1
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Oh SH, Rhee CK, Bae EJ, Ku H. Cost-effectiveness analysis of dupilumab among patients with uncontrolled severe asthma using LIBERTY ASTHMA QUEST Korean data. HEALTH ECONOMICS REVIEW 2024; 14:67. [PMID: 39186143 PMCID: PMC11346198 DOI: 10.1186/s13561-024-00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/03/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND A sub-analysis of the Korean population in the LIBERTY ASTHMA QUEST trial (NCT02414854) revealed that dupilumab effectively treated severe uncontrolled asthma. This study aimed to assess the cost-effectiveness of add-on therapy with dupilumab to background therapy in patients ≥ 12 years of age with uncontrolled severe asthma compared to that of background therapy in South Korea. METHODS The cost-effectiveness analysis was conducted using a Markov model over a lifetime from the Korean healthcare system perspective. Clinical efficacy and utility weights were obtained from post-hoc analyses of the Korean population in the QUEST trial. Data on the costs and treatment setting of exacerbation in a real-world setting were retrospectively collected using the administrative medical database from a single tertiary hospital. RESULTS The base-case results indicated that add-on dupilumab therapy increases costs ($112,924 for add-on dupilumab versus $29,545 for background therapy alone). However, add-on dupilumab increased quality-adjusted life years (QALYs, 8.03 versus 3.93, respectively), with fewer events of severe exacerbations per patient compared to using the background therapy alone (17.920 versus 19.911, respectively). The incremental cost-effectiveness ratio was $20,325 per QALY. Various sensitivity analyses supported the robustness of the base-case results. Probabilistic sensitivity analysis showed that the probability of add-on dupilumab being cost-effective was 87% at a threshold willingness-to-pay of $26,718 (KRW 35 million) per QALY gained. CONCLUSIONS Dupilumab is cost-effective for adolescents and adults with uncontrolled severe asthma in South Korea. Our study provides evidence to support clinicians and policymakers in making informed decisions for severe asthma management.
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Affiliation(s)
- Sung-Hee Oh
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Hyemin Ku
- NDnex, Saebitgongwon-ro 67, Gwangmyeong-si, Gyeonggi-do, 14348, Republic of Korea.
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2
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Lombardo N, Piazzetta GL, Lobello N, Cicala G, Patafi M, Benincasa AT, Pelaia C, Chiarella E, Pelaia G. Real-Life Effects of Omalizumab on Chronic Rhinosinusitis with Nasal Polyposis. J Pers Med 2023; 14:3. [PMID: 38276218 PMCID: PMC10820781 DOI: 10.3390/jpm14010003] [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: 11/01/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B lymphocytes in response to a stimulus. Omalizumab is an anti-IgE monoclonal antibody with well-recognized roles in allergic asthma and chronic spontaneous urticaria. The aim of this study was to evaluate the clinical efficacy of omalizumab in a cohort of 13 patients suffering from chronic rhinosinusitis with CRSwNP. The inclusion criteria considered were as follows: 18 years of age, with a diagnosis of chronic rhinosinusitis with severe nasal polyposis expressed by an NPS greater than or equal to 5 and/or a SNOT-22 greater than or equal to 50. In addition, in the enrolled patients, the classic treatment with corticosteroids had to have been suspended due to recurrence after surgery or lack of response. Our results highlighted that omalizumab treatment for 16 weeks improved the parameters analyzed: SNOT-22, NPS, NRS, and NCS. The clinical efficacy of omalizumab was further strengthened by a significant improvement in respiratory function as well as reductions in the nasal polyps' size and in the associated symptoms.
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Affiliation(s)
- Nicola Lombardo
- Otolaryngology Head and Neck Surgery, Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (G.C.); (A.T.B.)
| | - Giovanna Lucia Piazzetta
- Otolaryngology Head and Neck Surgery, Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (G.C.); (A.T.B.)
| | - Nadia Lobello
- Otolaryngology Head and Neck Surgery, Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (G.C.); (A.T.B.)
| | - Giuseppe Cicala
- Otolaryngology Head and Neck Surgery, Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (G.C.); (A.T.B.)
| | - Maria Patafi
- Department of Human Pathology, Division and School of Allergy and Clinical Immunology, University of Messina, 98100 Messina, Italy;
| | - Anna Teresa Benincasa
- Otolaryngology Head and Neck Surgery, Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (G.C.); (A.T.B.)
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (C.P.); (G.P.)
| | - Emanuela Chiarella
- Laboratory of Molecular Haematopoiesis and Stem Cell Biology, Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (C.P.); (G.P.)
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3
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Pedersen NH, Sørensen JA, Ghazanfar MN, Zhang DG, Vestergaard C, Thomsen SF. Biomarkers for Monitoring Treatment Response of Omalizumab in Patients with Chronic Urticaria. Int J Mol Sci 2023; 24:11328. [PMID: 37511088 PMCID: PMC10379579 DOI: 10.3390/ijms241411328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic urticaria (CU) is a debilitating skin disease affecting around 1% of the population. CU can be subdivided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Different pathophysiological mechanisms have been proposed to play a role in the development of CU, and these are also being investigated as potential biomarkers in the diagnosis and management of the disease. As of now the only assessment tools available for treatment response are patient reported outcomes (PROs). Although these tools are both validated and widely used, they leave a desire for more objective measurements. A biomarker is a broad subcategory of observations that can be used as an accurate, reproducible, and objective indicator of clinically relevant outcomes. This could be normal biological or pathogenic processes, or a response to an intervention or exposure, e.g., treatment response. Herein we provide an overview of biomarkers for CU, with a focus on prognostic biomarkers for treatment response to omalizumab, thereby potentially aiding physicians in personalizing treatments.
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Affiliation(s)
- Nadja Højgaard Pedersen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Jennifer Astrup Sørensen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Misbah Noshela Ghazanfar
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Ditte Georgina Zhang
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Christian Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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4
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Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. FRONTIERS IN ALLERGY 2023; 4:1137907. [PMID: 36970067 PMCID: PMC10036764 DOI: 10.3389/falgy.2023.1137907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Shared decision-making is an approach where physicians and patients work together to determine a personalized treatment course. Such an approach is integral to patient-centered care in chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a chronic inflammatory condition of the sinonasal cavity that can severely impact physical health, smell, and quality of life (QOL). Traditional standard-of-care treatment options include topical (i.e. sprays) and oral corticosteroids and endoscopic sinus surgery, but more recently, novel corticosteroid delivery methods (i.e. high volume irrigations, recently-approved exhalation breath-powered delivering devices, and drug-eluting steroid implants) and 3 new FDA approved biologics directed against type II immunomodulators have become available. The availability of these therapeutics offers exciting new opportunities in CRSwNP management but requires personalized and shared-decision making as each modality has variable impacts on CRSwNP and related comorbid conditions. Studies have published treatment algorithms, but the practical use of these lean guidelines is heavily influenced by the lens of the treating physician, the most common being otolaryngologists and allergy immunologists. Clinical equipoise occurs when there is no basis for one intervention to be regarded as “better” than another. While most guidelines, in general, support the use of topical corticosteroids with or without oral corticosteroids followed by ESS for the majority of unoperated CRSwNP patients, there are situations of clinical equipoise that arise particularly in CRSwNP who have failed surgery or those with severe comorbid conditions. In the shared decision-making process, clinicians and patients must consider symptomatology, goals, comfort, compliance, treatment efficacy, and treatment cost when determining the initial choice of therapy and escalation of therapy with the potential use of multiple modalities for recalcitrant CRSwNP. A summary of salient considerations that might constitute shared decision-making is presented in this summary.
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Affiliation(s)
- Shreya P. Ramkumar
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Devyani Lal
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Correspondence: Amar Miglani
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5
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Moni SS, Al Basheer A. Molecular targets for cystic fibrosis and therapeutic potential of monoclonal antibodies. Saudi Pharm J 2022; 30:1736-1747. [PMID: 36601503 PMCID: PMC9805982 DOI: 10.1016/j.jsps.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/01/2022] [Indexed: 12/24/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that affects the exocrine glands and is caused by cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations. Lung disease is the leading cause of morbidity in patients. Target-specific treatment of CF has been achieved using monoclonal antibodies (mAbs). The purpose of this article is to discuss the possibility of treating CF with mAbs through their significant target specificity. We searched electronic databases in Web of Science, PubMed, EMBASE, Scopus, and Google Scholar from 1984 to 2021. We discussed the critical role of targeted therapy in cystic fibrosis, as it will be more effective at suppressing the molecular networks. After conducting a critical review of the available literature, we concluded that it is critical to understand the fundamental molecular mechanisms underlying CF prior to incorporating biologics into the therapy regimen. Omalizumab, Mepolizumab, Benralizumab, Dupilumab and KB001-A have been successfully screened for asthma-complicated CF, and their efficacies have been well reported. Despite the availability of effective targeted biologics, treating CF has remained a difficult task, particularly when it comes to reduction of secondary inflammatory mediators. This review emphasizes the overall views on CF, the immunological mechanism of CF, and the prospective therapeutic use of mAbs as potential targeted biologics for enhancing the overall status of human health.
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6
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Aldinger JP, Dobyns T, Lam K, Han JK. The role of omalizumab in the treatment of chronic rhinosinusitits with nasal polyposis. Expert Opin Biol Ther 2021; 21:1143-1149. [PMID: 34334061 DOI: 10.1080/14712598.2021.1962282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) poses a significant healthcare challenge, with diminished quality of life for patients and high costs and resource utilization for disease management. The understanding of CRSwNP pathophysiology has progressed with identification of various inflammatory biomarkers and subsequent development of monoclonal antibodies that target the underlying mechanisms of inflammation.Areas covered: Omalizumab is a biologic agent for CRSwNP treatment that targets immunoglobulin (Ig)-E. The US FDA has approved the use of omalizumab as an add-on biologic therapy for nasal polyposis in December 2020. Two Phase III clinical trials, POLYP 1 and POLYP 2, have shown that omalizumab improves both subjective patient-reported outcomes and objective physician-evaluated metrics for CRSwNP. Ongoing studies are still exploring the efficacy, safety, and cost-effectiveness of biologics for CRSwNP.Expert opinion: Biologics will continue develop as a viable management option for CRSwNP. Omalizumab is regarded as a promising addition to current treatment strategies for refractory disease.
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Affiliation(s)
| | - Taylor Dobyns
- Eastern Virginia Medical School, Norfolk, United States
| | - Kent Lam
- Eastern Virginia Medical School, Norfolk, United States
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, United States
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7
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Yang R, Moosavi L, Eppanapally S, Aboeed A, Munoz A. Acute Interstitial Nephritis: A Rare and Unusual Side Effect of Omalizumab. J Investig Med High Impact Case Rep 2021; 8:2324709620946890. [PMID: 32744093 PMCID: PMC7412888 DOI: 10.1177/2324709620946890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acute interstitial nephritis (AIN) is a relatively common cause of acute kidney injury with etiologies that include drug therapy, infections, and systemic diseases. Of these etiologies, drug therapy accounts for ~70% of AIN cases. Although any drug can cause AIN, there are no reported cases of AIN caused by omalizumab, a humanized monoclonal antibody that binds to and inhibits circulating immunoglobulin E. In this article, we share the first reported case of AIN following administration of omalizumab for the treatment of moderate to severe persistent asthma.
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Affiliation(s)
- Rocky Yang
- Kern Medical Center-UCLA, Bakersfield, CA, USA
| | - Leila Moosavi
- American University of the Caribbean, Pembroke Pines, FL, USA
| | | | - Ayham Aboeed
- American University of the Caribbean, Pembroke Pines, FL, USA
| | - Augustine Munoz
- American University of the Caribbean, Pembroke Pines, FL, USA
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8
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Abstract
The global COVID-19 pandemic has brought respiratory disease to the forefront of public health, but asthma prevalence has been rising globally for decades. Asthma is mediated by errant immune activation and airway remodeling, but the influences of environment, nutrition, and comorbidities (e.g., asthma-chronic obstructive pulmonary disorder-overlap [ACO]) are still poorly understood. Even as a new generation of biologic-based treatments offer better airway control and reductions in mortality, a lack of prophylactic treatments and mechanistic understanding complicates efforts to prevent pathogenesis. This review will explicate and synthesize current knowledge on the effect of ACO and biologics (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) on pathogenesis, treatment, and prognosis.
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9
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Mandlik DS, Mandlik SK. Atopic dermatitis: new insight into the etiology, pathogenesis, diagnosis and novel treatment strategies. Immunopharmacol Immunotoxicol 2021; 43:105-125. [PMID: 33645388 DOI: 10.1080/08923973.2021.1889583] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is the long-lasting chronic inflammatory skin condition associated with cutaneous hyper-reactivity and triggered by environmental factors. The attributes of AD include dry skin, pruritus, lichenification and frequent eczematous abrasions. This has a strong heritable aspect and typically occurs with asthma and allergic rhinitis. The complex pathological mechanism behind AD etiology is epidermal barrier destruction resulting in the lack of filaggrin protein that can induce inflammation and T-cell infiltration. T-helper 2 cell-mediated pathways also bear the responsibility of damage to the epidermal barrier. Certain causative factors for AD include microbial imbalance of skin microbiota, immunoglobulin-E-induced sensitization and neuro-inflammation. Numerous beneficial topical and oral treatments have been available to patients and there are even more drugs in the pipeline for the treatment of AD. Topical moisturizers, corticosteroids, anti-inflammatory agents such as calcineurin inhibitors, phototherapy, cAMP-specific 3, 5 half-cyclic phosphodiesterase 4 inhibitors and systemic immunosuppressants are widely available for AD treatments. Different positions and pathways inside the immune system including JAK-STAT, phosphodiesterase 4, aryl hydrocarbon receptor and T-helper 2 cytokines are targeted by above-mentioned drug treatments. Instead of the severe side effects of topical steroids and oral antihistamines, herbal plants and their derived phytoconstituents are commonly used for the treatment of AD. A clear understanding of AD's cellular and molecular pathogenesis through substantial advancement in genetics, skin immunology and psychological factors resulted in advancement of AD management. Therefore, the review highlights the recent advancements in the understanding of clinical features, etiology, pathogenesis, treatment and management and non-adherence to AD treatment.
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Affiliation(s)
- Deepa S Mandlik
- Bharat Vidyapeeth, Deemed to be University, Poona College of Pharmacy, Pune, India
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10
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Abuzakouk M, Ghorab OKHA, Wahla AS, Zoumot Z, Nasir M, Grandon D, Uzbeck MH, Salvo F, Shafiq I. Efficacy and Safety of Biologic Agents in Chronic Urticaria, Asthma and Atopic Dermatitis - A Real-life Experience. Open Respir Med J 2020; 14:99-106. [PMID: 33717370 PMCID: PMC7931148 DOI: 10.2174/1874306402014010099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis. These therapeutic agents are especially useful for patients with severe or refractory symptoms. We present the real-life experience of four of the commonly used biologic agents in the United Arab Emirates. Methods: In this retrospective observational study, we reviewed the demographic, clinical, laboratory and treatment parameters for all patients treated with biologic agents. Results: 270 patients received biologics at our centre between May 2015 and December 2019 with a median age of 36.5 years. Omalizumab was the most prescribed agent (n=183, 67.8%) followed by dupilumab (n=54, 20%), benralizumab (n=22, 8.1%) and mepolizumab (n=11, 4.1%). Urticaria was the commonest treatment indication (n=148, 55%) followed by asthma (n=105, 39%) and atopic dermatitis (n=13, 5%). All chronic urticaria patients were treated with omalizumab and showed improvement in the mean urticaria control test score from 6.7±4.47 to 12.02±4.17, with a p-value of 0.001. Dupilumab was found to be the most commonly prescribed drug for asthma (37%), followed by omalizumab (32%), benralizumab (21%) and mepolizumab (10%). The mean Asthma control test score for all asthmatics combined increased from 17.06 ± 5.4 to 19.44 ± 5.6, with p-value 0.0012 with treatment; FeNO reduced from 60.02 ± 45.74 to 29.11 ± 27.92, with p-value 0.001 and mean FEV1 improved from 2.38L ± 0.8 to 2.67L ± 0.78, with p-value 0.045. Only 4 patients in the entire cohort reported adverse events. Conclusion: Our study demonstrated that biological agents are a safe and effective treatment for atopic asthma, chronic urticaria and atopic dermatitis.
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Affiliation(s)
- Mohamed Abuzakouk
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Omar K H A Ghorab
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ali S Wahla
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Zaid Zoumot
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mohsen Nasir
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Deepa Grandon
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mateen H Uzbeck
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Fulvio Salvo
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Irfan Shafiq
- Department of Respiratory and Allergy Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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11
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Kumar P, Sharma DK, Ashawat MS. Pathophysiology and Management of Atopic Dermatitis: A Laconic Review. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666190828152316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Conclusion:
Atopic Dermatitis (AD) is long-lasting degenerating skin disease with a characteristic
phenotype and stereotypically spread skin lesions. The AD results due to a complex interface
among genetic factors, host’s surroundings, pharmacological anomalies and immunological factors.
In previous decades, researchers had shown marked interest due to increased prevalence in developed
countries. In this review, basics along with the advances in pathogenesis and management of
AD have been discussed. The immunological factors i.e. Innate Lymphoid Cells, IL-22 and Toll-like
receptors have an important role in the pathogenesis. The proactive topical therapy by skincare,
topical glucocorticosteroids and calcineurin inhibitors have improved effect in the management of
AD. The human monoclonal antibody-based systemic drug (Duplimab) is a considerable advancement
in the management of AD. Other monoclonal antibody-based drugs (Lebrikizumab, Tralokinumab,
Apremilast and Nemolizumab) are in different phases of clinical trials. A better understanding of
genetics and immunoregulatory cascade will lead to the development of efficacious drugs and better
management therapy preventing the relapse of flares and improved life quality of AD patients.
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Affiliation(s)
- Pravin Kumar
- Department of Pharmaceutics, Laureate Institute of Pharmacy, VPO-Kathog, Kangra, H.P, 176031, India
| | | | - Mahendra Singh Ashawat
- Department of Pharmaceutics, Laureate Institute of Pharmacy, VPO-Kathog, Kangra, H.P, 176031, India
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12
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Structural and clinical impact of anti-allergy agents: An overview. Bioorg Chem 2019; 94:103351. [PMID: 31668464 DOI: 10.1016/j.bioorg.2019.103351] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Allergic disorders are markedly rising in industrialized countries. The identification of compounds that trigger the immunoglobulin E (IgE)-dependent allergic reaction remain the means to improve the quality of life by limiting patient's exposure to critical allergens. Information concerning the treatment and onset of allergic disorders including atopic dermatitis, allergic rhinitis, and bronchial asthma has been provided by the research over the past decade. Recent studies also indicated that allergic inflammation is associated closely with their exacerbation and progression and indeed is the basic pathophysiology of allergic diseases. As a result of immunological and molecular biological studies our understanding of the mechanism of allergic inflammation with regard to therapeutic agents has improved. While much effort has been paid to developing a new anti-allergic agent, the allergic disease has yet to be completely conquered. The more extensive research will allow the development of new therapeutics to combat allergic diseases. Currently, with respect to mechanism of action anti-allergy drugs are classified into five types including histamine H1 antagonists, leukotriene antagonists, Th2 cytokine inhibitors, thromboxane A2 inhibitors and mediator-release inhibitors. The use of two or more anti-allergy agents together is not acknowledged at present, but this will be the subject of research in the future because with different mechanisms of action anti-allergy agents used at the same time will theoretically increase their effects. This review article focuses on anti-allergy agents highlighting their applications, clinical trials and recent advancement on drugs.
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13
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Sanchez-Valenzuela MC, Garcia-Saucedo JC, Motoa G, Carrillo-Martin I, Gonzalez-Estrada A. Treatment of idiopathic anaphylaxis with omalizumab. Ann Allergy Asthma Immunol 2019; 123:612-613. [PMID: 31568858 DOI: 10.1016/j.anai.2019.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Maria C Sanchez-Valenzuela
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Juan C Garcia-Saucedo
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Gabriel Motoa
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ismael Carrillo-Martin
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
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14
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Kalamaha K, Reis E, Newton S, Roche C, Julson J, Fernandes H, Rodrigues J. Atopic dermatitis: a review of evolving targeted therapies. Expert Rev Clin Immunol 2019; 15:275-288. [DOI: 10.1080/1744666x.2019.1560267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kadra Kalamaha
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
| | - Erin Reis
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
| | - Shauna Newton
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
| | - Conor Roche
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
| | - Janet Julson
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
| | - Hermina Fernandes
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
- Hematology and Medical Oncology, Sanford Health, Bismarck, ND, USA
| | - Jonathan Rodrigues
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND, USA
- Allergy and Immunology, Sanford Health, Bismarck, ND, USA
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Megna M, Napolitano M, Patruno C, Villani A, Balato A, Monfrecola G, Ayala F, Balato N. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb) 2017; 7:1-23. [PMID: 28025775 PMCID: PMC5336433 DOI: 10.1007/s13555-016-0170-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Due to its chronic nature and frequently occurring relapses, AD has a substantial effect on patients' quality of life, often requiring long-term systemic treatment, especially in adult patients, who are more frequently refractory to adequate topical treatment with mid- to high-potent corticosteroids and/or calcineurin inhibitors. Therefore, treatment with systemic therapies is often needed to take control of the disease, prevent exacerbations and improve quality of life. However, data regarding systemic treatment effectiveness and long-term safety in adult patients with AD are insufficient. Indeed, standardized international guidelines are lacking, and the treatment approach widely differs among diverse countries. This review focuses on the use of systemic treatments in adult AD patients analyzing published literature.
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Affiliation(s)
- Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
| | | | - Cataldo Patruno
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Fabio Ayala
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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Subramaniyan R, Chopra A. Treatment of Chronic Spontaneous Urticaria with a Single Dose of Omalizumab: A Study of Four Cases. Indian J Dermatol 2016; 61:467. [PMID: 27512204 PMCID: PMC4966419 DOI: 10.4103/0019-5154.185745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Chronic spontaneous urticaria (CSU) has a detrimental effect on patients’ emotional and physical quality of life. Omalizumab, an anti-immunoglobulin E humanized monoclonal antibody, has been shown to be very effective in the treatment of refractory chronic urticaria patients but may not be an economically viable option for all CSU patients. However, we present a case series where a single dose of omalizumab gave sustained relief of symptoms in patients with CSU, which may be an economical option. Aims: The aim of this study is to assess the efficacy of a single dose of omalizumab in the treatment of CSU. Materials and Methods: Four patients of CSU whose disease was not controlled with four times the licensed dose of tablet fexofenadine 180 mg were exhibited one subcutaneous injection of omalizumab and were followed up at 4 weekly intervals for 24 weeks for Weekly Urticaria Activity Score 7 (UAS7) and Dermatology Life Quality Index (DLQI). Results: A sharp decline in UAS7 and DLQI was documented in 7–10 days. The decline was maintained up to 16 weeks in one case and 20 weeks in the other three cases. Both the scores at the end of the follow-up period of 24 weeks were better than the pre-omalizumab scores. Conclusion: The results of this case series indicate the efficacy of a single-dose omalizumab in treating moderate to severe refractory CSU. Further studies are required to identify the minimum frequency of administering omalizumab to effectively control CSU. This would greatly reduce the cost of this novel therapy.
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Affiliation(s)
| | - Ajay Chopra
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
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Godse K, Rajagopalan M, Girdhar M, Kandhari S, Shah B, Chhajed PN, Tahiliani S, Shankar DSK, Somani V, Zawar V. Position statement for the use of omalizumab in the management of chronic spontaneous urticaria in Indian patients. Indian Dermatol Online J 2016; 7:6-11. [PMID: 26955580 PMCID: PMC4763587 DOI: 10.4103/2229-5178.174314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) affects 1% of the world population and also their quality of life, and 50% of these patients are refractory to H1-antihistamines. Omalizumab is a humanized monoclonal anti-IgE antibody that binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast-cell degranulation. The EAACI/GA2LEN/EDF/WAO guidelines recommend omalizumab as the third-line of therapy as an add-on to antihistamines. The recommended dose of omalizumab is 300 mg, 4 weekly in the management of CSU refractory to standard of care with H1-antihistamines in adults and adolescents ≥12 years of age. In some patients, a dose of 150 mg may be acceptable. Omalizumab has a good safety profile. However, due to the biologic nature of the drug, all patients administered omalizumab must be observed for 2 h after administration for anaphylactoid reactions. There have been no studies on the effect of impaired renal or hepatic function on the pharmacokinetics of omalizumab. While no particular dose adjustment is recommended, omalizumab should be administered with caution in these patients.
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Affiliation(s)
- Kiran Godse
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | | | - Mukesh Girdhar
- Department of Dermatology, Max Super Speciality Hospital, New Delhi, India
| | | | - Bela Shah
- Department of Dermatology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Prashant N. Chhajed
- Department of Research, Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | | | - D. S. Krupa Shankar
- Dr. Krupa Shankar Skin Diagnosis Center, Mallige Medical Centre Pvt. Ltd., Bengaluru, Karnataka, India
| | - Vijay Somani
- Somani Skin Care Centre, Hyderabad, Telangana, India
| | - Vijay Zawar
- Skin Diseases Center, Nashik, Maharashtra, India
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