1
|
Papi A, Chipps BE, Beasley R, Panettieri RA, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Rees R, Albers FC, Cappelletti C. Albuterol-budesonide fixed-dose combination rescue inhaler for asthma: a plain language summary of the MANDALA study. Ther Adv Respir Dis 2024; 18:17534666241232264. [PMID: 38698565 PMCID: PMC11067641 DOI: 10.1177/17534666241232264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/25/2024] [Indexed: 05/05/2024] Open
Abstract
What is this summary about?This summary describes the results of a clinical study called MANDALA that was published in the New England Journal of Medicine in 2022. In the MANDALA study, researchers looked at a new asthma rescue inhaler that contains both albuterol and budesonide in a single inhaler (known as albuterol-budesonide, AIRSUPRA™). This summary describes the results for people aged 18 yearsand older who took part in the study.
Collapse
Affiliation(s)
- Alberto Papi
- Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy
| | - Bradley E. Chipps
- The Capital Allergy and Respiratory Disease Center, Sacramento, CA, USA
| | - Richard Beasley
- The Medical Research Institute of New Zealand; Capital and Coast District Health Board, and Victoria University of Wellington, Wellington, New Zealand
| | - Reynold A. Panettieri
- Rutgers Institute for Translational Medicine and Science; Child Health Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Elliot Israel
- Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Mark Cooper
- BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Lynn Dunsire
- BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | | | | | | | | |
Collapse
|
2
|
Chipps BE, Israel E, Beasley R, Panettieri RA, Albers FC, Rees R, Dunsire L, Danilewicz A, Johnsson E, Cappelletti C, Papi A. Albuterol-Budesonide Pressurized Metered Dose Inhaler in Patients With Mild-to-Moderate Asthma: Results of the DENALI Double-Blind Randomized Controlled Trial. Chest 2023; 164:585-595. [PMID: 37003355 DOI: 10.1016/j.chest.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND In the phase 3 MANDALA trial, as-needed albuterol-budesonide pressurized metered-dose inhaler significantly reduced severe exacerbation risk vs as-needed albuterol in patients with moderate-to-severe asthma receiving inhaled corticosteroid-containing maintenance therapy. This study (DENALI) was conducted to address the US Food and Drug Administration combination rule, which requires a combination product to demonstrate that each component contributes to its efficacy. RESEARCH QUESTION Do both albuterol and budesonide contribute to the efficacy of the albuterol-budesonide combination pressurized metered-dose inhaler in patients with asthma? STUDY DESIGN AND METHODS This phase 3 double-blind trial randomized patients aged ≥ 12 years with mild-to-moderate asthma 1:1:1:1:1 to four-times-daily albuterol-budesonide 180/160 μg or 180/80 μg, albuterol 180 μg, budesonide 160 μg, or placebo for 12 weeks. Dual-primary efficacy end points included change from baseline in FEV1 area under the curve from 0 to 6 h (FEV1 AUC0-6h) over 12 weeks (assessing albuterol effect) and trough FEV1 at week 12 (assessing budesonide effect). RESULTS Of 1,001 patients randomized, 989 were ≥ 12 years old and evaluable for efficacy. Change from baseline in FEV1 AUC0-6h over 12 weeks was greater with albuterol-budesonide 180/160 μg vs budesonide 160 μg (least-squares mean [LSM] difference, 80.7 [95% CI, 28.4-132.9] mL; P = .003). Change in trough FEV1 at week 12 was greater with albuterol-budesonide 180/160 and 180/80 μg vs albuterol 180 μg (LSM difference, 132.8 [95% CI, 63.6-201.9] mL and 120.8 [95% CI, 51.5-190.1] mL, respectively; both P < .001). Day 1 time to onset and duration of bronchodilation with albuterol-budesonide were similar to those with albuterol. The albuterol-budesonide adverse event profile was similar to that of the monocomponents. INTERPRETATION Both monocomponents contributed to albuterol-budesonide lung function efficacy. Albuterol-budesonide was well tolerated, even at regular, relatively high daily doses for 12 weeks, with no new safety findings, supporting its use as a novel rescue therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03847896; URL: www. CLINICALTRIALS gov.
Collapse
Affiliation(s)
| | - Elliot Israel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, State University of New Jersey, New Brunswick, NJ
| | | | | | - Lynn Dunsire
- BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | - Eva Johnsson
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Alberto Papi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
3
|
Papi A, Chipps BE, Beasley R, Panettieri RA, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med 2022; 386:2071-2083. [PMID: 35569035 DOI: 10.1056/nejmoa2203163] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND As asthma symptoms worsen, patients typically rely on short-acting β2-agonist (SABA) rescue therapy, but SABAs do not address worsening inflammation, which leaves patients at risk for severe asthma exacerbations. The use of a fixed-dose combination of albuterol and budesonide, as compared with albuterol alone, as rescue medication might reduce the risk of severe asthma exacerbation. METHODS We conducted a multinational, phase 3, double-blind, randomized, event-driven trial to evaluate the efficacy and safety of albuterol-budesonide, as compared with albuterol alone, as rescue medication in patients with uncontrolled moderate-to-severe asthma who were receiving inhaled glucocorticoid-containing maintenance therapies, which were continued throughout the trial. Adults and adolescents (≥12 years of age) were randomly assigned in a 1:1:1 ratio to one of three trial groups: a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide (with each dose consisting of two actuations of 90 μg and 80 μg, respectively [the higher-dose combination group]), a fixed-dose combination of 180 μg of albuterol and 80 μg of budesonide (with each dose consisting of two actuations of 90 μg and 40 μg, respectively [the lower-dose combination group]), or 180 μg of albuterol (with each dose consisting of two actuations of 90 μg [the albuterol-alone group]). Children 4 to 11 years of age were randomly assigned to only the lower-dose combination group or the albuterol-alone group. The primary efficacy end point was the first event of severe asthma exacerbation in a time-to-event analysis, which was performed in the intention-to-treat population. RESULTS A total of 3132 patients underwent randomization, among whom 97% were 12 years of age or older. The risk of severe asthma exacerbation was significantly lower, by 26%, in the higher-dose combination group than in the albuterol-alone group (hazard ratio, 0.74; 95% confidence interval [CI], 0.62 to 0.89; P = 0.001). The hazard ratio in the lower-dose combination group, as compared with the albuterol-alone group, was 0.84 (95% CI, 0.71 to 1.00; P = 0.052). The incidence of adverse events was similar in the three trial groups. CONCLUSIONS The risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide than with as-needed use of albuterol alone among patients with uncontrolled moderate-to-severe asthma who were receiving a wide range of inhaled glucocorticoid-containing maintenance therapies. (Funded by Avillion; MANDALA ClinicalTrials.gov number, NCT03769090.).
Collapse
Affiliation(s)
- Alberto Papi
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Bradley E Chipps
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Richard Beasley
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Reynold A Panettieri
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Elliot Israel
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Mark Cooper
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Lynn Dunsire
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Allison Jeynes-Ellis
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Eva Johnsson
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Robert Rees
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Christy Cappelletti
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| | - Frank C Albers
- From the Department of Respiratory Medicine, University of Ferrara Medical School, Ferrara, Italy (A.P.); the Capital Allergy and Respiratory Disease Center, Sacramento, CA (B.E.C.); the Medical Research Institute of New Zealand, Capital and Coast District Health Board, and Victoria University Wellington - all in Wellington, New Zealand (R.B.); Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick (R.A.P.); Brigham and Women's Hospital, Harvard Medical School, Boston (E.I.); BioPharmaceuticals Research and Development, AstraZeneca, Cambridge (M.C., L.D.), and Avillion, London (A.J.-E., R.R.) - both in the United Kingdom; BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (E.J.); BioPharmaceuticals Research and Development, AstraZeneca, Durham, NC (C.C.); and Avillion, Northbrook, IL (F.C.A.)
| |
Collapse
|
4
|
Albers FC, Bratton DJ, Gunsoy NB, Cockle SM, Alfonso‐Cristancho R, Braunstahl G. Mepolizumab improves work productivity, activity limitation, symptoms, and rescue medication use in severe eosinophilic asthma. Clin Respir J 2022; 16:252-258. [PMID: 35081275 PMCID: PMC9060075 DOI: 10.1111/crj.13474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/25/2021] [Indexed: 11/25/2022]
Abstract
Patients with severe eosinophilic asthma experience daily activity limitations and reduced productivity at work. Using anonymized individual patient-level data from two previously conducted randomized, double-blind, placebo-controlled studies (MENSA [GSK ID:115588/NCT01691521]; MUSCA [GSK ID:200862/NCT02281318]), we investigated the effect of mepolizumab on work productivity, activity limitation, symptoms, and rescue medication use. Patient-reported outcomes including Work Productivity and Activity Impairment-General Health (WPAI-GH) scores (impairment percentages, 0%-100%), global activity limitation (scale 1-4), and perceived change in activity limitation (Likert scale 1-7) since the start of the study were analyzed. WPAI-GH scores from MENSA were analyzed post hoc for employed patients using mixed model repeated measures; global activity limitation and perceived change in activity limitation from MUSCA were analyzed by ordinal logistic regression. Mean changes from baseline in daily asthma symptom scores (scale 0-5) and rescue medication use (occasions/day) were also assessed, via a post hoc meta-analysis of MENSA and MUSCA. At study end, WPAI-GH scores indicative of overall work impairment, impairment while working, and activity impairment consistently improved with mepolizumab versus placebo. Overall, 76% versus 54% of patients rated their activity as "much better," "better," or "slightly better" since the start of the study with mepolizumab versus placebo. Mepolizumab was associated with numerically larger improvements from baseline in asthma symptoms (treatment difference 0.21-0.29 points) and rescue medication use (treatment difference -0.08 to -0.22 occasions/day) versus placebo. Our results indicate that patients with severe eosinophilic asthma may experience improved activity limitation, work productivity, symptoms, and rescue medication use with mepolizumab.
Collapse
Affiliation(s)
| | | | | | | | | | - Gert‐Jan Braunstahl
- Department of Pulmonary MedicineFranciscus Gasthuis and VlietlandRotterdamThe Netherlands
| |
Collapse
|
5
|
Chipps BE, Albers FC, Reilly L, Johnsson E, Cappelletti C, Papi A. Efficacy and safety of as-needed albuterol/budesonide versus albuterol in adults and children aged ≥4 years with moderate-to-severe asthma: rationale and design of the randomised, double-blind, active-controlled MANDALA study. BMJ Open Respir Res 2021; 8:8/1/e001077. [PMID: 34887317 PMCID: PMC8663093 DOI: 10.1136/bmjresp-2021-001077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction Uncontrolled asthma is associated with substantial morbidity. While fast-acting bronchodilators provide quick relief from asthma symptoms, their use as rescue fails to address the underlying inflammation. Combining a short-acting beta2-agonist, such as albuterol (salbutamol), with an inhaled corticosteroid, such as budesonide, in a single inhaler as rescue therapy could help control both bronchoconstriction and inflammation, and reduce the risk of asthma exacerbations. Methods and analysis The Phase 3 MANDALA study was designed to determine the efficacy of albuterol in combination with budesonide (albuterol/budesonide 180/160 µg or 180/80 µg, two actuations of 90/80 µg or 90/40 µg, respectively) versus albuterol (180 µg, two actuations of 90 µg) as rescue therapy in adult, adolescent and paediatric patients with moderate-to-severe asthma. This event-driven study enrolled symptomatic patients (3000 adults/adolescents and 100 children aged 4–11 years) who experienced ≥1 severe asthma exacerbation in the previous year and were receiving maintenance therapy for ≥3 months prior to study entry. The primary efficacy endpoint was time-to-first severe asthma exacerbation. Ethics and dissemination The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, and that are consistent with International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use and Good Clinical Practice and the applicable regulatory requirements. Trial registration NCT03769090.
Collapse
Affiliation(s)
| | | | - Laurence Reilly
- Acumen Life Science Investment Consulting Limited, Tamworth, UK
| | - Eva Johnsson
- BioPharmaceuticals R&D, AstraZeneca R&D Gothenburg, Goteborg, Sweden
| | - Christy Cappelletti
- BioPharmaceuticals R&D, AstraZeneca Pharmaceuticals LP Durham, Durham, North Carolina, USA
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
6
|
LaForce C, Chipps BE, Albers FC, Reilly L, Johnsson E, Andrews H, Cappelletti C, Maes A, Papi A. Albuterol/budesonide for the treatment of exercise-induced bronchoconstriction in patients with asthma: The TYREE study. Ann Allergy Asthma Immunol 2021; 128:169-177. [PMID: 34699967 DOI: 10.1016/j.anai.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND PT027 is a fixed-dose combination of albuterol (salbutamol) and budesonide in a single pressurized metered-dose inhaler. OBJECTIVE To evaluate the efficacy and safety of albuterol/budesonide compared with placebo in patients with asthma and exercise-induced bronchoconstriction (EIB). METHODS In this randomized, double-blind, 2-period, single-dose crossover study, adolescents and adults with asthma and EIB (defined by ≥20% decrease from pre-exercise challenge forced expiratory volume in 1 second [FEV1]) were randomized to albuterol/budesonide (180/160 µg) followed by placebo (n = 29) or the reverse sequence (n = 31). Subjects were stratified by background therapy (as-needed short-acting β2-agonist alone or low-to-medium dose inhaled corticosteroid plus as-needed short-acting β2-agonist). FEV1 was measured 5 minutes pre-dose, 30 minutes postdose (5 minutes pre-exercise challenge [baseline]), and 5, 10, 15, 30, and 60 minutes postexercise. The primary end point was maximum percentage fall from baseline in FEV1 up to 60 minutes postexercise challenge. RESULTS Least squares mean maximum percentage fall in FEV1 up to 60 minutes postexercise challenge was 5.45% with albuterol/budesonide vs 18.97% with placebo (difference, -13.51% [95% confidence interval, -16.94% to -10.09%]; P < .001). More subjects were fully protected (maximum percentage fall in FEV1 post-exercise challenge < 10%) with albuterol/budesonide than with placebo (78.3% vs 28.3%; P < .001). The treatment effect was consistent irrespective of background inhaled corticosteroid therapy, and albuterol/budesonide was well tolerated. CONCLUSION In adolescents and adults with asthma and EIB, a single dose of albuterol/budesonide 180/160 µg taken approximately 30 minutes before exercise was significantly more effective than placebo in preventing EIB.
Collapse
Affiliation(s)
- Craig LaForce
- North Carolina Clinical Research, Raleigh, North Carolina.
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | | | | | - Eva Johnsson
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Andrea Maes
- BioPharmaceuticals R&D, AstraZeneca, Wilmington, Delaware; Insmed Inc, Bridgewater, New Jersey
| | - Alberto Papi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
7
|
Lemiere C, Taillé C, Lee JK, Smith SG, Mallett S, Albers FC, Bradford ES, Yancey SW, Liu MC. Impact of baseline clinical asthma characteristics on the response to mepolizumab: a post hoc meta-analysis of two Phase III trials. Respir Res 2021; 22:184. [PMID: 34158028 PMCID: PMC8218390 DOI: 10.1186/s12931-021-01767-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe asthma is associated with a broad range of phenotypes and clinical characteristics. This analysis assessed whether select baseline patient characteristics could prognosticate mepolizumab efficacy in severe eosinophilic asthma. METHODS This was a post hoc meta-analysis of data from the Phase III MENSA (NCT01691521/MEA115588) and MUSCA (NCT02281318/200862) studies. Patients aged ≥ 12 years with severe eosinophilic asthma and a history of exacerbations were randomised to receive placebo (MENSA/MUSCA), mepolizumab 75 mg intravenously (MENSA) or 100 mg subcutaneously (SC) (MENSA/MUSCA) every 4 weeks for 32 (MENSA) or 24 (MUSCA) weeks. The primary endpoint was the annual rate of clinically significant exacerbations; other outcomes included the proportion of patients with no exacerbations and changes from baseline in pre-bronchodilator forced expiratory volume in 1 s (FEV1), St George's Respiratory Questionnaire (SGRQ) total score and Asthma Control Questionnaire (ACQ)-5 score. Analyses were performed by baseline age of asthma onset (< 18 years; 18-40 years; ≥ 40 years); lung function (% predicted FEV1 ≤ 60; 60-80; > 80); airway reversibility (reversible [≥ 12% change in FEV1]; non-reversible [< 12% change in FEV1]); perennial and/or seasonal allergen sensitivity (yes/no); asthma control (uncontrolled [ACQ-5 score ≥ 1.5]; partial/complete control [ACQ-5 score < 1.5]). RESULTS Overall, 936 patients received mepolizumab 100 mg SC or placebo. Across age at asthma onset, lung function and airway reversibility subgroups, mepolizumab reduced the rate of clinically significant exacerbations by 49-63% versus placebo. Improvements in lung function, SGRQ total score and ACQ-5 score were also seen with mepolizumab versus placebo across most age and lung function subgroups. Clinically significant exacerbations were reduced with mepolizumab versus placebo irrespective of season or allergen sensitivity; SGRQ total and ACQ-5 scores were generally improved across seasons. CONCLUSIONS Mepolizumab efficacy was consistent for patients with varying age at asthma onset, lung function, airway reversibility and allergen sensitivities at baseline. Our results indicate that mepolizumab is likely to be beneficial for patients with severe eosinophilic asthma with a broad range of baseline clinical characteristics; large-scale real-world studies are needed to confirm the external validity of these findings. Trial registration Post hoc meta-analysis of data from MENSA (NCT01691521/MEA115588) and MUSCA (NCT02281318/200862).
Collapse
Affiliation(s)
- Catherine Lemiere
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Camille Taillé
- Service de Pneumologie, Hôpital Bichat, AP-HP-Nord, Paris, France.,INSERM U1152, Université de Paris, Paris, France.,INSERM 12, F-CRIN, Clinical Research Initiative In Severe Asthma: A Level for Innovation & Science (CRISALIS), Toulouse, France
| | | | - Steven G Smith
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Stephen Mallett
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, UK
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.,Avillion US Inc., Northbrook, IL, USA
| | - Eric S Bradford
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA.,Aeglea BioTherapeutics, Austin, TX, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Mark C Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA.
| |
Collapse
|
8
|
Prazma CM, Idzko M, Douglass JA, Bourdin A, Mallett S, Albers FC, Yancey SW. Response to Mepolizumab Treatment in Patients with Severe Eosinophilic Asthma and Atopic Phenotypes. J Asthma Allergy 2021; 14:675-683. [PMID: 34163180 PMCID: PMC8214022 DOI: 10.2147/jaa.s298559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/23/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Improved understanding of characteristics that may influence treatment response across phenotypes may help guide treatment decisions. Patients and Methods This was a post hoc analysis of MENSA, a multicenter, randomized, double-blind, placebo-controlled trial (NCT01691521). Patients aged ≥12 years with severe eosinophilic asthma received mepolizumab (75 mg intravenously or 100 mg subcutaneously) or placebo, plus standard of care, every 4 weeks for 32 weeks. Outcomes assessed were the annualized rate of clinically significant exacerbations and change from baseline in Asthma Control Questionnaire (ACQ)-5 score. Subgroup analyses were performed by baseline blood eosinophil count (<150, ≥150–300, ≥300 cells/μL) within atopic subgroups (non-atopic [specific immunoglobulin E <0.35 kU/L], atopic [≥0.35–17.5 kU/L], strongly atopic [>17.5 kU/L]), and by house dust mite (HDM) sensitivity. Results Of 576 patients analyzed, 272 were non-atopic, 181 were atopic and 94 were strongly atopic; 29 had missing atopy data. In patients with blood eosinophil counts ≥300 cells/µL, mepolizumab versus placebo reduced clinically significant exacerbations by 74%, 43% and 25% in the non-atopic, atopic and strongly atopic subgroups. Similar reductions were observed in all atopic subgroups in other blood eosinophil count categories where there were sufficient patient numbers for analysis, except for non-atopic patients with baseline blood eosinophil counts of <150 cells/μL. Improvements in ACQ-5 scores of –0.75, –0.73 and –0.78 with mepolizumab versus placebo were observed in non-atopic, atopic and strongly atopic patients with blood eosinophil counts ≥300 cells/µL; consistent improvements in ACQ-5 were not observed in patients with blood eosinophil counts <150 or ≥150–300 cells/μL. Reductions in clinically significant exacerbations with mepolizumab versus placebo were also observed irrespective of sensitivity to HDMs. Conclusion Mepolizumab was associated with a trend for reductions in clinically significant exacerbations and improved asthma control versus placebo in patients with severe eosinophilic asthma, irrespective of atopic status or HDM sensitivity. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/l92s5nzD3OI
Collapse
Affiliation(s)
| | - Marco Idzko
- Division of Pneumology, Medical University of Vienna, Vienna, Austria.,Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - Jo Anne Douglass
- The Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Arnaud Bourdin
- Departement de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, Montpellier, France
| | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| |
Collapse
|
9
|
Lugogo N, Liu MC, Pavord I, Mitchell PD, Smith SG, Mallett S, Albers FC, Bradford ES, Yancey SW, Bel EH. Clinical effects of mepolizumab in patients with severe eosinophilic asthma according to background therapy: A meta-analysis. J Allergy Clin Immunol Pract 2021; 9:3506-3509.e3. [PMID: 34111572 DOI: 10.1016/j.jaip.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich.
| | - Mark C Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Md
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Patrick D Mitchell
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven G Smith
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Stephen Mallett
- Research and Development, Statistics, Programming, and Data Standards, GSK, Stockley Park West, Uxbridge, Middlesex, United Kingdom
| | | | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Liu MC, Chipps B, Munoz X, Devouassoux G, Bergna M, Smith SG, Price RG, Galkin DV, Azmi J, Mouneimne D, Albers FC, Chapman KR. Benefit of switching to mepolizumab from omalizumab in severe eosinophilic asthma based on patient characteristics. Respir Res 2021; 22:144. [PMID: 33971856 PMCID: PMC8111733 DOI: 10.1186/s12931-021-01733-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background The OSMO study assessed the efficacy of switching to mepolizumab in patients with severe eosinophilic asthma that was uncontrolled whilst receiving omalizumab. The objective of this analysis was to assess the proportion of patients achieving pre-defined improvements in up to four efficacy outcomes and the relationship between patient baseline characteristics and treatment response. Methods This was a post hoc analysis of OSMO study data (GSK ID:204471; ClinicalTrials.gov No. NCT02654145). Patients with severe eosinophilic asthma uncontrolled by high-dose inhaled corticosteroids, other controller(s) and omalizumab subcutaneously (≥ 4 months) were switched to mepolizumab 100 mg administered subcutaneously. Endpoints included the proportion of responders—i.e. patients achieving a pre-defined clinical improvement in ≥ 1 of the following outcomes: (1) Asthma Control Questionnaire (ACQ)-5 score (≥ 0.5-points), (2) St George’s Respiratory Questionnaire (SGRQ) total score (≥ 4-points), (3) pre-bronchodilator forced expiratory volume in 1s (FEV1; ≥ 100 mL), all at Week 32, and (4) annualised rate of clinically significant exacerbations (≥ 50% reduction). Results Of the 145 patients included, 94%, 83%, 63% and 31% were responders for ≥ 1, ≥ 2, ≥ 3 and 4 outcomes, respectively; 75% and 78% were ACQ-5 and SGRQ score responders, and 50% and 69% were FEV1 and exacerbation responders. Subgroup analyses demonstrated improvements irrespective of baseline blood eosinophil count, prior omalizumab treatment regimen/duration, comorbidities, prior exacerbation history, maintenance oral corticosteroid use, ACQ-5 and SGRQ scores, and body weight/body mass index. Conclusions After switching to mepolizumab, almost all patients with uncontrolled severe eosinophilic asthma on omalizumab achieved a beneficial response in ≥ 1 clinical outcome. Improvements were observed regardless of baseline characteristics. Trial registration This manuscript is a post hoc analysis of data from the OSMO study. ClinicalTrials.gov, NCT02654145. Registered January 13, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01733-9.
Collapse
Affiliation(s)
- Mark C Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, CA, USA
| | - Xavier Munoz
- Pulmonology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Ciber Enfermedades Respiratorias, Madrid, Spain
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, UCB Lyon, Lyon, France
| | - Miguel Bergna
- Respiratory Research, CEMER, Vicente Lopez, Buenos Aires, Argentina
| | - Steven G Smith
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | | | - Dmitry V Galkin
- Global Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.,Chiesi USA, Cary, NC, USA
| | - Jay Azmi
- Respiratory TAU, GSK, Uxbridge, Middlesex, UK
| | | | - Frank C Albers
- Global Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.,Avillion US Inc, Northbrook, IL, USA
| | - Kenneth R Chapman
- Asthma and Airway Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
11
|
Kim MK, Park HS, Park CS, Min SJ, Albers FC, Yancey SW, Mayer B, Kwon N. Efficacy and safety of mepolizumab in Korean patients with severe eosinophilic asthma from the DREAM and MENSA studies. Korean J Intern Med 2021; 36:362-370. [PMID: 32450626 PMCID: PMC7969054 DOI: 10.3904/kjim.2019.198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/15/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS The efficacy and safety of mepolizumab in patients with severe eosinophilic asthma has been evaluated in a global clinical trial programme. This post hoc analysis assesses the efficacy and safety of mepolizumab in Korean patients. METHODS Data from Korean patients in the Phase III, placebo-controlled, randomised DREAM (MEA112997/NCT01000506) and MENSA (MEA115588/ NCT01691521) studies were included. Patients ≥ 12 years old with severe eosinophilic asthma received mepolizumab (DREAM: 75, 250 or 750 mg intravenously [IV]; MENSA: 75 mg IV or 100 mg subcutaneously [SC]), or placebo every 4 weeks for 52 weeks (DREAM) or 32 weeks (MENSA). The primary outcome was the rate of clinically significant asthma exacerbations. Secondary outcomes included forced expiratory volume in 1 second (FEV1), Asthma Control Questionnaire (ACQ) and St George's Respiratory Questionnaire (SGRQ) scores (MENSA only). Blood eosinophil counts (BEC) and safety were assessed throughout. RESULTS Reductions in the rate of clinically significant asthma exacerbations were observed with the approved (100 mg SC) and bioequivalent (75 mg IV) doses of mepolizumab in Korean patients who participated in DREAM and MENSA. In MENSA, trends for improvements from baseline at week 32 in pre-bronchodilator FEV1 (75 mg IV group), ACQ-5 and SGRQ scores (in both treatment groups) were seen versus placebo in Korean patients. Incidence of on-treatment adverse events was similar in Korean patients versus non-Korean patients as were observed reductions from baseline in BEC. CONCLUSION Mepolizumab treatment provided clinical benefits for Korean patients with severe eosinophilic asthma; the safety profile is consistent with the overall population.
Collapse
Affiliation(s)
- Mi-Kyeong Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Hae-Sim Park, M.D. Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5150 Fax: +82-31-219-5154 E-mail:
| | - Choon-Sik Park
- Department of Pulmonology and Allergy, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Frank C. Albers
- Global Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| | - Steven W. Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | | | - Namhee Kwon
- Respiratory Medical Franchise, GSK, Brentford, UK
| |
Collapse
|
12
|
Pavord ID, Bleecker ER, Buhl R, Chanez P, Bel EH, Howarth P, Bratton DJ, Albers FC, Yancey S. Response to mepolizumab treatment is sustained across 4-weekly dosing periods. ERJ Open Res 2020; 6:00068-2020. [PMID: 32963999 PMCID: PMC7487353 DOI: 10.1183/23120541.00068-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Background Mepolizumab (100 mg delivered s.c. every 4 weeks) is indicated for add-on maintenance treatment for patients with severe eosinophilic asthma. Mepolizumab has been shown to reduce exacerbations and the requirement for daily oral corticosteroids, and improve asthma control and symptoms. However, data on the durability of the response to mepolizumab during dosing periods are limited. The aim of this study was to investigate the efficacy profile in patients with severe eosinophilic asthma over the 4-weekly dosing period for various fixed mepolizumab doses. Methods This was a post hoc analysis of data from the phase IIb/III DREAM study. Patients ≥12 years of age with severe eosinophilic asthma were randomised (1:1:1:1) to receive intravenous mepolizumab 75 mg (equivalent to 100 mg s.c.), 250 mg, 750 mg or placebo, plus standard of care, every 4 weeks for 52 weeks. The number of exacerbations and eDiary data (peak expiratory flow, rescue medication use and symptom scores) from two periods in each 4-weekly dosing interval (days 1-14 and 15-28) over the 52-week treatment period were analysed. Findings eDiary data and the proportion of patients experiencing ≥1 exacerbation were similar during the first and second 2 weeks of a dosing period across all mepolizumab doses. Interpretation These results demonstrate that the response to mepolizumab is sustained over the 4-weekly dosing period with no differences across a 10-fold dose range and supports the use of the current mepolizumab dosing regimen in patients with severe eosinophilic asthma.
Collapse
Affiliation(s)
- Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Eugene R Bleecker
- Genomics and Precision Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Roland Buhl
- Dept of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Pascal Chanez
- Clinique des bronches allergies et sommeil, INSERM C2VN Center and CIC Nord APHM, Aix-Marseille University, Marseille, France
| | - Elisabeth H Bel
- Dept of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| | - Steven Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| |
Collapse
|
13
|
Wardlaw A, Howarth PH, Israel E, Taillé C, Quirce S, Mallett S, Bates S, Albers FC, Kwon N. Fungal sensitization and its relationship to mepolizumab response in patients with severe eosinophilic asthma. Clin Exp Allergy 2020; 50:869-872. [PMID: 32515118 PMCID: PMC7540511 DOI: 10.1111/cea.13680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew Wardlaw
- Institute for Lung Health, University of Leicester, Leicester, UK
| | - Peter H Howarth
- Global Medical Franchise, GSK House, Brentford, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.,Respiratory Medical Franchise, GSK, Brentford, UK
| | - Elliot Israel
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Camille Taillé
- AP-HP, Hôpital Bichat, Service de Pneumologie et Centre de Référence des Maladies Pulmonaires Rares, Dépt Hospitalo-Universitaire FIRE, Université Paris Diderot, INSERM UMR, Paris, France
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | | | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| | - Namhee Kwon
- Respiratory Medical Franchise, GSK, Brentford, UK
| |
Collapse
|
14
|
Albers FC, Hozawa S, Bratton DJ, Yancey SW, Prazma CM, Humbert M, Liu MC. Update: Mepolizumab treatment in patients with severe eosinophilic asthma and prior omalizumab use. Allergy 2020; 75:942-946. [PMID: 31520471 PMCID: PMC7216893 DOI: 10.1111/all.14048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Frank C. Albers
- Respiratory Medical Franchise GSK Research Triangle Park NC USA
| | | | | | | | | | - Marc Humbert
- Assistance Publique‐Hôpitaux de Paris Département Hospitalo‐Universitaire Thorax Innovation Service de Pneumologie Hôpital Bicêtre Université Paris‐Sud INSERM Unités Mixte de Recherche 999 Le Kremlin‐Bicêtre France
| | - Mark C. Liu
- Johns Hopkins Asthma and Allergy Center Baltimore MD USA
| |
Collapse
|
15
|
Engelkes M, de Ridder MA, Svensson E, Berencsi K, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers FC, Cockle SM, Bradford ES, Suruki RY, Brusselle GG, Rijnbeek PR, Sturkenboom MC, Verhamme KM. Multinational cohort study of mortality in patients with asthma and severe asthma. Respir Med 2020; 165:105919. [PMID: 32174450 DOI: 10.1016/j.rmed.2020.105919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Musculoskeletal Pharmaco and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank C Albers
- Global Respiratory Franchise, GlaxoSmithKline, Research Triangle Park, NC, United States
| | - Sarah M Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric S Bradford
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, United States
| | | | - Guy Go Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, ErasmusMC, Rotterdam, the Netherlands
| | | | | | | |
Collapse
|
16
|
Howarth P, Chupp G, Nelsen LM, Bradford ES, Bratton DJ, Smith SG, Albers FC, Brusselle G, Bachert C. Severe eosinophilic asthma with nasal polyposis: A phenotype for improved sinonasal and asthma outcomes with mepolizumab therapy. J Allergy Clin Immunol 2020; 145:1713-1715. [PMID: 32084443 DOI: 10.1016/j.jaci.2020.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Peter Howarth
- Global Medical, Global Specialty & Primary Care, Brentford, Middlesex, United Kingdom.
| | - Geoffrey Chupp
- Yale Center for Asthma and Airways Disease (YCAAD), Yale School of Medicine, New Haven, Conn
| | | | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | | | - Steven G Smith
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC
| | - Guy Brusselle
- Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Claus Bachert
- Upper Airways Research Laboratory, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
17
|
Müllerová H, Cockle SM, Gunsoy NB, Nelsen LM, Albers FC. Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study. J Asthma 2020; 58:459-470. [PMID: 31874051 DOI: 10.1080/02770903.2019.1708095] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Severe asthma (SA) can be uncontrolled despite guideline-directed treatment. We described SA characteristics and identified factors associated with uncontrolled disease and frequent exacerbations. METHODS Post hoc analysis of the observational IDEAL study (201722/NCT02293265) included patients with SA aged ≥12 years receiving high-dose inhaled corticosteroids plus additional controller(s) for ≥12 months. Uncontrolled SA was defined by Asthma Control Questionnaire (ACQ)-5 scores ≥1.5 or ≥1 exacerbations (prior year), and further stratified by exacerbation frequency (no/infrequent [0-1] vs frequent [≥2]; prior year); associated factors were determined using multivariate logistic regression. RESULTS Of 670 patients with SA, 540 (81%) were uncontrolled (ACQ-5 scores ≥1.5: 80%; ≥1 exacerbations [prior year]: 71%). Uncontrolled patients had lower lung function and worse health-related quality of life (HRQoL) than controlled patients; 197/540 (37%) experienced frequent exacerbations (prior year). Worse St George's Respiratory Questionnaire (SGRQ) total score, comorbid sinusitis, or eczema were significantly associated with uncontrolled SA; younger age, never smoker status, exacerbation requiring hospitalization (previous year), worse SGRQ symptom score, comorbid nasal polyps, COPD, or osteoporosis were significantly associated with uncontrolled SA with frequent exacerbations. CONCLUSIONS In IDEAL, one-fifth of patients with SA were controlled, based on symptoms. Uncontrolled, exacerbating SA was associated with specific comorbidities, frequent exacerbations, a lower lung function, and compromised HRQoL, although inference from this analysis is limited by the selective cross-sectional nature of the cohort. Nonetheless, these data highlight the need for more effective precision treatments in this population.
Collapse
Affiliation(s)
- Hana Müllerová
- Real World Evidence, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | - Sarah M Cockle
- Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Necdet B Gunsoy
- Value Evidence and Outcomes, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| |
Collapse
|
18
|
Chapman KR, Albers FC, Chipps B, Muñoz X, Devouassoux G, Bergna M, Galkin D, Azmi J, Mouneimne D, Price RG, Liu MC. The clinical benefit of mepolizumab replacing omalizumab in uncontrolled severe eosinophilic asthma. Allergy 2019; 74:1716-1726. [PMID: 31049972 PMCID: PMC6790683 DOI: 10.1111/all.13850] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Background Mepolizumab and omalizumab are treatments for distinct but overlapping severe asthma phenotypes. Objective To assess if patients eligible for both biologics but not optimally controlled with omalizumab experience improved asthma control when switched directly to mepolizumab. Methods OSMO was a multicenter, open‐label, single‐arm, 32‐week trial in patients with ≥2 asthma exacerbations in the year prior to enrollment, despite receiving high‐dose inhaled corticosteroids and other controller(s), plus omalizumab (≥4 months). At baseline, patients with blood eosinophil counts ≥150 cells/µL (or ≥300 cells/µL in the prior year) and an Asthma Control Questionnaire (ACQ)‐5 score ≥1.5 discontinued omalizumab and immediately commenced mepolizumab 100 mg subcutaneously every 4 weeks. Endpoints included change from baseline in ACQ‐5 score (primary), St George's Respiratory Questionnaire (SGRQ) score and the proportions of ACQ‐5 and SGRQ responders, all at Week 32, and the annualized exacerbation rate over the study period. Results At Week 32 (intent‐to‐treat population [n = 145]), the least squares (LS) mean changes (standard error [SE]) in ACQ‐5 and SGRQ total scores were −1.45 (0.107) and −19.0 (1.64) points; with 77% and 79% of patients achieving the minimum clinically important differences (ACQ‐5: ≥0.5 points; SGRQ: ≥4 points), respectively. The annualized rate of clinically significant exacerbations was 1.18 events/year, a 64% reduction from 3.26 events/year during the previous year. Safety and immunogenicity profiles were consistent with previous trials. Conclusion After directly switching from omalizumab to mepolizumab, patients with uncontrolled severe eosinophilic asthma experienced clinically significant improvements in asthma control, health status, and exacerbation rate, with no tolerability issues reported.
Collapse
Affiliation(s)
- Kenneth R. Chapman
- Asthma and Airway Centre University Health Network, University of Toronto Toronto Ontario Canada
| | - Frank C. Albers
- Global Respiratory Medical Franchise GSK Research Triangle Park North Carolina
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center Sacramento California
| | - Xavier Muñoz
- Pulmonology Department Hospital Universitari Vall d'Hebron Barcelona Spain
- Ciber Enfermedades Respiratorias Madrid Spain
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon UCB Lyon 1 Lyon France
| | - Miguel Bergna
- Respiratory Research CEMER, Vicente Lopez Buenos Aires Argentina
| | - Dmitry Galkin
- Global Respiratory Medical Franchise GSK Research Triangle Park North Carolina
| | | | | | | | - Mark C. Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine Johns Hopkins Asthma and Allergy Center Baltimore Maryland
| |
Collapse
|
19
|
Khurana S, Brusselle GG, Bel EH, FitzGerald JM, Masoli M, Korn S, Kato M, Albers FC, Bradford ES, Gilson MJ, Price RG, Humbert M. Long-term Safety and Clinical Benefit of Mepolizumab in Patients With the Most Severe Eosinophilic Asthma: The COSMEX Study. Clin Ther 2019; 41:2041-2056.e5. [PMID: 31447130 DOI: 10.1016/j.clinthera.2019.07.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/24/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The goal of this study was to assess the long-term safety and efficacy of mepolizumab in patients with the most severe eosinophilic asthma. METHODS This multicenter, open-label, long-term, Phase IIIb study (COSMEX [COSMOS Extension]; 201312/NCT02135692) enrolled patients from the 52-week, open-label extension study COSMOS (A Study to Determine Long-term Safety of Mepolizumab in Asthmatic Subjects) that previously enrolled patients from the double-blinded, placebo-controlled Phase III studies MENSA (Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma) and SIRIUS (Steroid Reduction with Mepolizumab Study). To enter COSMEX, patients had to have life-threatening/seriously debilitating asthma before entering MENSA or SIRIUS and to have completed these previous studies with demonstrated improvement while receiving mepolizumab. In COSMEX, patients received mepolizumab 100 mg subcutaneously every 4 weeks as add-on therapy for up to 172 weeks. Primary endpoints were adverse event frequency and exacerbation rate per year; also assessed were forced expiratory volume in 1 s, Asthma Control Questionnaire-5 score, and daily oral corticosteroid (OCS) use. FINDINGS Of the 340 patients enrolled, 339 received mepolizumab; median treatment duration within this extension study was 2.2 years, equating to 718 patient-years of additional exposure. No new safety signals were identified. Patients receiving mepolizumab throughout this study and previous studies had lasting reductions in exacerbation rate and daily OCS use and improvements in forced expiratory volume in 1 s and Asthma Control Questionnaire-5 score. In COSMEX, the on-treatment exacerbation rate (95% CI) was 0.93 (0.81-1.06) event/year for clinically significant exacerbations, 0.13 (0.10-0.18) event/year for exacerbations requiring hospitalization/emergency department visit, and 0.07 (0.05-0.10) event/year for exacerbations requiring hospitalization. In patients requiring systemic/oral corticosteroids with ≥128 weeks of continuous enrollment across SIRIUS, COSMOS, and COSMEX, mepolizumab maintained the median daily OCS dose at 1.3-2.8 mg during COSMEX, with additional patients no longer requiring OCS after extended mepolizumab treatment. IMPLICATIONS This study indicates that long-term mepolizumab treatment is well tolerated and associated with sustained clinical benefits in patients with severe eosinophilic asthma. ClinicalTrials.gov identifier: NCT02135692.
Collapse
Affiliation(s)
- Sandhya Khurana
- Department of Medicine/Pulmonary, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Mark FitzGerald
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Masoli
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Stephanie Korn
- Pulmonary Department, Universitätsmedizin Mainz, Mainz, Germany
| | - Motokazu Kato
- Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Osaka, Japan
| | - Frank C Albers
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC, USA.
| | - Eric S Bradford
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Martyn J Gilson
- Respiratory Research and Development, GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, United Kingdom
| | - Robert G Price
- Clinical Statistics, GlaxoSmithKline, Stevenage, Hertfordshire, United Kingdom
| | - Marc Humbert
- Assistance Publique -Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Paris, France; Univ. Paris-Sud, Université Paris-Saclay, Paris, France; INSERM U999, Le Kremlin-Bicêtre, Paris, France
| |
Collapse
|
20
|
Albers FC, Papi A, Taillé C, Bratton DJ, Bradford ES, Yancey SW, Kwon N. Mepolizumab reduces exacerbations in patients with severe eosinophilic asthma, irrespective of body weight/body mass index: meta-analysis of MENSA and MUSCA. Respir Res 2019; 20:169. [PMID: 31362741 PMCID: PMC6664536 DOI: 10.1186/s12931-019-1134-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We assessed the efficacy of the licensed mepolizumab dose (100 mg subcutaneously [SC]) in patients with severe eosinophilic asthma according to body weight/body mass index (BMI). METHODS This was a post hoc individual patient-level meta-analysis of data from the Phase 3 studies MENSA (MEA115588/NCT01691521) and MUSCA (200862/NCT02281318). Patients aged ≥12 years with severe eosinophilic asthma and a history of exacerbations were randomised to 4-weekly placebo, mepolizumab 75 mg intravenously (IV) or 100 mg SC (MENSA) or placebo or mepolizumab 100 mg SC (MUSCA) for 32 (MENSA) or 24 (MUSCA) weeks. The primary endpoint was the annual rate of clinically significant exacerbations; other outcomes included the proportion of patients with no exacerbations, lung function, St George's Respiratory Questionnaire (SGRQ) and Asthma Control Questionnaire-5 (ACQ-5) scores and blood eosinophil counts. Analyses were performed by baseline body weight and BMI (≤60, > 60-75, > 75-90, > 90, < 100, ≥100 kg; ≤25, > 25-30, > 30, < 36, ≥36 kg/m2). RESULTS Overall, 936 patients received placebo or mepolizumab 100 mg SC. Across all body weight/BMI categories, mepolizumab reduced the rate of clinically significant exacerbations by 49-70% versus placebo. Improvements with mepolizumab versus placebo were also seen in lung function in all body weight/BMI categories except > 90 kg; improvements in SGRQ and ACQ-5 scores were seen across all categories. CONCLUSIONS Mepolizumab 100 mg SC has consistent clinical benefits in patients with severe eosinophilic asthma across a range of body weights and BMIs. Data show that the fixed-dose regimen of mepolizumab is suitable, without the need for weight-based dosing. TRIAL REGISTRATION This manuscript is a post hoc meta-analysis of data from the Phase 3 studies MENSA and MUSCA. ClinicalTrials.gov, NCT01691521 (MEA115588; MENSA). Registered September 24, 2012. ClinicalTrials.gov, NCT02281318 (200862; MUSCA). Registered November 3, 2014.
Collapse
Affiliation(s)
- Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA. .,Present address: Avillion US Inc., Northbrook, IL, USA.
| | - Alberto Papi
- Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Camille Taillé
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence des Maladies Pulmonaires Rares, INSERM UMR1152, Paris, France
| | | | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Namhee Kwon
- Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK
| |
Collapse
|
21
|
Khurana S, Lyness JM, Mallett S, Nelsen LM, Prazma CM, Albers FC, Forshag M, Llanos JP, Yancey SW, Ortega HG. Association of depressive symptoms with health status and markers of uncontrolled severe asthma. Allergy Asthma Proc 2019; 40:230-239. [PMID: 31262378 DOI: 10.2500/aap.2019.40.4229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: There are limited data that describe the association between markers of asthma control and depressive symptoms in severe asthma. Objective: To evaluate the association between depressive symptoms and markers of asthma control in patients with uncontrolled severe eosinophilic asthma. Methods: Baseline data from the MENSA and SIRIUS studies (N = 681) of mepolizumab intervention in severe eosinophilic asthma was used. We analyzed the relationships between depressive symptom severity by using the Beck Depression Inventory (BDI-II) and quality of life by using the St. George's Respiratory Questionnaire (SGRQ), asthma control questionnaire-5 (ACQ-5), polypharmacy, and sleep symptoms. Results: When compared with patients with less severe depressive symptoms, patients with more severe depressive symptoms were predominantly female (81% versus 54%), had a higher mean body mass index (30.56 versus 27.67 kg/m²), were more likely to have a blood eosinophil count of ≥300 cells/uL within the previous 12 months (81% versus 68%), and to have experienced a near-fatal asthma event (16% versus 7%). The mean SGRQ score was higher in the severe BDI-II category compared with the minimal depressive symptoms category, which indicated a worse quality of life (71.6 versus 41.4, p < 0.001). Eighty-nine percent of the patients in the severe BDI-II category had poorly controlled asthma (ACQ-5 score ≥ 1.5) compared with 63% in the minimal category (p < 0.001). Conclusion: Increased severity of depressive symptoms was associated with worse respiratory-related quality of life and asthma control in the patients with severe eosinophilic asthma. These findings highlight the need for a multidimensional approach for the management of uncontrolled asthma, including timely identification of depressive symptoms. Additional research is needed to further explore the interactions between the two common conditions.Clinical trials NCT01691521 and NCT01619508, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link>.
Collapse
Affiliation(s)
- Sandhya Khurana
- From the Department of Medicine, Pulmonary Diseases and Critical Care, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M. Lyness
- Department of Psychiatry and Neurology, University of Rochester Medical Center, Rochester, New York
| | - Stephen Mallett
- Clinical Statistics, GlaxoSmithKline (GSK), Stockley Park, Middlesex, United Kingdom
| | - Linda M. Nelsen
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania
| | | | - Frank C. Albers
- Respiratory Franchise, GSK, Research Triangle Park, North Carolina
| | - Mark Forshag
- Respiratory United States Medical Affairs, GSK, Research Triangle Park, North Carolina
| | - Jean-Pierre Llanos
- Respiratory United States Medical Affairs, GSK, Research Triangle Park, North Carolina
| | - Steven W. Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, North Carolina
| | - Hector G. Ortega
- Respiratory United States Medical Affairs, GSK, Research Triangle Park, North Carolina
| |
Collapse
|
22
|
Nelsen LM, Cockle SM, Gunsoy NB, Jones P, Albers FC, Bradford ES, Mullerova H. Impact of exacerbations on St George's Respiratory Questionnaire score in patients with severe asthma: post hoc analyses of two clinical trials and an observational study. J Asthma 2019; 57:1006-1016. [PMID: 31251094 DOI: 10.1080/02770903.2019.1630640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the effect of asthma exacerbations and mepolizumab treatment on health status of patients with severe asthma using the St George's Respiratory Questionnaire (SGRQ).Methods: Post hoc analyses were conducted using data from two randomized controlled trials in patients ≥12 years old with severe eosinophilic asthma randomized to receive placebo or mepolizumab 75 mg intravenously (32-week MENSA study) or 100 mg subcutaneously (MENSA/24-week MUSCA studies), and an observational single-visit study in patients with severe asthma (IDEAL). Linear regression models assessed the impact of historical exacerbations on baseline SGRQ total and domain scores (using data from each of the three studies), and within-study severe exacerbations and mepolizumab treatment on end-of-study SGRQ scores (using data from MENSA/MUSCA).Results: Overall, 1755 patients were included (MENSA, N = 540; MUSCA, N = 551; IDEAL, N = 664). In all studies, higher numbers of historical exacerbations were associated with worse baseline SGRQ total scores. Each additional historical exacerbation (beyond the second [MENSA/MUSCA]) or first [IDEAL] was associated with worsening mean total SGRQ scores of +1.5, +1.1 at baseline and +2.3 within the year prior to study enrollment. During MENSA and MUSCA, each within-study severe exacerbation was associated with a worsening in total SGRQ score of +2.4 and +3.4 points at study end. Independent of exacerbation reduction, mepolizumab accounted for an improvement in total SGRQ score of -5.3 points (MENSA) and -6.2 points (MUSCA).Conclusions: These findings support an association between a higher number of exacerbations and worse health status in patients with severe (eosinophilic) asthma.
Collapse
Affiliation(s)
- Linda M Nelsen
- Patient Centered Outcomes, Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | | | - Paul Jones
- Respiratory Medical, GSK House, Brentford, UK
| | - Frank C Albers
- Respiratory Medical Franchise, GSK SK, Research Triangle Park, NC, USA
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Hana Mullerova
- Real World Evidence and Epidemiology, GSK, Stockley Park, Uxbridge, UK
| |
Collapse
|
23
|
Humbert M, Albers FC, Bratton DJ, Yancey SW, Liu MC, Hozawa S, Llanos JP, Kwon N. Effect of mepolizumab in severe eosinophilic asthma according to omalizumab eligibility. Respir Med 2019; 154:69-75. [PMID: 31220806 DOI: 10.1016/j.rmed.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with severe asthma can present with overlapping eosinophilic and allergic phenotypes, which makes it challenging when deciding which biologic therapy is most appropriate to reduce exacerbations and help achieve asthma control. OBJECTIVE This post hoc meta-analysis evaluated the efficacy of the licensed dose of mepolizumab (100 mg administered subcutaneously [SC]) versus placebo in patients with severe eosinophilic asthma (SEA), according to omalizumab eligibility and associated allergic characteristics. METHODS Data from two Phase 3 studies (MENSA [MEA115588/NCT01691521]; MUSCA [200862/NCT02281318]) were analyzed. Patients ≥12 years of age with SEA who experienced ≥2 exacerbations in the previous year received placebo, mepolizumab 100 mg SC or 75 mg intravenously, plus standard of care (high-dose inhaled corticosteroids and other controllers), every 4 weeks. Data from patients who received ≥1 dose placebo or mepolizumab 100 mg SC were used for this analysis. The primary endpoint was the rate of clinically significant exacerbations; other outcomes included forced expiratory volume in 1 s (FEV1), Asthma Control Questionnaire (ACQ-5) score and quality of life measured using St George's Respiratory Questionnaire (SGRQ). RESULTS Rate reductions in clinically significant exacerbations with mepolizumab versus placebo were similar in omalizumab eligible and ineligible patients (57% vs 55%). FEV1, ACQ-5 and SGRQ scores improved with mepolizumab versus placebo regardless of omalizumab eligibility, Immunoglobulin E levels, or atopic status. CONCLUSION This analysis indicated that mepolizumab 100 mg SC has clinical benefit in patients with blood eosinophil counts ≥150 cells/μL (or history of ≥300 cells/μL), regardless of allergic characteristics or omalizumab eligibility.
Collapse
Affiliation(s)
- Marc Humbert
- Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, INSERM U 999, Le Kremlin-Bicêtre, France.
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.
| | - Daniel J Bratton
- Clinical Statistics, GSK, Stockley Park, Uxbridge, Middlesex, UK.
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA.
| | - Mark C Liu
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA.
| | | | | | - Namhee Kwon
- Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK.
| |
Collapse
|
24
|
Prazma CM, Bel EH, Price RG, Bradford ES, Albers FC, Yancey SW. Oral corticosteroid dose changes and impact on peripheral blood eosinophil counts in patients with severe eosinophilic asthma: a post hoc analysis. Respir Res 2019; 20:83. [PMID: 31053134 PMCID: PMC6499981 DOI: 10.1186/s12931-019-1056-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An inverse relationship between oral corticosteroid (OCS) dose and peripheral blood eosinophil (PBE) count is widely recognized in patients with severe eosinophilic asthma; however, there are limited data available to quantify this relationship. This post hoc analysis of the SIRIUS study (NCT01691508) examined the impact of weekly incremental OCS dose reductions on PBE counts during the 3-8-week optimization phase of the study. METHODS SIRIUS was a randomized, double-blind study involving patients with severe asthma (≥12 years old), which included an initial OCS dose optimization phase prior to randomization. Regression analysis assuming a linear relationship between change in OCS dose and change in log (PBE count) during the optimization phase was used to estimate the changes in PBE count following specific decreases in OCS dose. RESULTS All 135 patients from the SIRIUS intent-to-treat population were included in this analysis. During the optimization period, 44% (60/135) of patients reduced their OCS dose, with an increase in geometric mean PBE count of 110 cells/μL (200 to 310 cells/μL; geometric mean ratio from beginning to end of the optimization phase: 1.52) recorded in these patients. The model estimated that reduction of daily OCS dose by 5 mg/day led to a 41% increase in PBE count (mean ratio to beginning of optimization phase: 1.41 [95% confidence interval (CI); 1.22, 1.63]). CONCLUSION These data confirmed and quantified the inverse association between OCS dose and PBE count. These insights will help to inform clinicians when tapering OCS doses in patients with severe eosinophilic asthma.
Collapse
Affiliation(s)
- Charlene M Prazma
- Respiratory Medical Franchise, GSK, Research Triangle Park, 5 Moore Drive, PO Box 13398, Raleigh-Durham, North Carolina, 27709, USA.
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, Raleigh-Durham, NC, USA
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, 5 Moore Drive, PO Box 13398, Raleigh-Durham, North Carolina, 27709, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, Raleigh-Durham, NC, USA
| |
Collapse
|
25
|
Ortega HG, Meyer E, Brusselle G, Asano K, Prazma CM, Albers FC, Mallett SA, Yancey SW, Gleich GJ. Update on immunogenicity in severe asthma: Experience with mepolizumab. J Allergy Clin Immunol Pract 2019; 7:2469-2475.e1. [PMID: 30954640 DOI: 10.1016/j.jaip.2019.03.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/01/2019] [Accepted: 03/26/2019] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Koichiro Asano
- Pulmonary Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC
| | - Stephen A Mallett
- Clinical Statistics, GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom
| | - Steve W Yancey
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC
| | | |
Collapse
|
26
|
Müllerová H, Meeraus WH, Galkin DV, Albers FC, Landis SH. Clinical burden of illness among patients with severe eosinophilic COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:741-755. [PMID: 31114180 PMCID: PMC6497493 DOI: 10.2147/copd.s194511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background: There are currently limited real-world data on the clinical burden of illness in patients with COPD who continue to exacerbate despite receiving triple therapy. The aim of this study was to compare the burden of COPD in patients with and without a phenotype characterized by a high blood eosinophil count and high risk of exacerbations while receiving triple therapy. Methods: This retrospective cohort study (GSK ID: 207323/PRJ2647) used UK Clinical Practice Research Datalink records linked with Hospital Episode Statistics. Eligible patients had a COPD medical diagnosis code recorded between January 1, 2004 and December 31, 2014, and a blood eosinophil count recorded on/after that date. Patients were followed from index date (first qualifying blood eosinophil count) until December 31, 2015. The study phenotype was defined as ≥2 moderate/≥1 severe acute exacerbation of COPD (AECOPD) in the year prior to the index date, current use of multiple-inhaler triple therapy (MITT), and blood eosinophil count ≥150 cells/µL on the index date. Outcomes measured during follow-up included moderate/severe AECOPDs, severe AECOPDs, all-cause mortality, primary care (GP) clinical consultations, and non-AECOPD-related unscheduled hospitalizations. Results: Of 46,814 patients eligible for inclusion, 2512 (5.4%) met the definition of the study phenotype. Adjusted rate ratios (95% CI) of moderate/severe AECOPDs and all-cause mortality in patients with the study phenotype versus those without were 2.32 (2.22, 2.43) and 1.26 (1.16, 1.37), respectively. For GP visits and non-AECOPD-related unscheduled hospitalizations, adjusted rate ratios (95% CI), in patients with the study phenotype versus those without, were 1.09 (1.05, 1.12) and 1.31 (1.18, 1.46), respectively. Conclusion: Patients with COPD and raised blood eosinophil counts who continue to exacerbate despite MITT represent a distinct subgroup who experience substantial clinical burden and account for high healthcare expenditure. There is a need for more effective management and therapeutic options for these patients.
Collapse
Affiliation(s)
| | | | | | | | - Sarah H Landis
- Respiratory Epidemiology, GSK, Uxbridge, UK.,Patient Centered Outcomes and Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| |
Collapse
|
27
|
Gunsoy NB, Bratton DJ, Albers FC, Busse W. Reply. J Allergy Clin Immunol 2019; 143:1267-1268. [PMID: 30639066 DOI: 10.1016/j.jaci.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/16/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | - Daniel J Bratton
- Clinical Statistics, GSK, Stockley Park, Uxbridge, United Kingdom
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC
| | - William Busse
- Department of Medicine, Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, Wis.
| |
Collapse
|
28
|
Khatri S, Moore W, Gibson PG, Leigh R, Bourdin A, Maspero J, Barros M, Buhl R, Howarth P, Albers FC, Bradford ES, Gilson M, Price RG, Yancey SW, Ortega H. Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma. J Allergy Clin Immunol 2018; 143:1742-1751.e7. [PMID: 30359681 DOI: 10.1016/j.jaci.2018.09.033] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mepolizumab has demonstrated favorable safety and efficacy profiles in placebo-controlled trials of 12 months' duration or less; however, long-term data are lacking. OBJECTIVE We sought to evaluate the long-term safety and efficacy of mepolizumab in patients with severe eosinophilic asthma (SEA). METHODS COLUMBA (Open-label Long Term Extension Safety Study of Mepolizumab in Asthmatic Subjects, NCT01691859) was an open-label extension study in patients with SEA previously enrolled in DREAM (Dose Ranging Efficacy And Safety With Mepolizumab in Severe Asthma, NCT01000506). Patients received 100 mg of subcutaneous mepolizumab every 4 weeks plus standard of care until a protocol-defined stopping criterion was met. Safety end points included frequency of adverse events (AEs), serious AEs, and AEs of special interest. Efficacy end points included annualized exacerbation rates, changes from baseline in Asthma Control Questionnaire 5 scores, and blood eosinophil counts. Immunogenicity was also assessed. RESULTS Overall, 347 patients were enrolled for an average of 3.5 years (maximum, 4.5 years; total exposure, 1201 patient-years). On-treatment AEs were reported in 94% of patients (exposure-adjusted rate, 3688 events/1000 patient-years). The most frequently reported on-treatment AEs were respiratory tract infection, headache, bronchitis, and asthma worsening. Seventy-nine (23%) patients experienced 1 or more on-treatment serious AEs; there were 6 deaths, none of which were assessed as related to mepolizumab. For patients with 156 weeks or greater enrollment, the exacerbation rate was 0.74 events/y (weeks 0-156), a 56% reduction from the off-treatment period between DREAM and COLUMBA. For all patients, at the first postbaseline assessment, the mean Asthma Control Questionnaire 5 score was reduced by 0.47 points, and blood eosinophil counts were reduced by 78%, with similar improvements maintained throughout the study. The immunogenicity profile (8% anti-drug antibodies) was consistent with previous studies. CONCLUSION These data support the long-term safety and efficacy of mepolizumab in patients with SEA.
Collapse
Affiliation(s)
- Sumita Khatri
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wendy Moore
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, NC
| | - Peter G Gibson
- Priority Research Center for Healthy Lungs and Center of Excellence in Severe Asthma, University of Newcastle, Newcastle, Australia
| | - Richard Leigh
- Department of Medicine and Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arnaud Bourdin
- Department of Respiratory Diseases PhyMedExp, University of Montpellier, Montpellier, France; Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - Jorge Maspero
- Fundación Cidea Allergy and Respiratory Research Unit, Buenos Aires, Argentina
| | - Manuel Barros
- School of Medicine, Universidad de Valparaiso, Valparaiso, Chile; Hospital Carlos van Buren, Valparaiso, Chile
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Peter Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom; Global Respiratory Franchise, GSK House, Brentford, Middlesex, United Kingdom
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Martyn Gilson
- Respiratory Research and Development, GSK, Uxbridge, Middlesex, United Kingdom
| | - Robert G Price
- Clinical Statistics, GSK, Stevenage, Hertfordshire, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | | |
Collapse
|
29
|
Busse W, Chupp G, Nagase H, Albers FC, Doyle S, Shen Q, Bratton DJ, Gunsoy NB. Anti-IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison. J Allergy Clin Immunol 2018; 143:190-200.e20. [PMID: 30205189 DOI: 10.1016/j.jaci.2018.08.031] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/24/2018] [Accepted: 08/31/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Three anti-IL-5 pathway-directed therapies are approved for use in patients with severe eosinophilic asthma (SEA); however, no head-to-head comparison data are available. OBJECTIVE We sought to compare the efficacy of licensed doses of mepolizumab, benralizumab, and reslizumab in patients with SEA, according to baseline blood eosinophil counts. METHODS This indirect treatment comparison (ITC) used data from a Cochrane review and independent searches. Eligible studies were randomized controlled trials in patients aged 12 years or greater with SEA. End points included annualized rate of clinically significant exacerbations and change from baseline in Asthma Control Questionnaire score and FEV1. An ITC was performed in patients with Asthma Control Questionnaire scores of 1.5 or greater and stratified by baseline blood eosinophil count. RESULTS Eleven studies were included. All treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control versus placebo in all blood eosinophil count subgroups. Mepolizumab reduced clinically significant exacerbations by 34% to 45% versus benralizumab across subgroups (rate ratio ≥400 cells/μL: 0.55 [95% CI, 0.35-0.87]; ≥300 cells/μL: 0.61 [95% CI, 0.37-0.99]; and ≥150 cells/μL: 0.66 [95% CI, 0.49-0.89]; all P < .05) and by 45% versus reslizumab in the 400 cells/μL or greater subgroup (rate ratio, 0.55 [95% CI, 0.36-0.85]; P = .007). Asthma control was significantly improved with mepolizumab versus benralizumab (all subgroups: P < .05) and versus reslizumab in the 400 cells/μL or greater subgroup (P = .004). Benralizumab significantly improved lung function versus reslizumab in the 400 cells/μL or greater subgroup (P = .025). CONCLUSIONS This ITC of the licensed doses suggests that mepolizumab was associated with significantly greater improvements in clinically significant exacerbations and asthma control compared with reslizumab or benralizumab in patients with similar blood eosinophil counts.
Collapse
Affiliation(s)
- William Busse
- Department of Medicine, Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, Wis.
| | | | - Hiroyuki Nagase
- Teikyo University School of Medicine, Division of Respiratory Medicine and Allergology, Department of Medicine, Tokyo, Japan
| | - Frank C Albers
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC
| | - Scott Doyle
- Value Evidence & Outcomes, GlaxoSmithKline, Brentford, United Kingdom
| | - Qin Shen
- Analytics and Innovation, Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Pa
| | - Daniel J Bratton
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, United Kingdom
| | - Necdet B Gunsoy
- Value Evidence & Outcomes, GlaxoSmithKline, Brentford, United Kingdom
| |
Collapse
|
30
|
Ortega H, Yancey SW, Keene ON, Gunsoy NB, Albers FC, Howarth PH. Asthma Exacerbations Associated with Lung Function Decline in Patients with Severe Eosinophilic Asthma. J Allergy Clin Immunol Pract 2018; 6:980-986.e1. [PMID: 29398640 DOI: 10.1016/j.jaip.2017.12.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited data describe the association between the frequency of asthma exacerbations and the decline in lung function in severe asthma. OBJECTIVE To determine whether asthma exacerbations are associated with enhanced decline in lung function. METHODS Changes in lung function were analyzed retrospectively using data from the DREAM and MENSA studies of mepolizumab intervention in patients with severe asthma. Patients were either nonsmokers or former smokers. A linear regression model was used to analyze the relationship between the number of exacerbations and decline in FEV1 across treatment groups. RESULTS In a combined post hoc analysis, 57% (n = 572) of patients had no exacerbations and experienced an improvement in postbronchodilator FEV1 of 143 mL. In contrast, in patients who experienced 3 or more exacerbations, there was a decrease in postbronchodilator FEV1 of 77 mL in the combined analysis. The linear modeling analysis estimated that for each exacerbation seen during the observational period, there was a decrease of 50 mL in FEV1 (P < .001). CONCLUSIONS A direct relationship between the number of exacerbations in patients with severe eosinophilic asthma and decline in lung function was observed. Repeated exacerbations may be associated with accelerated loss of lung function.
Collapse
Affiliation(s)
- Hector Ortega
- Respiratory, US Medical Affairs, GSK, La Jolla, Calif.
| | - Steven W Yancey
- Respiratory Medicine Development Center, GSK, Research Triangle Park, NC
| | - Oliver N Keene
- Clinical Statistics, GSK, Stockley Park, Middlesex, United Kingdom
| | - Necdet B Gunsoy
- Clinical Statistics, GSK, Stockley Park, Middlesex, United Kingdom
| | - Frank C Albers
- Respiratory Medicine Development Center, GSK, Research Triangle Park, NC
| | - Peter H Howarth
- Research and Development, GSK, Stockley Park, Middlesex, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom
| |
Collapse
|
31
|
Ortega H, Menzies-Gow A, Llanos-Ackert JP, Forshag MS, Albers FC, Gunsoy N, Bradford E, Yancey SW, Kraft M. Improvement of lung function measured by AM PEF in patients with severe eosinophilic asthma treated with mepolizumab: A combined analysis of the MENSA and MUSCA studies. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
32
|
Galkin D, Liu MC, Chipps BE, Chapman KR, Muñoz X, Angel Bergna M, Azmi J, Mouneimne D, Joksaite S, Albers FC. Efficacy and Safety of Mepolizumab in Uncontrolled Patients with Severe Eosinophilic Asthma Following a Switch from Omalizumab (OSMO Study): Exacerbation and Safety Outcomes. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
33
|
Gunsoy NB, Cockle SM, Yancey SW, Keene ON, Bradford ES, Albers FC, Pavord ID. Evaluation of Potential Continuation Rules for Mepolizumab Treatment of Severe Eosinophilic Asthma. J Allergy Clin Immunol Pract 2017; 6:874-882.e4. [PMID: 29258789 DOI: 10.1016/j.jaip.2017.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mepolizumab significantly reduces exacerbations in patients with severe eosinophilic asthma. The early identification of patients likely to receive long-term benefit from treatment could ensure effective resource allocation. OBJECTIVE To assess potential continuation rules for mepolizumab in addition to initiation criteria defined as 2 or more exacerbations in the previous year and blood eosinophil counts of 150 cells/μL or more at initiation or 300 cells/μL or more in the previous year. METHODS This post hoc analysis included data from 2 randomized, double-blind, placebo-controlled studies (NCT01000506 and NCT01691521) of mepolizumab in patients with severe eosinophilic asthma (N = 1,192). Rules based on blood eosinophils, physician-rated response to treatment, FEV1, Asthma Control Questionnaire (ACQ-5) score, and exacerbation reduction were assessed at week 16. To assess these rules, 2 key metrics accounting for the effects observed in the placebo arm were developed. RESULTS Patients not meeting continuation rules based on physician-rated response, FEV1, and the ACQ-5 score still derived long-term benefit from mepolizumab. Nearly all patients failing to reduce blood eosinophils had counts of 150 cells/μL or less at baseline. For exacerbations, assessment after 16 weeks was potentially premature for predicting future exacerbations. CONCLUSION There was no evidence of a reliable physician-rated response, ACQ-5 score, or lung function-based continuation rule. The added value of changes in blood eosinophils at week 16 over baseline was marginal. Initiation criteria for mepolizumab treatment provide the best method for assessing patient benefit from mepolizumab treatment, and treatment continuation should be reviewed on the basis of a predefined reduction in long-term exacerbation frequency and/or oral corticosteroid dose.
Collapse
Affiliation(s)
- Necdet B Gunsoy
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, United Kingdom.
| | - Sarah M Cockle
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC
| | - Oliver N Keene
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, United Kingdom
| | - Eric S Bradford
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC
| | - Frank C Albers
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC
| | - Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
34
|
Pavord ID, Chanez P, Criner GJ, Kerstjens HAM, Korn S, Lugogo N, Martinot JB, Sagara H, Albers FC, Bradford ES, Harris SS, Mayer B, Rubin DB, Yancey SW, Sciurba FC. Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease. N Engl J Med 2017; 377:1613-1629. [PMID: 28893134 DOI: 10.1056/nejmoa1708208] [Citation(s) in RCA: 344] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype may benefit from treatment with mepolizumab, a monoclonal antibody directed against interleukin-5. METHODS We performed two phase 3, randomized, placebo-controlled, double-blind, parallel-group trials comparing mepolizumab (100 mg in METREX, 100 or 300 mg in METREO) with placebo, given as a subcutaneous injection every 4 weeks for 52 weeks in patients with COPD who had a history of moderate or severe exacerbations while taking inhaled glucocorticoid-based triple maintenance therapy. In METREX, unselected patients in the modified intention-to-treat population with an eosinophilic phenotype were stratified according to blood eosinophil count (≥150 per cubic millimeter at screening or ≥300 per cubic millimeter during the previous year). In METREO, all patients had a blood eosinophil count of at least 150 per cubic millimeter at screening or at least 300 per cubic millimeter during the previous year. The primary end point was the annual rate of moderate or severe exacerbations. Safety was also assessed. RESULTS In METREX, the mean annual rate of moderate or severe exacerbations in the modified intention-to-treat population with an eosinophilic phenotype (462 patients) was 1.40 per year in the mepolizumab group versus 1.71 per year in the placebo group (rate ratio, 0.82; 95% confidence interval [CI], 0.68 to 0.98; adjusted P=0.04); no significant between-group differences were found in the overall modified intention-to-treat population (836 patients) (rate ratio, 0.98; 95% CI, 0.85 to 1.12; adjusted P>0.99). In METREO, the mean annual rate of moderate or severe exacerbations was 1.19 per year in the 100-mg mepolizumab group, 1.27 per year in the 300-mg mepolizumab group, and 1.49 per year in the placebo group. The rate ratios for exacerbations in the 100-mg and 300-mg mepolizumab groups versus the placebo group were 0.80 (95% CI, 0.65 to 0.98; adjusted P=0.07) and 0.86 (95% CI, 0.70 to 1.05; adjusted P=0.14), respectively. A greater effect of mepolizumab, as compared with placebo, on the annual rate of moderate or severe exacerbations was found among patients with higher blood eosinophil counts at screening. The safety profile of mepolizumab was similar to that of placebo. CONCLUSIONS Mepolizumab at a dose of 100 mg was associated with a lower annual rate of moderate or severe exacerbations than placebo among patients with COPD and an eosinophilic phenotype. This finding suggests that eosinophilic airway inflammation contributes to COPD exacerbations. (Funded by GlaxoSmithKline; METREX and METREO ClinicalTrials.gov numbers, NCT02105948 and NCT02105961 .).
Collapse
MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Biomarkers/blood
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Eosinophils
- Female
- Glucocorticoids/therapeutic use
- Humans
- Injections, Subcutaneous
- Intention to Treat Analysis
- Leukocyte Count
- Male
- Middle Aged
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/immunology
Collapse
Affiliation(s)
- Ian D Pavord
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Pascal Chanez
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Gerard J Criner
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Huib A M Kerstjens
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Stephanie Korn
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Njira Lugogo
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Jean-Benoit Martinot
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Hironori Sagara
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Frank C Albers
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Eric S Bradford
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Stephanie S Harris
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Bhabita Mayer
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - David B Rubin
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Steven W Yancey
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| | - Frank C Sciurba
- From the Respiratory Medicine Unit and Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford (I.D.P.), and Clinical Statistics, GlaxoSmithKline, Uxbridge (B.M.) - both in the United Kingdom; the Department of Respiratory Medicine and CIC Nord, Aix-Marseille University, Marseille, France (P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Department of Pulmonary Medicine and Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands (H.A.M.K.); the Pulmonary Department, Mainz University Hospital, Mainz, Germany (S.K.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham (N.L.), and the Respiratory Medical Franchise (F.C.A.) and the Respiratory Therapeutic Area (E.S.B., S.S.H., D.B.R., S.W.Y.), GlaxoSmithKline, Research Triangle Park - all in North Carolina; the Department of Pneumology, Centre Hospitalier Universitaire-Université Catholique de Louvain, Namur, Namur, Belgium (J.-B.M.); the Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Tokyo (H.S.); and the Department of Medicine, University of Pittsburgh, Pittsburgh (F.C.S.)
| |
Collapse
|
35
|
Albers FC, Müllerová H, Gunsoy NB, Shin JY, Nelsen LM, Bradford ES, Cockle SM, Suruki RY. Biologic treatment eligibility for real-world patients with severe asthma: The IDEAL study. J Asthma 2017. [PMID: 28622052 DOI: 10.1080/02770903.2017.1322611] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Severe asthma comprises several distinct phenotypes. Consequently, patients with severe asthma can be eligible for more than one biologic treatment targeting Th2 inflammation, such as anti-interleukin (IL)-5 and anti-immunoglobulin (Ig) E. The objective of this study was to describe treatment eligibility and overlap in treatment eligibility for mepolizumab (anti-IL-5), omalizumab (anti-IgE) and reslizumab (anti-IL-5) in patients with severe asthma, who were recruited from clinical practice. METHODS This cross-sectional, single-visit, observational study in six countries enrolled patients with severe asthma (defined by American Thoracic Society/European Respiratory Society guidelines). Assessable patients were analysed as a total cohort and a sub-cohort, who were not currently receiving omalizumab. Treatment eligibility was defined according to the local prescribing information or protocol-defined inclusion/exclusion criteria. Patients currently receiving omalizumab were automatically categorised as omalizumab-eligible. RESULTS The total cohort comprised 670 patients who met the analysis criteria, of whom 20% were eligible for mepolizumab, 31-41% were eligible for omalizumab (depending on eligibility criteria used), and 5% were eligible for reslizumab. In patients not currently receiving omalizumab (n = 502), proportions eligible for each biologic were similar (mepolizumab: 20%, reslizumab 6%) or lower (omalizumab 7-21%) than those for the total cohort. Overlap in treatment eligibility varied; in mepolizumab-eligible patients not currently receiving omalizumab (n = 101), 27-37% were omalizumab-eligible and 18% were reslizumab-eligible. CONCLUSIONS Treatment eligibility for mepolizumab and omalizumab was higher than that for reslizumab. Although there was some overlap in treatment eligibility, the patient groups eligible for treatment with anti-IL-5 or anti-IgE therapies were often distinct, emphasising the different phenotypes and endotypes in severe asthma.
Collapse
Affiliation(s)
- Frank C Albers
- a Respiratory Medical Franchise, GSK , Research Triangle Park , NC , USA
| | - Hana Müllerová
- b Real World Evidence, GSK , Stockley Park, Uxbridge , Middlesex , UK
| | - Necdet B Gunsoy
- c Clinical Statistics, GSK , Stockley Park, Uxbridge , Middlesex , UK
| | | | - Linda M Nelsen
- e Value Evidence and Outcomes, GSK , Collegeville , PA , USA
| | - Eric S Bradford
- a Respiratory Medical Franchise, GSK , Research Triangle Park , NC , USA
| | - Sarah M Cockle
- f Value Evidence and Outcomes, GSK House , Brentford , Middlesex , UK
| | - Robert Y Suruki
- g Worldwide Epidemiology, GSK , Research Triangle Park , NC , USA.,h Department of Epidemiology, UCB Biosciences , Research Triangle Park , NC , USA
| |
Collapse
|
36
|
Chupp GL, Bradford ES, Albers FC, Bratton DJ, Wang-Jairaj J, Nelsen LM, Trevor JL, Magnan A. Reappraisal of the clinical effect of mepolizumab - Authors' reply. Lancet Respir Med 2017; 5:e21. [PMID: 28664853 DOI: 10.1016/s2213-2600(17)30184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Geoffrey L Chupp
- Yale Center for Asthma and Airways Disease, Yale School of Medicine, New Haven, CT 06520-8057, USA.
| | - Eric S Bradford
- Respiratory Therapeutic Area, GlaxoSmithKline (GSK), Research Triangle Park, NC, USA
| | - Frank C Albers
- Respiratory Medical Franchise, GlaxoSmithKline (GSK), Research Triangle Park, NC, USA
| | | | | | | | - Jennifer L Trevor
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Antoine Magnan
- l'Institut du Thorax, Universite de Nantes, CHU de Nantes, Nantes, France
| |
Collapse
|
37
|
Nelsen LM, Vernon M, Ortega H, Cockle SM, Yancey SW, Brusselle G, Albers FC, Jones PW. Evaluation of the psychometric properties of the St George's Respiratory Questionnaire in patients with severe asthma. Respir Med 2017; 128:42-49. [PMID: 28610668 DOI: 10.1016/j.rmed.2017.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Limited data exist on the quantitative validity of the St George's Respiratory Questionnaire (SGRQ) in asthma populations. This study evaluated the psychometric properties of the SGRQ in patients with severe asthma. METHODS This was a post-hoc analysis of pooled data from MENSA (N = 576; NCT01691508) and SIRIUS (N = 135; NCT01691521), two randomized, placebo controlled trials of mepolizumab in patients with severe asthma. Patients completed the SGRQ at Baseline and Exit (MENSA Week 32; SIRIUS Week 24). Distributional characteristics, internal consistency reliability, test-retest reliability, convergent and discriminant validity, known-groups validity and responsiveness were assessed. RESULTS Internal consistency reliability was acceptable for the total and domain scores at Baseline and Exit (Cronbach's α was 0.92 and 0.94 at Baseline and Exit, respectively, for the total score). Test-retest reliability was demonstrated (intraclass correlation coefficients >0.7) for total score and the Activity and Impacts domains. Convergent and discriminant validity were demonstrated with measures associated or not associated with respiratory-related health status. Known groups validity based on baseline FEV1% predicted, Asthma Control Questionnaire (ACQ)-5 score, exacerbations and eosinophil counts was demonstrated for the SGRQ total and domain scores. Responses to therapy based on clinician-rated response, patient-rated response, ACQ-5 change score and exacerbations generally correlated with improvements in SGRQ scores. CONCLUSIONS This analysis demonstrated that the SGRQ has acceptable psychometric properties in patients with severe asthma, exceeding the thresholds for adequate reliability, validity and responsiveness. The SGRQ appears to be a good instrument for identifying response to therapy in patients with severe asthma.
Collapse
Affiliation(s)
- Linda M Nelsen
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.
| | | | - Hector Ortega
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Sarah M Cockle
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Guy Brusselle
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank C Albers
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Paul W Jones
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| |
Collapse
|
38
|
Suruki RY, Daugherty JB, Boudiaf N, Albers FC. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm Med 2017; 17:74. [PMID: 28449686 PMCID: PMC5406966 DOI: 10.1186/s12890-017-0409-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. METHODS Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010-2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009-2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date). Outcomes included: frequency of exacerbations (asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks) 12 months post-index, asthma-related ED visits/hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model. RESULTS Of the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit/hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32-35% for an exacerbation requiring ED visit/hospitalization versus oral corticosteroids. CONCLUSION Increased disease severity was associated with higher exacerbation frequency, ED/hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management.
Collapse
Affiliation(s)
- Robert Y Suruki
- Worldwide Epidemiology, GSK, Research Triangle Park, Durham, NC, USA.,Present Address: UCB Biosciences, Epidemiology, Research Triangle Park, Durham, NC, USA
| | - Jonas B Daugherty
- Value Outcomes and Epidemiology, PAREXEL International, Research Triangle Park, Durham, NC, USA.,Present Address: Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Nada Boudiaf
- Worldwide Epidemiology, GSK, Stockley Park, Uxbridge, UK.,Present Address: Chiltern International Ltd, Slough, Berkshire, UK
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, 5 Moore Drive, PO Box 13398, Durham, NC, 27709, USA.
| |
Collapse
|
39
|
Chupp GL, Bradford ES, Albers FC, Bratton DJ, Wang-Jairaj J, Nelsen LM, Trevor JL, Magnan A, Ten Brinke A. Efficacy of mepolizumab add-on therapy on health-related quality of life and markers of asthma control in severe eosinophilic asthma (MUSCA): a randomised, double-blind, placebo-controlled, parallel-group, multicentre, phase 3b trial. Lancet Respir Med 2017; 5:390-400. [PMID: 28395936 DOI: 10.1016/s2213-2600(17)30125-x] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mepolizumab, an anti-interleukin-5 monoclonal antibody approved as add-on therapy to standard of care for patients with severe eosinophilic asthma, has been shown in previous studies to reduce exacerbations and dependency on oral corticosteroids compared with placebo. We aimed to further assess mepolizumab in patients with severe eosinophilic asthma by examining its effect on health-related quality of life (HRQOL). METHODS We did a randomised, double-blind, placebo-controlled, parallel-group, multicentre, phase 3b trial (MUSCA) in 146 hospitals or research centres in 19 countries worldwide. Eligible participants were patients aged 12 years or older with severe eosinophilic asthma and a history of at least two exacerbations requiring treatment in the previous 12 months before screening despite regular use of high-dose inhaled corticosteroids plus other controller medicines. Exclusion criteria included current smokers or former smokers with a history of at least ten pack-years. We randomly assigned participants (1:1) by country to receive a subcutaneous injection of either mepolizumab 100 mg or placebo, plus standard of care, every 4 weeks for 24 weeks (the final dose was given at week 20). We did the randomisation using an interactive voice response system and a centralised, computer-generated, permuted-block design of block size six. The two treatments were identical in appearance and administered in a masked manner; patients, investigators, other site staff and the entire study team including those assessing outcomes data were also masked to group assignment. The primary endpoint was the mean change from baseline in the St George's Respiratory Questionnaire (SGRQ) total score at week 24 in the modified intention-to-treat (modified ITT) population (analysed according to their randomly assigned treatment). Safety was assessed in all patients who received at least one dose of trial medication (analysed according to the actual treatment received). This trial is registered with ClinicalTrials.gov, number NCT02281318. FINDINGS We recruited patients between Dec 11, 2014, and Nov 20, 2015, and the study was undertaken between Dec 11, 2014, and June 10, 2016. The modified ITT population comprised 274 patients assigned to mepolizumab 100 mg and 277 assigned to placebo. Mepolizumab versus placebo showed significant improvements at week 24 from baseline in SGRQ total score (least squares mean [SE] change from baseline -15·6 (1·0) vs -7·9 (1·0), a treatment difference of -7·7 (95% CI -10·5 to -4·9; p<0·0001). No deaths occurred during the study. 192 (70%) of 273 patients who received mepolizumab and 207 (74%) of 278 who received placebo reported at least one on-treatment adverse event, the most common of which were headache (in 45 [16%] given mepolizumab vs 59 [21%] given placebo) and nasopharyngitis (in 31 [11%] given mepolizumab vs 46 [17%] given placebo). 15 (5%) and 22 (8%) patients had an on-treatment serious adverse event in the mepolizumab and placebo groups, respectively; the most common was asthma in both groups (in three [1%] given mepolizumab vs nine [3%] given placebo). INTERPRETATION Mepolizumab was associated with significant improvements in HRQOL in patients with severe eosinophilic asthma, and had a safety profile similar to that of placebo. These results add to and support the use of mepolizumab as a favourable add-on treatment option to standard of care in patients with severe eosinophilic asthma. FUNDING GlaxoSmithKline.
Collapse
Affiliation(s)
- Geoffrey L Chupp
- Yale Center for Asthma and Airway Disease, Yale School of Medicine, New Haven, CT, USA.
| | - Eric S Bradford
- Respiratory Therapeutic Area, GlaxoSmithKline (GSK), Research Triangle Park, NC, USA
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
| | | | | | | | - Jennifer L Trevor
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Antoine Magnan
- l'Institut du Thorax, Universite de Nantes, CHU de Nantes, Nantes, France
| | - Anneke Ten Brinke
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| |
Collapse
|
40
|
Nelsen LM, Kimel M, Murray LT, Ortega H, Cockle SM, Yancey SW, Brusselle G, Albers FC, Jones PW. Qualitative evaluation of the St George's Respiratory Questionnaire in patients with severe asthma. Respir Med 2017; 126:32-38. [PMID: 28427547 DOI: 10.1016/j.rmed.2017.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Content validity is the extent to which a patient-reported outcome measure evaluates the concepts most relevant to a patient's condition and treatment. The St George's Respiratory Questionnaire (SGRQ) has been validated in a range of respiratory conditions. This study evaluated the content validity of the SGRQ in patients with severe asthma. METHODS A qualitative study, guided by a protocol, which included concept elicitation and cognitive debriefing of the SGRQ, was conducted in patients aged ≥18 years with history of severe asthma and blood eosinophil counts of ≥150/μL (past month) or ≥300/μL (past 12 months). Patients were recruited until saturation for concept elicitation was achieved (i.e. no additional concepts identified). Concepts identified by the patients were then mapped to the SGRQ. RESULTS 18 patient interviews provided concept saturation. Concept elicitation confirmed that the SGRQ includes the commonly reported asthma symptoms and their impact on daily life. In total, 89-100% of patients routinely experienced cough, nighttime awakenings, shortness of breath, chest tightness, sleep difficulty, phlegm/mucus, and wheezing. Patients reported asthma impacting daily and physical activities, mood and sleep. Cognitive interviewing confirmed that patients understood the instructions, items and response options in the SGRQ. Nearly half of the concepts in the SGRQ were endorsed by ≥12 patients; of the 17 items with scoring weights ≥85, 11 were mentioned by ≥12 patients. CONCLUSIONS This study demonstrates that the SGRQ is a relevant, comprehensive and content-valid instrument to assess health status in patients with severe asthma.
Collapse
Affiliation(s)
- Linda M Nelsen
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.
| | | | | | - Hector Ortega
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | | | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Guy Brusselle
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank C Albers
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | | |
Collapse
|
41
|
Albers FC, Cockle S, Gunsoy N, Shin JY, Nelsen LM, Müllerová H. Eligibility for mepolizumab, omalizumab and reslizumab in the EU population: The IDEAL Study. Pneumologie 2017. [DOI: 10.1055/s-0037-1598374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- FC Albers
- GlaxoSmithKline, Research Triangle Park
| | - S Cockle
- GlaxoSmithKline, Stockley Park, Uxbridge
| | - N Gunsoy
- GlaxoSmithKline, Stockley Park, Uxbridge
| | | | | | | |
Collapse
|
42
|
Albers FC, Price RG, Yancey SW, Bradford E. ENCORE: Effect of Mepolizumab in Severe Eosinophilic Asthma Patients Eligible for Omalizumab Treatment. Pneumologie 2017. [DOI: 10.1055/s-0037-1598373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- FC Albers
- GlaxoSmithKline, Research Triangle Park
| | - RG Price
- GlaxoSmithKline, Stockley Park, Uxbridge
| | - SW Yancey
- GlaxoSmithKline, Research Triangle Park
| | | |
Collapse
|
43
|
Prazma CM, Wenzel SE, Nelsen LM, Gunsoy NB, Cockle SM, Albers FC, Ortega H, Yancey SW. Perception of oral corticosteroid side effects in patients with corticosteroid-dependent asthma. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Trevor JL, Bradford ES, Albers FC, Bratton DJ, Wang-Jairaj J, Nelsen LM, Chupp GL, Magnan A, ten Brinke A. Mepolizumab Improves Lung Function and Exacerbation Rates in Severe Eosinophilic Asthma: The Musca Study - a Phase IIIb Randomized, Placebo-Controlled Tria. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
45
|
Liu MC, Keene ON, Yancey SW, Bratton DJ, Albers FC. Efficacy Of Mepolizumab In Patients With Severe Eosinophilic Asthma And Nasal Polyps. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
Cockle SM, Stynes G, Gunsoy NB, Parks D, Alfonso-Cristancho R, Wex J, Bradford ES, Albers FC, Willson J. Comparative effectiveness of mepolizumab and omalizumab in severe asthma: An indirect treatment comparison. Respir Med 2016; 123:140-148. [PMID: 28137490 DOI: 10.1016/j.rmed.2016.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/24/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Severe asthma is a heterogeneous disease. Patients with both eosinophilic and allergic asthma phenotypes may be eligible for treatment with mepolizumab and omalizumab. Evidence on the relative effectiveness of these treatments in this 'overlap' population would be informative for clinical and payer decision making. METHODS A systematic literature review and indirect treatment comparison (Bayesian framework) were performed to assess the comparative effectiveness and tolerability of mepolizumab and omalizumab, as add-ons to standard of care. Studies included in the primary analysis were double-blind, randomized controlled trials, ≥12 weeks' duration enrolling patients with severe asthma with a documented exacerbation history and receiving high-dose inhaled corticosteroids plus ≥1 additional controller. Two populations were examined: patients potentially eligible for 1) both treatments (Overlap population) and 2) either treatment (Trial population). RESULTS In the Overlap population, no differences between treatments in clinically significant exacerbations and exacerbations requiring hospitalization were found, although trends favored mepolizumab (rate ratio [RR]:0.66 [95% credible intervals (Crl):0.37,1.19]; 0.19[0.02,2.32], respectively). In the Trial population, mepolizumab treatment produced greater reductions in clinically significant exacerbations (RR:0.63 [95% CrI:0.45,0.89]) but not exacerbations requiring hospitalization compared with omalizumab (RR:0.58 [95% Crl: 0.16,2.13]), although the trend favored mepolizumab. Both treatments had broadly comparable effects on lung function, and similar tolerability profiles. CONCLUSIONS Whilst this analysis has limitations due to a restricted evidence base and residual heterogeneity, it showed that in patients with severe asthma, mepolizumab seems to be at least as effective as omalizumab and that the tolerability profiles of the two treatments did not meaningfully differentiate.
Collapse
Affiliation(s)
- Sarah M Cockle
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| | - Gillian Stynes
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK
| | | | - Daniel Parks
- Value Evidence Analytics, GSK, Philadelphia, PA, USA
| | | | - Jaro Wex
- Global Market Access Solutions, Health Economics and Outcomes Research, London, UK
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Frank C Albers
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Jenny Willson
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK.
| |
Collapse
|
47
|
Hartmann CEA, Gait C, Gunsoy NB, Mehta RA, Albers FC. S4 Implications of guidance in scotland on eligibility for treatment with mepolizumab and omalizumab – an ideal study analysis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Mehta RA, Hartmann CEA, Gunsoy NB, Albers FC. P159 Therapeutic benefit of mepolizumab in the scottish medicines consortium (SMC) restricted sub-population – a post-hoc meta-analysis of phase iib/iii trials. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
49
|
Suruki RY, Gunsoy N, Shin JY, Daugherty J, Nelsen L, Bradford E, Albers FC. The Identification and Description of Severe Asthma Patients in a Cross-Sectional Study —the Ideal Study. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
50
|
Prazma CM, Bel EH, Barnes NC, Price R, Albers FC, Yancey SW. Steroid Sparing Response with Mepolizumab: Durability of Steroid Reduction in Severe Asthma. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|