1
|
Pfaar O, Nell MJ, Boot JD, Versteeg SA, van Ree R, Roger A, Riechelmann H, Sperl A, Oude Elberink JNG, Diamant Z, Bachert C. A randomized, 5-arm dose finding study with a mite allergoid SCIT in allergic rhinoconjunctivitis patients. Allergy 2016; 71:967-76. [PMID: 26864207 DOI: 10.1111/all.12860] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The safety and tolerability of a mite allergoid subcutaneous allergen immunotherapy (SCIT) product was previously established. The aim of this study (EudraCT number: 2011-000393-61) was to find the optimally safe and effective allergoid dose by evaluating several dosages in patients with house dust mite (HDM)-induced allergic rhinoconjunctivitis (ARC) using a titrated nasal provocation test (TNPT). METHODS In total, 290 adult ARC patients (148 females; 142 males) with established HDM allergy and with a positive TNPT were randomized to receive placebo or mite allergoid SCIT 6667, 20 000, 50 000 or 100 000 AUeq/ml for 12 months. Patients were updosed weekly, followed by monthly maintenance dosing. The primary study endpoint comprised the clinical response to TNPT after 12 months of treatment. Secondary endpoints included response to TNPT after 6 months, PNIF measurements, symptom and medication scores during the last 8 weeks of treatment, serum immunoglobulins and safety assessments. RESULTS After 12 months, a dose-response was observed showing statistically significant improvements in the TNPT with SCIT concentrations of ≥20 000 AUeq/ml, while no significantly different outcomes were reached after 6 months. Specific serum IgG and IgG4 levels were dose dependently increased. In the highest dose group, more treatment-emergent adverse events were observed compared with the lower dose groups. CONCLUSION In this mite allergoid SCIT dose finding study in HDM-induced ARC, concentrations of ≥20 000 AUeq/ml showed both immunological effects and clinical efficacy in the TNPT compared with placebo. The risk-benefit ratio favours 20 000 AUeq/ml and 50 000 AUeq/ml strengths for further clinical development.
Collapse
Affiliation(s)
- O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Department of Otorhinolaryngology; Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | | | | | - S. A. Versteeg
- Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - R. van Ree
- Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhino-laryngology; Academic Medical Center; Amsterdam The Netherlands
| | - A. Roger
- Unitat d'Allèrgia; Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - H. Riechelmann
- Department of Otorhinolaryngology - Head & Neck Surgery; Medical University of Innsbruck; Innsbruck Austria
| | - A. Sperl
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - J. N. G. Oude Elberink
- Department of Allergology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Z. Diamant
- Department of Respiratory Medicine & Allergology; Institute for Clinical Science; Skane University Hospital; Lund Sweden
- Department of Clinical Pharmacy & Pharmacology and Department of Gen Practice; University Medical Center Groningen; University Groningen; Groningen The Netherlands
| | - C. Bachert
- Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| |
Collapse
|
2
|
den Hartog G, van Neerven RJJ, Boot JD, Jansen APH, Savelkoul HFJ. House dust mite-specific IgA2 is associated with protection against eczema in allergic patients. Allergy 2016; 71:563-6. [PMID: 26582722 DOI: 10.1111/all.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
Upon inhalation, house dust mite (HDM) allergens are deposited at the nasal and oral mucosa, where IgA is produced abundantly. IgA subclasses have been linked to protection against respiratory allergy previously. It is currently not known whether and how the human IgA subclasses IgA1 and IgA2 contribute to the clinical status of house dust mite-allergic patients. Saliva and serum samples were collected, and HDM-specific, IgE, IgG4, IgA1 and IgA2 levels were determined. HDM-specific levels of IgA in serum were similar to levels measured in nonallergic controls, but HDM-specific levels of IgA2 in saliva were decreased in allergic subjects. HDM-allergic patients who suffered from rhinitis and eczema showed a significant decrease in IgA2-levels compared to patients who suffered from rhinitis only. Taken together, our findings indicate that HDM-specific IgA2, but not IgA1, levels in serum and saliva are reduced in HDM-allergic patients suffering from eczema.
Collapse
Affiliation(s)
- G. den Hartog
- Cell Biology & Immunology Group; Wageningen University; Wageningen The Netherlands
| | - R. J. J. van Neerven
- Cell Biology & Immunology Group; Wageningen University; Wageningen The Netherlands
- FrieslandCampina; Amersfoort The Netherlands
| | | | - A. P. H. Jansen
- Department of Otorhinolaryngology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - H. F. J. Savelkoul
- Cell Biology & Immunology Group; Wageningen University; Wageningen The Netherlands
| |
Collapse
|
3
|
Pfaar O, Twuijver E, Boot JD, Opstelten DJE, Klimek L, Ree R, Diamant Z, Kuna P, Panzner P. A randomized DBPC trial to determine the optimal effective and safe dose of a SLIT-birch pollen extract for the treatment of allergic rhinitis: results of a phase II study. Allergy 2016; 71:99-107. [PMID: 26417901 PMCID: PMC5057302 DOI: 10.1111/all.12760] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) is a potential efficacious and safe treatment option for patients with respiratory, IgE-mediated allergic diseases. A combined tolerability, dose-finding study with a sublingual liquid birch pollen preparation (SB) was conducted. METHODS Two hundred and sixty-nine adults with birch-pollen-induced AR were randomized to placebo, SB: 3333, 10,000, 20,000 or 40,000 AUN/ml. Differences in symptom scores following a titrated nasal provocation test (TNPT) at baseline and after 5 months of treatment were determined. Safety, tolerability, birch-pollen-specific immunoglobulin levels and peak nasal inspiratory flow (PNIF) were also measured (all measures determined outside the birch pollen season). RESULTS In all treatment groups, an improvement in symptom scores after treatment compared to baseline was observed, with an additional stepwise improvement in the active groups compared to placebo, which was significant in high-dose groups (P = 0.008 and P < 0.001, respectively). For this primary endpoint, a significant linear dose-response curve was observed: the higher the dose, the better the improvement observed. Likewise, active treatment resulted in an increase in PNIF and serum IgG levels compared to placebo. The highest improvements were found in the 40,000 AUN/ml group. All active dosages resulted in more adverse reactions than placebo, which were mainly mild and well-controlled. CONCLUSIONS A multicentre trial evaluated the dose-response and tolerability of SB. All active treatment groups showed better responses than placebo for both primary and secondary parameters. The results indicate that, within the studied dose range, SB 40,000 AUN/ml is the most optimal effective and safe dose (ClinicalTrials.gov: NCT01639768).
Collapse
Affiliation(s)
- O. Pfaar
- Center for Rhinology and Allergology Wiesbaden Germany
- Department of Otorhinolaryngology, Head and Neck Surgery Medical Faculty Mannheim Universitätsmedizin Mannheim Heidelberg University Mannheim Germany
| | | | | | | | - L. Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - R. Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Z. Diamant
- Department of Respiratory Medicine & Allergology Institute for Clinical Science Skane University Hospital Lund Sweden
- Departments of Clinical Pharmacy & Pharmacology and General Practice University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - P. Kuna
- Dept. of Internal Medicine Asthma and Allergy Medical University of Lodz Lodz Poland
| | - P. Panzner
- Department of Allergology and Immunology Medical Faculty in Plzen Charles University Prague Prague Czech Republic
| |
Collapse
|
4
|
Peñas A, García-González M, Cruz MJ, Valdesoiro L, Boot JD, Larramona H, Asensio O, Grau R, Costa J, Bosque M. Observational study of the safety of a cluster schedule for subcutaneous immunotherapy in a pediatric population. J Investig Allergol Clin Immunol 2013; 23:63-65. [PMID: 23653981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- A Peñas
- Pediatric Allergology and Pneumology Unit, Hospital de Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Wang WY, Boot JD, Mascelli MA, Gerth van Wijk R, Diamant Z. Comparison of biomarkers between allergic rhinitis only and allergic rhinitis with concomitant asthma. Allergy 2009; 64:1102-3. [PMID: 19236317 DOI: 10.1111/j.1398-9995.2009.01996.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- W Y Wang
- Centre for Human Drug Research, Department of Respiratory & Allergy, Zernikedreef 10, Leiden, the Netherlands.
| | | | | | | | | |
Collapse
|
6
|
Belkowski SM, Boot JD, Mascelli MA, Diamant Z, de Garavilla L, Hertzog B, Polkovitch D, Towers M, Batheja A, D'Andrea MR. Cleaved secretory leucocyte protease inhibitor as a biomarker of chymase activity in allergic airway disease. Clin Exp Allergy 2009; 39:1179-86. [PMID: 19400896 DOI: 10.1111/j.1365-2222.2009.03247.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Secretory leucocyte protease inhibitor (SLPI), which is present in many physiological fluids including saliva, sputum and nasal discharge, is the most effective inhibitor of chymase. Previously, we demonstrated that chymase is able to cleave SLPI and that the cleaved portion, cSLPI, is a biomarker of chymase activity. OBJECTIVE We investigated the potential of cSLPI as a biomarker of chymase activity in subjects with allergic rhinitis (AR) and asthmatic airway disease. METHODS Baseline sputum samples were collected from atopic asthmatics and healthy controls (HC). Nasal lavages (NAL) were performed in subjects with AR both at baseline and following a nasal challenge with allergen or placebo. Levels of cSLPI and chymase were determined by Western analysis, and tryptase and alpha-2 macroglobulin were measured by immunoassay. RESULTS As compared with HC, asthmatics showed a significant increase in baseline cSLPI/total SLPI ratios and an increase in chymase levels. There was a high correlation of cSLPI/SLPI ratios to chymase levels in normal individuals and untreated asthmatics. In the NAL of patients with AR, as compared with placebo, allergen challenge increased inflammatory biomarkers, including cSLPI/SLPI ratios, chymase levels, tryptase levels and alpha2-macroglobulin levels. Correlations were observed between cSLPI/SLPI ratios and chymase levels and cSLPI/SLPI ratios and alpha2-macroglobulin levels; no correlation was seen between cSLPI/SLPI ratios and tryptase levels. CONCLUSION Our data indicate that cSLPI reflects chymase activity in AR and asthma. Hence, cSLPI may serve as a biomarker for disease activity and for monitoring the efficacy of novel anti-inflammatory treatments in chymase-mediated diseases.
Collapse
Affiliation(s)
- S M Belkowski
- Johnson and Johnson Pharmaceutical Research and Development, Spring House, PA 19477, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Boot JD, de Ridder L, de Kam ML, Calderon C, Mascelli MA, Diamant Z. Comparison of exhaled nitric oxide measurements between NIOX MINO electrochemical and Ecomedics chemiluminescence analyzer. Respir Med 2008; 102:1667-71. [PMID: 18694637 DOI: 10.1016/j.rmed.2008.06.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 06/16/2008] [Accepted: 06/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exhaled nitric oxide (eNO) is an established, noninvasive biomarker of active airway inflammation in (atopic) asthma. Treatment with anti-inflammatory therapy, such as inhaled corticosteroids, effectively decreases eNO levels. The NIOX MINO (MINO) is a hand-held, relatively inexpensive, electrochemical device that has been shown to yield comparable eNO measurements to the NIOX stationary unit. AIM To compare measurements of MINO with another widely used and validated stationary chemiluminescence analyzer, the Ecomedics (ECO). METHODS We performed subsequent eNO measurements on ECO and MINO in 50 subjects (19 healthy volunteers, 18 healthy smokers and 13 non-smoking, atopic asthmatics, not on controller therapy) on two visits 4-10 days apart. The mean of three acceptable measurements by ECO and the first acceptable measurement with the MINO were used for analysis. RESULTS Both devices yielded reproducible eNO values for all subjects on both visits, with an overall CV of 22.7% (ECO) and 18.3% (MINO). A significant correlation was found between both devices (r=0.97, p<0.0001). Bland-Altman plots showed a high degree of agreement for the entire study population (mean difference MINO vs ECO=-10%; 95% limit of agreement were -36% and +28%) and in the three individual subgroups. CONCLUSIONS Exhaled NO values measured with the MINO are reproducible and in agreement with the ECO. Our results add further evidence to the reliability of the MINO and warrant its applicability in research and clinical practice.
Collapse
Affiliation(s)
- J D Boot
- Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands.
| | | | | | | | | | | |
Collapse
|
8
|
Boot JD, Chandoesing P, de Kam ML, Mascelli MA, Das AM, Gerth van Wijk R, de Groot H, Verhoosel R, Hiemstra PS, Diamant Z. Applicability and reproducibility of biomarkers for the evaluation of anti-inflammatory therapy in allergic rhinitis. J Investig Allergol Clin Immunol 2008; 18:433-442. [PMID: 19123434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND We aimed to study the reproducibility of several biomarkers of allergic rhinitis to investigate their potential as outcome measures in clinical intervention trials. Furthermore, we investigated the kinetics of the biomarkers studied in nasal lavage and brush material following a placebo-controlled nasal allergen challenge. METHODS We performed a skin prick test and measured serum specific immunoglobulin (Ig) E levels and inflammatory biomarkers in nasal lavage and brush material in 20 patients with allergic rhinitis on 2 separate days (washout, 14-21 days). The patients were then randomly assigned to undergo an intranasal challenge with a relevant allergen (n=10) or diluent (n=10) in order to assess the kinetics of several biomarkers of allergic airway inflammation in nasal lavage and brush samples. RESULTS Baseline serum IgE levels and skin wheal sizes were highly reproducible measurements, with a coefficient of variation (CV) of 13.4% and 18.2%, respectively. This was not the case with the majority of inflammatory biomarkers, whose CV varied considerably (range, 6.1%-224.1%). The nasal allergen challenge induced an increase in composite symptom scores in all patients. Compared to placebo, tryptase (P=.004), eosinophilic cationic protein (ECP) (P=.03) and alpha2-macroglobulin (P=.002) were increased in nasal lavage at 20 minutes post allergen. Nasal lavage ECP levels and nasal brush eosinophils were still significantly increased at 7 hours (P=.03 and P=.04), but all statistical significance had been lost at 24 hours post challenge. CONCLUSION Serum specific IgE assays and skin prick tests exhibited good reproducibility in patients with clinically stable allergic rhinitis. We were also able to investigate the kinetics of allergen-induced upper airway inflammatory markers in nasal lavage and brush material. Hence, nasal allergen challenge, when used in combination with nasal lavage and brush sampling, is a suitable research tool for early drug development.
Collapse
Affiliation(s)
- J D Boot
- Centre for Human Drug Research, Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Boot JD, de Kam ML, Mascelli MA, Miller B, van Wijk RG, de Groot H, Cohen AF, Diamant Z. Nasal nitric oxide: longitudinal reproducibility and the effects of a nasal allergen challenge in patients with allergic rhinitis. Allergy 2007; 62:378-84. [PMID: 17362248 DOI: 10.1111/j.1398-9995.2007.01328.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exhaled nitric oxide (eNO) is a validated noninvasive marker of airway inflammation in asthma. In patients with allergic rhinitis (AR), increased levels of nasal nitric oxide (nNO) have also been measured. However, the applicability of nNO as a marker of upper airway inflammation awaits validation. AIM To test the longitudinal reproducibility of standardized nNO measurements in patients with AR and the effects of nasal allergen challenge. METHODS Twenty patients with clinically stable, untreated AR participated in a combined study design. First, reproducibility of nNO was tested over 1, 7, and 14-21 days. Subsequently, the effect of nasal allergen challenge on nNO was studied in a placebo-controlled, parallel design. Nasal NO was measured with a chemoluminescence analyzer. Ten subjects randomly underwent a standardized nasal allergen challenge; 10 subjects received placebo. Response to nasal challenge was monitored by composite symptom scores. RESULTS There was a good reproducibility of nNO up to 7 days [coefficient of variation (CV) over 1 (16.45%) and 7 days (21.5%)], decreasing over time [CV (14-21 days): 38.3%]. As compared with placebo, allergen challenge caused a significant increase in symptom scores (P < 0.001), accompanied by a decrease in nNO at 20 min postchallenge (P = 0.001). Furthermore, there was a gradual increase in nNO at 7 h, reaching significance at 24-h postallergen (P = 0.04). CONCLUSIONS Similar to eNO in asthma, nNO is a noninvasive marker, potentially suitable to monitor upper airway inflammation following allergen-induced late response. Present data show a good reproducibility of nNO measurements, decreasing over time, probably because of subclinical seasonal influences.
Collapse
MESH Headings
- Adult
- Allergens/administration & dosage
- Animals
- Antigens, Dermatophagoides/administration & dosage
- Antigens, Plant/administration & dosage
- Biomarkers/metabolism
- Cats/immunology
- Female
- Humans
- Male
- Middle Aged
- Nasal Mucosa/metabolism
- Nasal Provocation Tests
- Nitric Oxide/biosynthesis
- Poaceae/immunology
- Pollen/immunology
- Reproducibility of Results
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/metabolism
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/metabolism
Collapse
Affiliation(s)
- J D Boot
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Boot JD, Tarasevych S, Sterk PJ, Schoemaker RC, Wang L, Amin D, Cohen AF, Diamant Z. Reversal of the late asthmatic response increases exhaled nitric oxide. Respir Med 2006; 99:1591-4. [PMID: 15878654 DOI: 10.1016/j.rmed.2005.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 03/06/2005] [Indexed: 11/25/2022]
Affiliation(s)
- J D Boot
- Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Boot JD, Panzner P, Diamant Z. A critical appraisal of methods used in early clinical development of novel drugs for the treatment of asthma. Pulm Pharmacol Ther 2006; 20:201-19. [PMID: 16584905 DOI: 10.1016/j.pupt.2006.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 02/06/2006] [Accepted: 02/14/2006] [Indexed: 11/16/2022]
Abstract
Asthma is a heterogeneous disorder characterized by chronic airway inflammation, hyperresponsiveness and remodeling. Being the hallmark of asthma, airway inflammation has become the most important target for therapeutic agents. Consequently, during the past decade various semi-and non-invasive methods have been explored to sample the airway inflammation in asthma. In this review, we provide a practical overview of the current status of various sampling techniques including sputum induction, exhaled breath analysis, and bronchoprovocation tests (BPTs). We focus on their applicability for monitoring in clinical practice and in intervention trials in asthma.
Collapse
Affiliation(s)
- J D Boot
- Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands
| | | | | |
Collapse
|