Biologics for atopic diseases: Indication, side effect management, and new developments

Managing Severe Adverse Reactions to Biologicals in Severe Asthma

BACKGROUND

The use of biological agents in the treatment of various inflammatory and malignancy conditions has expanded rapidly. However, these agents can induce hypersensitivity reactions, posing significant clinical challenges.

METHODS

We conducted a retrospective study that included nine patients with severe asthma who experienced hypersensitivity reactions to biological agents (omalizumab, benralizumab and dupilumab).

RESULTS

Hypersensitivity reactions to biologicals in severe asthma were observed in 9 of 68 patients treated. In five cases, treatment was stopped or changed to another available biological, and for four patients administered under close surveillance, titrated provocation or desensitization was applied. Successful desensitization was achieved in three of the patients, allowing them to continue therapy without adverse reactions. Improvements in asthma control were observed post-desensitization, leading to the reduced need for systemic steroid treatments and an increase in quality of life.

CONCLUSIONS

This study highlights the importance of recognizing hypersensitivity reactions to biologicals to have an appropriate approach for patients with severe asthma. As an effective approach for patients experiencing hypersensitivity reactions to biological agents, desensitization allows treatment continuation.

Customer-centric product presentations for monoclonal antibodies

Delivering customer-centric product presentations for biotherapeutics, such as monoclonal antibodies (mAbs), represents a long-standing and paramount area of engagement for pharmaceutical scientists. Activities include improving experience with the dosing procedure, reducing drug administration-related expenditures, and ultimately shifting parenteral treatments outside of a controlled healthcare institutional setting. In times of increasingly cost-constrained markets and reinforced with the coronavirus pandemic, this discipline of "Product Optimization" in healthcare has gained momentum and changed from a nice-to-have into a must. This review summarizes latest trends in the healthcare ecosystem that inform key strategies for developing customer-centric products, including the availability of a wider array of sustainable drug delivery options and treatment management plans that support dosing in a flexible care setting. Three disease area archetypes with varying degree of implementation of customer-centric concepts are introduced to highlight relevant market differences and similarities. Namely, rheumatoid arthritis and inflammatory bowel disease, multiple sclerosis, and oncology have been chosen due to differences in the availability of subcutaneously dosed and ready-to-use self-administration products for mAb medicines and their follow-on biologics. Different launch scenarios are described from a manufacturer's perspective highlighting the necessity of platform approaches. To unfold the full potential of customer-centric care, value-based healthcare provider reimbursement schemes that incentivize the efficiency of care need to be broadly implemented.

Treatment Patterns among Patients with Atopic Dermatitis in Secondary Care: A National, Observational, Non-interventional, Retrospective Study in Sweden

This non-interventional, observational, longitudinal study describes treatment patterns of atopic dermatitis (AD) in Sweden. Data from 3 Swedish registries were merged, and included patients who received an AD diagnosis (during the period 1997 to 2019) and had AD treatment prescribed (during the period 2006 to 2020). Treatment persistence, treatment sequencing, time-to-event analysis, and 12-month prevalence were analysed. Overall, data for 99,885 patients with AD were included, of whom 4,086 (4.1%) received systemic treatments. Median persistence rates were 12.6 (95% CI 11.9, 13.4) months for methotrexate, 10.8 (9.1, 13.0) months for azathioprine, 5.6 (3.8, 6.2) months for mycophenolate, 5.1 (4.4, 5.7) months for alitretinoin and 3.4 (3.2, 3.7) months for cyclosporine. Median (Q1, Q3) time from first secondary care visit for AD to first systemic treatment was 5.8 (2.2, 11.0) years overall and 4.4 (1.3, 9.1) years in the Stockholm region. Methotrexate was a prominent first- and second-line treatment used during the period 2006 to 2020. Dupilumab was introduced during the study period and was increasingly used as first- or second-line therapy over time. The 12-month prevalence of AD generally remained steady, with a gradual increase observed over time for the overall population. A steep increase was observed in Stockholm from 2011. This study shows that a small proportion of patients with AD are offered systemic treatments in Sweden, with long periods in secondary care prior to systemic treatments and low persistence on systemic treatments. Regional differences highlight a need for national treat ment guidelines.

The effects of the COVID-19 pandemic on the treatment of allergic eye diseases

PURPOSE OF REVIEW

To analyze if recommendations given before and during the COVID-19 pandemic are still a valid option for patients suffering of ocular allergy (OA).

RECENT FINDINGS

During the last year many doctors and patients requested suggestions for the treatment of OA patients in COVID-19 time. Most of them were given by phone calls and emails following the recommendations given by Scientific Societies.

SUMMARY

Considering the current multiple problems related to the COVID-19 pandemic, OA has not been considered a priority, even though patients need treatments. Topical antiallergic drugs are still the first option to treat all kind of OA, with the addition of topical corticosteroids in the severe forms of vernal and atopic keratoconjunctivitis (VKC and AKC) even in patients at risk of COVID-19. Topical immunomodulation is still recommended in severe forms of VKC and AKC unless the patient is infected. The number of patients treated with these drugs in our Center was similar than previous years. The risk to have a VKC patient affected by COVID-19 is similar to the general pediatric population but with a lower OR. In 2021, still in COVID-time, the management of OA should follow the previous recommendations with an update due to the risk of infection.

[Treatment of atopic dermatitis with dupilumab : A retrospective cohort analysis from dermatological practice]

Wir präsentieren die Ergebnisse einer retrospektiven Datenauswertung von 44 Patienten einer Praxiskohorte, deren atopische Dermatitis (AD) über bis zu 3 Jahre mit dem IL(Interleukin)-4/13-Rezeptor-Antikörper Dupilumab behandelt wurde. Die Betreuung erfolgte in den letzten 21 Monaten in einer Spezialsprechstunde Immundermatologie, in der die aufwendige Dokumentation realisiert werden konnte. Die Charakteristika der Kohorte hinsichtlich Alters- und Geschlechterverteilung, Schwere und Dauer der Erkrankung sind vergleichbar mit den großen Patientenkollektiven der Zulassungsstudien. Die therapeutische Effizienz unter Praxis-Alltagsbedingungen erwies sich als sehr gut (Anteil Patienten EASI [Eczema Area and Severity Index] 50, 75, 90 nach 16 Wochen: 94, 84, 60 %) und anhaltend (86 % EASI 90 nach 52 Wochen Therapie). Etwa die Hälfte unserer Patienten hatte anamnestisch oder bei Therapiebeginn eine Beteiligung der Gesichtshaut und/oder Augen. Diese Patientengruppe erwies sich als betreuungsintensiver, weil die Gesichts- und periorbitale Dermatitis sowie begleitende Konjunktividen verzögert abheilten, zu Rezidiven neigten und häufig einer zusätzlichen topischen Therapie bedurften. Wir haben keine schweren Nebenwirkungen in den hier ausgewerteten 48 Patientenjahren festgestellt. Dupilumab erwies sich als sichere und effiziente Therapie für die atopische Dermatitis in der dermatologischen Praxis.

Precision medicine reaching out to the patients in allergology - a German-Japanese workshop report

An expert workshop in collaboration of the German Society of Allergy and Clinical Immunology (DGAKI) and the Japanese Society of Allergy (JSA) provided a platform for key opinion leaders of both countries aimed to join expertise and to highlight current developments and achievements in allergy research. Key domains of the meeting included the following seven main sections and related subchapters: 1) basic immunology, 2) bronchial asthma, 3) prevention of allergic diseases, 4) food allergy and anaphylaxis, 5) atopic dermatitis, 6) venom allergy, and 7) upper airway diseases. This report provides a summary of panel discussions of all seven domains and highlights unmet needs and project possibilities of enhanced collaborations of scientific projects.

The Effect of SARS-CoV-2 Virus Infection on the Course of Atopic Dermatitis in Patients

Background and Objectives: Atopic dermatitis (AD) is a disease with a complex pathophysiology involving immune-mediated reactions that lead to skin lesions that are typically localized and recurrent. Following the outbreak of the COVID-19 (coronavirus disease 2019) pandemic, attempting to assess the impact of SARS-CoV-2 infection on diseases caused by complex immune mechanisms has become important. The aim of this study was to assess the impact of SARS-CoV-2 infection on the course of AD, including immunosuppressive therapy, in patients with a severe form of the disease. Materials and Methods: A retrospective analysis of 21 adults aged 18 to 52 years with AD diagnosed with COVID-19, including patients requiring hospitalization, was performed. Results: During SARS-CoV-2 infection, temporary exacerbation of skin lesions and/or skin pruritus was observed in nine (43%) patients but without the need for systemic treatment intervention. Patients with severe AD who received immunosuppressive therapy most often manifested mild exacerbation of skin symptoms. The skin condition improved in three patients. There was no significant effect of disease severity on the risk of severe COVID-19 (HR = 0.45; 95% CI: 0.32-0.65). Conclusions: The course of atopic dermatitis during SARS-CoV-2 infection may be different from the severity of its symptoms due to the lack of a significant influence. The immunosuppressive treatment used in patients with severe AD did not significantly affect the course of SARS-CoV-2 infection.