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Domingo C, Monserrate DR, Sogo A, Mirapeix RM. The Incredible Adventure of Omalizumab. Int J Mol Sci 2024; 25:3056. [PMID: 38474304 DOI: 10.3390/ijms25053056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
The basis of our current understanding of allergies begins with the discovery of IgE in the mid-1960s. The whole theory of the physiology and pathophysiology of allergic diseases, including rhinitis and asthma, dates from that period. Among the key regions of IgE identified were the FAB (fragment antigen binding) portion that has the ability to capture allergens, and the Cε3 domain, through which IgE binds to its membrane receptor. It was then postulated that blocking IgE at the level of the Cε3 domain would prevent it from binding to its receptor and thus set in motion the allergic cascade. This was the beginning of the development of omalizumab, a monoclonal antibody with an anti-IgE effect. In this article, we review the pathophysiology of allergic disease and trace the clinical development of omalizumab. We also review the benefits of omalizumab treatment that are apparently unrelated to allergies, such as its effect on immunity and bronchial remodeling.
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Affiliation(s)
- Christian Domingo
- Department of Pulmonary Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08202 Sabadell, Spain
| | - Daniel R Monserrate
- Department of Pulmonary Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08202 Sabadell, Spain
| | - Ana Sogo
- Department of Pulmonary Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08202 Sabadell, Spain
| | - Rosa M Mirapeix
- Unitat d'Anatomia, Departament de Ciències Morfològiques, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola, Spain
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Nieto A, El-Sayed ZA, Gómez RM, Hossny E, Jiu-Yao W, Kalayci Ö, Morais-Almeida M, Phipatanakul W, Pitrez PM, Pozo Beltrán CF, Xepapadaki P, Papadopoulos NG. Unanswered questions on the use of biologics in pediatric asthma. World Allergy Organ J 2023; 16:100837. [PMID: 38020283 PMCID: PMC10656246 DOI: 10.1016/j.waojou.2023.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
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Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit. Health Research Institute. Children's Hospital La Fe, Valencia, Spain
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Wang Jiu-Yao
- Research Center of Allergy, Immunology, and Microbiome (A.I.M.). China Medical University Children's Hospital, Taichung, Taiwan
| | - Ömer Kalayci
- Pediatric Allergy and Asthma, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo Marcio Pitrez
- School of Medicine, Pediatric Pulmonary Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK
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Delgado J, Navarro A, Álvarez-Gutiérrez FJ, Cisneros C, Domínguez-Ortega J. [Unmet Needs in Severe Allergic Asthma]. OPEN RESPIRATORY ARCHIVES 2023; 5:100282. [PMID: 38053757 PMCID: PMC10694599 DOI: 10.1016/j.opresp.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Severe asthma affects 3%-10% of the world's population, according to estimates by the Global Initiative for ASTHMA (GINA). Allergic asthma is one of the most common phenotypes of severe asthma and it is characterized by allergen-induced type 2 inflammation in which immunoglobulin E (IgE) is a key mediator, making it an important therapeutic target. The introduction of targeted biological therapies or treatments has entered the management for severe asthma in the era of precision medicine, and the goal of treatment is clinical remission of the disease. There is a significant percentage of patients with severe allergic asthma who do not respond to treatments and whose symptoms are not controlled. In this paper, a group of experts in the management of severe allergic asthma reviewed and evaluated the most relevant evidence regarding the pathophysiology and phenotypes of severe allergic asthma, the role of IgE in allergic inflammation, allergen identification, techniques, biomarkers and diagnostic challenges, available treatments and strategies for disease management, with a special focus on biological treatments. From this review, recommendations were developed and validated through a Delphi consensus process with the aim of offering improvements in the management of severe allergic asthma to the professionals involved and identifying the unmet needs in the management of this pathology.
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Affiliation(s)
- Julio Delgado
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Ana Navarro
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | | | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, Instituto de Investigación IDiPAZ, Madrid, España
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From the Allergic Cascade to the Epithelium-Driven Disease: The Long Road of Bronchial Asthma. Int J Mol Sci 2023; 24:ijms24032716. [PMID: 36769038 PMCID: PMC9917117 DOI: 10.3390/ijms24032716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
In medicine, much of the progress made is due to the emergence of new drugs [...].
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Tajiri T, Suzuki M, Kutsuna T, Nishiyama H, Ito K, Takeda N, Fukumitsu K, Kanemitsu Y, Fukuda S, Umemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Yoshikawa K, Niimi A. Specific IgE Response and Omalizumab Responsiveness in Severe Allergic Asthma. J Asthma Allergy 2023; 16:149-157. [PMID: 36714051 PMCID: PMC9879023 DOI: 10.2147/jaa.s393683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/04/2023] [Indexed: 01/23/2023] Open
Abstract
Objective Omalizumab has demonstrated clinical efficacy in patients with severe allergic asthma sensitized to perennial allergens and/or severe pollinosis through inhibition of IgE-dependent allergic response. When considering the "one airway, one disease" concept, sensitization to pollen could predict responsiveness to omalizumab. This study aimed to assess whether the pretreatment specific IgE response could be a predictor of responsiveness to omalizumab in severe allergic asthma sensitized to perennial allergens. Methods In this retrospective study, 41 adult patients with severe allergic asthma sensitized to perennial allergens (27 females; mean age 59 years) who had completed 52-week omalizumab treatment were enrolled. The Global Evaluation of Treatment Effectiveness was performed, and demographic characteristics and the positive ratios of specific IgE responses classified into five subgroups (pollen, dust mite, house dust, mold, and animal dander) were compared between responders and non-responders. Multivariate logistic regression analyses were performed to identify predictors of responsiveness to omalizumab. Results Thirty-one patients (76%) were identified as responders. The number of sensitized aeroallergen subgroups and sensitization to pollens were significantly higher in responders than in non-responders (both p<0.05). Multivariate logistic regression analysis showed that sensitization to pollen (OR = 8.41, p = 0.02) was independently associated with the effectiveness of omalizumab. Conclusion Pretreatment serum pollen-specific IgE could be a predictor of responsiveness to omalizumab.
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Affiliation(s)
- Tomoko Tajiri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan,Correspondence: Tomoko Tajiri, Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan, Tel +81-52-853-8216, Email
| | - Motohiko Suzuki
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan,Department of Otorhinolaryngology, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Takeo Kutsuna
- Department of Respiratory Medicine, Daido Hospital, Nagoya, Aichi, Japan
| | - Hirono Nishiyama
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Takehiro Umemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Kosho Yoshikawa
- Department of Respiratory Medicine, Daido Hospital, Nagoya, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
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Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:422-432. [PMID: 34763123 DOI: 10.1016/j.jaip.2021.10.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an important factor in biologic selection, especially given the documented ability of some biologics to reduce OCS dependence. Comorbid diseases and relevant safety considerations to each biologic should also be considered. More data are needed to determine whether biomarker profiles identify patients suited to one biologic versus another as limited data support differential predictors of response. Further prospective head-to-head trials and post hoc analyses of clinical trial data are warranted. The authors believe that these recommendations have value as they offer expert opinion to assist health care providers in making difficult decisions regarding the quality of care in severe, type 2 asthma with biologic medications. They remain conditional and are based on limited data owing to a lack of head-to-head comparisons.
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Carpagnano GE, Pelaia C, D'Amato M, Crimi N, Scichilone N, Scioscia G, Resta O, Calabrese C, Pelaia G, Quarato CMI, Foschino Barbaro MP. Switching from omalizumab to mepolizumab: real-life experience from Southern Italy. Ther Adv Respir Dis 2021; 14:1753466620929231. [PMID: 32482128 PMCID: PMC7268123 DOI: 10.1177/1753466620929231] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Current availability of several biologic treatments for severe asthma makes it possible to choose the most appropriate for each patient. Sometimes a good percentage of patients with severe asthma may be eligible for biologics that target either the allergic phenotype or the eosinophilic one, but not all respond to that selected as first choice. The aim of our real-life study was to assess whether, for patients with severe eosinophilic allergic asthma, not previously controlled by the anti-IgE omalizumab, the shift to another biologic targeting interleukin-5, such as mepolizumab, may represent a good therapeutic choice. METHODS A total of 41 consecutive patients with severe, persistent allergic, eosinophilic asthma, uncontrolled despite treatment with omalizumab, were enrolled in seven certified Clinical Respiratory Units of Southern Italy (Catania, Catanzaro, Foggia, Bari, Palermo, and two University Respiratory Units of Naples) and shifted to mepolizumab without a wash-out period. Data at baseline, after at least 12 months of therapy with omalizumab, and after at least 12 months of treatment with mepolizumab were collected. RESULTS After at least 12 months of therapy with mepolizumab, patients experienced a significant decrease in the number of exacerbations/year (5.8 ± 1.8 versus 0.7 ± 0.9, p < 0.0001), an increment of asthma control test score (12 ± 2.7 versus 21.9 ± 2.7, p < 0.0001), an increase in pre-bronchodilator forced expiratory volume in 1 s (1.56 ± 0.45 l versus 1.86 ± 0.52 l, p < 0.0001), and a reduction of blood eosinophils (584 ± 196 cells/µl versus 82 ± 56 cells/µl, p < 0.0001). The percentage of patients who were dependent on corticosteroids significantly decreased from 46% at baseline to 5% during treatment with mepolizumab. CONCLUSION Results of our real-life multicentric experience confirms that the shift to mepolizumab could be a good therapeutic strategy in severe eosinophilic allergic asthma not previously controlled by omalizumab. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Corrado Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Maria D'Amato
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Nunzio Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, Catania, Italy
| | - Nicola Scichilone
- Department of Medicine, Pneumology, Physiology and Nutrition, University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Policlinico Riuniti di Foggia - Viale Pinto, 1, 71122, Italy
| | - Onofrio Resta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, Section of Respiratory Disease, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
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Soong W, Yoo B, Pazwash H, Holweg CTJ, Casale TB. Omalizumab response in patients with asthma by number and type of allergen. Ann Allergy Asthma Immunol 2021; 127:223-231. [PMID: 33838339 DOI: 10.1016/j.anai.2021.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 04/01/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The anti-immunoglobulin E therapy, omalizumab, improves asthma control and reduces exacerbations in patients with moderate-to-severe allergic asthma. However, it has been suggested that omalizumab should be reserved for highly allergic patients with multiple allergen sensitivities or perennial-only sensitivities. OBJECTIVE To examine impact of allergy burden, including number and type of allergen sensitivities, on omalizumab response in a real-world setting. METHODS This post hoc analysis evaluated a subset of omalizumab-treated patients from the Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (NCT01922037) who had completed 13 allergen assessments (N=478). Patients were classified by allergen burden (nonsensitized, 1, 2-4, or ≥5 allergen sensitivities) and type of allergen (nonsensitized, seasonal, perennial, or both). Outcome measures included exacerbation rate vs previous year and improvements in lung function and Asthma Quality of Life Questionnaire (AQLQ). RESULTS Comparable adjusted exacerbation rates were observed after omalizumab initiation, regardless of number or type of allergen sensitizations (0.56-0.85/y). Improvements in forced expiratory volume in 1 second from baseline at months 6 (0.03-0.09 L) and 12 (-0.08 to 0.08 L) were also similar across subgroups. Least squares mean change in AQLQ from baseline at months 6 (1.0-1.2) and 12 (1.1-1.4) was comparable across patient subgroups, and similar percentages of patients achieved AQLQ minimal clinically important difference of at least a 0.5-point improvement at month 6 (71%-75%), which was maintained or improved to month 12 (71%-89%). In all analyses, 95% confidence intervals overlapped. CONCLUSION Overall findings suggest that patients with allergic asthma achieved comparable improvements across distinct outcome measures after omalizumab therapy in a real-world setting, regardless of number and type of allergen sensitizations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01922037.
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Affiliation(s)
- Weily Soong
- Alabama Allergy and Asthma Center, Homewood, Alabama
| | - Bongin Yoo
- Genentech, Inc., South San Francisco, California
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Vaník P, Novosad J, Kirchnerová O, Krčmová I, Teřl M. Effect of individual allergen sensitization on omalizumab treatment outcomes in patients with severe allergic asthma determined using data from the Czech Anti-IgE Registry. Allergy Asthma Clin Immunol 2020; 16:81. [PMID: 32944035 PMCID: PMC7493349 DOI: 10.1186/s13223-020-00479-1] [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: 04/29/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
Background Omalizumab is an efficient drug for patients with uncontrolled severe allergic asthma (SAA). However, little is known about the differences in omalizumab treatment outcomes among patients with different types of atopic sensitization. Here, we assessed the effect of sensitization to individual allergens or their combinations on the outcomes of anti-IgE therapy in patients with SAA. Methods We performed a post hoc analysis of data of subgroups of patients enrolled in the Czech Anti-IgE Registry (CAR). The patients were evaluated at baseline and 16 weeks and 12 months after omalizumab treatment initiation. We analyzed the dependence of primary treatment outcomes [global evaluation of treatment effectiveness (GETE) after 16 weeks of treatment, a reduction in severe exacerbation rate (ER), and an improvement in the asthma control test (ACT) result during 12 months of treatment] and secondary outcomes [a reduction in systemic corticosteroid (SCS) use, an improvement in lung functions, and a fraction of exhaled nitric oxide] of patients with SAA treated with omalizumab for 12 months on sensitization to different perennial aeroallergens. We assessed sensitization to house dust mites, molds, and pets at baseline using skin prick tests and/or specific IgE measurement (semiquantitative evaluation). We compared polysensitized patients (sensitized to all tested allergens) with monosensitized (single positivity) or partially polysensitized patients (combined positivity but not to all allergens). Results We enrolled 279 patients (58.3% women, mean age 52.9 years). Omalizumab treatment presented an 82.8% response rate (according to GETE). It significantly reduced severe asthma exacerbations and SCS use, and improved the ACT result in 161 responders. We identified a subgroup of responders with distinct sensitization patterns (polysensitization to all tested perennial allergens) with higher odds of being responders (OR = 2.217, p = 0.02) and lower tendency to improve ACT result (OR 0.398, p = 0.023) and reduce ER (OR 0.431, p = 0.034) than non-polysensitized patients. Conclusions The clinical benefit of sensitization for patients with SAA receiving omalizumab may be particularly dependent on sensitization pattern. Polysensitized patients showed a higher tendency to be responders (GETE), but a lower tendency to improve the ACT result and reduce ER than non-polysensitized patients.
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Affiliation(s)
- Petr Vaník
- Department of Respiratory Diseases, B. Němcové 54, Hospital České Budějovice, a.s., Faculty of Medicine in Pilsen, Charles University, 37001 Prague, Czech Republic
| | - Jakub Novosad
- Institute of Clinical Immunology and Allergy, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Olga Kirchnerová
- Department of Pneumology and Phthisiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Irena Krčmová
- Institute of Clinical Immunology and Allergy, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Milan Teřl
- Department of Pneumology and Phthisiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
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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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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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Caruso M, Morjaria J, Emma R, Amaradio MD, Polosa R. Biologic agents for severe asthma patients: clinical perspectives and implications. Intern Emerg Med 2018; 13:155-176. [PMID: 29238905 DOI: 10.1007/s11739-017-1773-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
Asthma is a chronic inflammatory multifactorial disorder of the airways characterized by the involvement of immune cells and mediators in its onset and maintenance. Traditional therapeutic strategies have been unsatisfactory in controlling the underlying pathology, especially in the more severe states. Hence in the last couple of decades, new biological approaches targeting molecular mediators have been developed. In this narrative review we examine biological agents currently available for the management of severe asthma, focusing our attention on their clinical application, pros and cons, and in particular on gaps regarding the use of these agents. The most well-known and used biologic agent in clinical practice is omalizumab, though there is emerging evidence for mepolizumab too. The future of these biological therapies is to broaden our knowledge of their practical use and ascertain predictive biomarkers, or define an algorithm, useful in the optimal application of these 'biological weapons'.
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MESH Headings
- Anti-Asthmatic Agents/pharmacokinetics
- Anti-Asthmatic Agents/pharmacology
- Anti-Asthmatic Agents/therapeutic use
- Antibodies, Anti-Idiotypic/pharmacology
- Antibodies, Anti-Idiotypic/therapeutic use
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Asthma/drug therapy
- Biological Factors/pharmacokinetics
- Biological Factors/pharmacology
- Biological Factors/therapeutic use
- Humans
- Interleukin-5/antagonists & inhibitors
- Interleukin-5/pharmacology
- Interleukin-5/therapeutic use
- Omalizumab/pharmacokinetics
- Omalizumab/pharmacology
- Omalizumab/therapeutic use
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Affiliation(s)
- Massimo Caruso
- Department of Clinical and Experimental Medicine, A.O.U. Policlinico - Vittorio Emanuele, Università degli Studi di Catania, Via S. Sofia, 78, 95123, Catania, Italy.
| | | | - Rosalia Emma
- Department of Clinical and Experimental Medicine, A.O.U. Policlinico - Vittorio Emanuele, Università degli Studi di Catania, Via S. Sofia, 78, 95123, Catania, Italy
| | - Maria Domenica Amaradio
- Department of Internal and Emergency Medicine, AOU "Policlinico - Vittorio Emanuele", Catania, Italy
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, A.O.U. Policlinico - Vittorio Emanuele, Università degli Studi di Catania, Via S. Sofia, 78, 95123, Catania, Italy
- Department of Internal and Emergency Medicine, AOU "Policlinico - Vittorio Emanuele", Catania, Italy
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13
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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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