammation, exercise capacity, psychological distress (Hospital Anxiety and Depression Scale), daily-life physical activity (DLPA), and pulmonary function were evaluated before, immediately after, and 3 months after the intervention. RESULTS Both interventions presented similar results regarding the ACQ score, psychological distress, ASFD, DLPA, and airway inflammation (P > .05). However, participants in the AG were 2.6 times more likely to experience clinical improvement at the 3-month follow-up than participants in the BG (P = .02). A greater proportion of participants in the AG also presented a reduction in the number of days without rescue medication use compared with BG (34% vs 8%; P = .04). CONCLUSIONS Outpatients with moderate-to-severe asthma who participated in aerobic training or breathing exercise programs presented similar results in asthma control, quality of life, asthma symptoms, psychological distress, physical activity, and airway inflammation. However, a greater proportion of participants in the AG presented improvement in asthma control and reduced use of rescue medication.
Collapse
Affiliation(s)
- Karen B Evaristo
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Felipe Augusto Rodrigues Mendes
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Physical Therapy, Universidade Ibirapuera, São Paulo, Brazil
| | - Milene G Saccomani
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alberto Cukier
- Department of Pulmonary Division (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Regina M Carvalho-Pinto
- Department of Pulmonary Division (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcos R Rodrigues
- Department of Sports, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Danilo F Santaella
- Department of Sports, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Beatriz M Saraiva-Romanholo
- Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Physical Therapy, University City of Sao Paulo (UNICID), São Paulo, Brazil
| | - Milton A Martins
- Department of Sports, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
3
|
Chan TC, Hu TH, Chu YH, Hwang JS. Assessing effects of personal behaviors and environmental exposure on asthma episodes: a diary-based approach. BMC Pulm Med 2019; 19:231. [PMID: 31791294 PMCID: PMC6889623 DOI: 10.1186/s12890-019-0998-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Quantifying the effects of personal health behaviors and environmental exposure on asthma flare-ups is a challenge. Most studies have focused on monitoring the symptoms and drug usage for relieving symptoms. In this study, we emphasize the need to understand how personal and environmental conditions are related to the occurrence of asthma symptoms. Methods We designed an online health diary platform to collect personal health behaviors from children, their parents and other adults with any allergic diseases including asthma, allergic rhinitis, atopic dermatitis and allergic conjunctivitis. The participants used mobile devices or computers to record their daily health-related activities such as sleep, exercise, diet, perception of air quality and temperature, and asthma symptoms. The participants also recorded secondhand smoke exposure and the time of activities, which were combined with ambient air quality measurements for calculating personal air pollution exposure. A generalized linear mixed model was used to estimate the effects of the factors. Results During the study period (January 2017–June 2017, and October 2017–September 2018), 132 participants provided 25,016 diary entries, and 84 participants had experienced asthma symptoms in 1458 diary entries. The results showed some different risk factors for the minors and adults. For minors, high-intensity exercise, contact with persons with influenza-like illness (ILI) and the perception of hot temperature and bad indoor air quality were associated with the occurrence of asthma episodes. The identified risk factors for the adult participants included having dehumidifiers at home, exposure to secondhand smoke, having bad sleep quality, contact with persons with ILI, not eating fruit and seafood, perceiving cold temperature, bad quality of indoor and outdoor air, and exposure to high concentration of ozone. Conclusions The revealed personal risk factors and perceptions of air quality and temperature may provide guidance on behavioral change for people susceptible to asthma to help control acute onset and severe exacerbation of asthma flare-ups.
Collapse
Affiliation(s)
- Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan
| | - Yen-Hua Chu
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan.
| |
Collapse
|
4
|
Arbuckle R, Staunton H, Sully K, Tomkins S, Khindri S, Svedsater H, Nelsen L. Use of Both Qualitative and Quantitative Methods to Estimate Meaningful Change Thresholds for Key Endpoints in Pediatric Asthma Trials. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:340-347. [PMID: 30832972 DOI: 10.1016/j.jval.2018.09.2845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/03/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Diary-derived symptom score and rescue medication use endpoints, such as symptom-free days (SFDs) and rescue medication-free days (RFD), are frequently used as clinical trial endpoints. Estimates of meaningful change for SFDs and RFDs have not been generated in pediatric populations. This research aimed to generate evidence supporting estimates of the individual within-patient changes that constitute an important or meaningful change in SFDs, RFDs, and updated estimates on the Childhood Asthma Control Test (C-ACT) in pediatric asthma populations aged 5-11 years. METHODS Semistructured, qualitative interviews were conducted with children (ages 8-11 years) who had asthma and parents/caregivers of children (4-11 years) with asthma. Before the interview (4-9 days) participants were asked to complete a morning and evening diary. RESULTS On average, parent/caregiver estimates of the difference in SFDs between a "very bad" and a "little bad" week for their children's asthma were largely concordant with the values reported by their children (differences of 1.8 and 1.4 SFDs, respectively). Both parents/caregivers and children were able to articulate what a meaningful level of change would be on the C-ACT at the item level. This qualitative study generated C-ACT item-level meaningful change estimates in the region of 1-3 category change, which potentially suggests that, if scaled up to represent C-ACT total score, this would lead to change estimates of 7-15 points. CONCLUSIONS Our findings suggest that both children with asthma and parents/caregivers can quantitatively estimate and to some extent qualitatively articulate meaningful change in SFDs and RFDs.
Collapse
Affiliation(s)
| | | | - Kate Sully
- Adelphi Values, Macclesfield, Cheshire, UK
| | | | | | | | | |
Collapse
|
5
|
Oliver AJ, Covar RA, Goldfrad CH, Klein RM, Pedersen SE, Sorkness CA, Tomkins SA, Villarán C, Grigg J. Randomised trial of once-daily vilanterol in children with asthma on inhaled corticosteroid therapy. Respir Res 2016; 17:37. [PMID: 27044326 PMCID: PMC4820901 DOI: 10.1186/s12931-016-0353-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/30/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are effective maintenance treatments for childhood asthma; however, many children remain uncontrolled. Vilanterol (VI) is an inhaled long-acting beta-2 agonist which, in combination with the ICS fluticasone furoate, is being explored as a once-daily treatment for asthma in children. We evaluated the dose-response, efficacy, and safety of once-daily VI (6.25 μg, 12.5 μg and 25 μg) administered in the evening over 4 weeks, on background fluticasone propionate (FP) in children with asthma inadequately controlled on ICS. METHODS This was a Phase IIb, multicentre, randomised, double-blind, parallel-group, placebo-controlled study in children ages 5-11 years with persistent asthma on ICS and as-needed short-acting beta-agonist. The study comprised a 4-week run-in, 4-week treatment period, and 1-week follow-up. From study start, children replaced their current ICS with open-label FP 100 μg twice daily. Children were randomised to receive placebo, VI 6.25 μg, VI 12.5 μg or VI 25 μg once daily. Primary endpoint was treatment difference between VI 25 and placebo groups in mean change from baseline in evening peak expiratory flow averaged over the 4-week treatment. Secondary endpoints included change from baseline in trough forced expiratory volume in one second (FEV1) at Week 4 and change from baseline in percentage of rescue-free and symptom-free 24-h periods. Safety assessments included incidence of adverse events (AEs) and asthma exacerbations. RESULTS In total, 456 children comprised the intention-to-treat population. The adjusted treatment difference between VI 25 and placebo groups for the primary endpoint was not statistically significant (p = 0.227) so no statistical inference was made for other VI dose comparisons or other endpoints. No difference in change from baseline in trough FEV1 was observed for any VI treatments versus placebo; however, VI 25 resulted in an additional 0.6 rescue-free days and 0.7 symptom-free days per week versus placebo. The incidence of AEs was slightly higher in the VI groups (28-33 %) versus placebo (22 %). Nine children experienced asthma exacerbations during the treatment period. CONCLUSION VI plus FP did not result in significant improvements in lung function versus placebo plus FP, but was well tolerated at all doses assessed. TRIAL REGISTRATION NCT01573767 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Amanda J. Oliver
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - Ronina A. Covar
- />Department of Pediatrics, National Jewish Health, Denver, CO USA
| | - Caroline H. Goldfrad
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - Ryan M. Klein
- />Southern California Clinical Trials, Newport Beach, CA USA
| | - Søren E. Pedersen
- />University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark
| | | | - Susan A. Tomkins
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - César Villarán
- />Clinica Ricardo Palma, Javier Prado Este 1166 San Isidro, Lima, Perú
| | - Jonathan Grigg
- />Blizard Institute, Queen Mary University London, London, UK
| |
Collapse
|
6
|
Bernstein DI, Bateman ED, Woodcock A, Toler WT, Forth R, Jacques L, Nunn C, O'Byrne PM. Fluticasone furoate (FF)/vilanterol (100/25 mcg or 200/25 mcg) or FF (100 mcg) in persistent asthma. J Asthma 2015; 52:1073-83. [PMID: 26291137 DOI: 10.3109/02770903.2015.1056350] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Fluticasone furoate (FF; inhaled corticosteroid) combined with vilanterol (VI; long-acting beta(2) agonist) is a once-daily therapy for asthma and chronic obstructive pulmonary disease. This 12-week phase III study compared the efficacy and safety of once-daily (evening dosing) FF/VI 100/25 mcg versus FF 100 mcg (primary objective) and FF/VI 100/25 mcg versus FF/VI 200/25 mcg (descriptive comparison only) in patients (n = 1039) ≥12 years with moderate-to-severe persistent asthma. METHODS The primary end point was weighted mean (wm) 0-24-h serial forced expiratory volume in 1 s (FEV(1)) at week 12. Secondary end points (change from baseline) were trough FEV(1) and the proportion (%) of rescue-free 24-h periods (both powered), the proportion (%) of symptom-free 24-h periods, and morning and evening peak expiratory flow (PEF). Safety data (adverse events, AEs) were collected throughout. RESULTS Compared with FF 100 mcg, FF/VI 100/25 mcg significantly improved wmFEV(1) (p < 0.001), trough FEV(1) (p = 0.014), % rescue-free (p < 0.001), % symptom-free (p = 0.002) 24-h periods, and morning and evening PEF (p < 0.001). FF/VI 200/25 mcg produced small numerical improvements versus FF/VI 100/25 mcg for all end points. Incidence of AEs was similar across groups. CONCLUSIONS FF/VI 100/25 mcg resulted in significant improvements in all primary and secondary end points versus FF 100 mcg. Numerical improvements occurred with FF/VI 200/25 mcg versus FF/VI 100/25 mcg. All treatments were well tolerated.
Collapse
Affiliation(s)
- David I Bernstein
- a Division of Immunology and Allergy , University of Cincinnati and Bernstein Clinical Research Center , Cincinnati , OH , USA
| | - Eric D Bateman
- b Department of Medicine , University of Cape Town , Cape Town , South Africa
| | - Ashley Woodcock
- c Institute of Inflammation and Repair, University of Manchester , Manchester , UK
| | - William T Toler
- d Respiratory Medicines Development Center, GSK , Research Triangle Park , NC , USA
| | - Richard Forth
- e GSK Business Unit, PAREXEL , Research Triangle Park , NC , USA
| | - Loretta Jacques
- f Respiratory Medicines Development Centre, GSK , London , UK , and
| | - Carol Nunn
- f Respiratory Medicines Development Centre, GSK , London , UK , and
| | - Paul M O'Byrne
- g Michael G. DeGroote School of Medicine , Hamilton , ON , Canada
| |
Collapse
|