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Faiz A, Mahbub RM, Boedijono FS, Tomassen MI, Kooistra W, Timens W, Nawijn M, Hansbro PM, Johansen MD, Pouwels SD, Heijink IH, Massip F, de Biase MS, Schwarz RF, Adcock IM, Chung KF, van der Does A, Hiemstra PS, Goulaouic H, Xing H, Abdulai R, de Rinaldis E, Cunoosamy D, Harel S, Lederer D, Nivens MC, Wark PA, Kerstjens HAM, Hylkema MN, Brandsma CA, van den Berge M. IL-33 Expression Is Lower in Current Smokers at both Transcriptomic and Protein Levels. Am J Respir Crit Care Med 2023; 208:1075-1087. [PMID: 37708400 PMCID: PMC10867944 DOI: 10.1164/rccm.202210-1881oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/14/2023] [Indexed: 09/16/2023] Open
Abstract
Rationale: IL-33 is a proinflammatory cytokine thought to play a role in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). A recent clinical trial using an anti-IL-33 antibody showed a reduction in exacerbation and improved lung function in ex-smokers but not current smokers with COPD. Objectives: This study aimed to understand the effects of smoking status on IL-33. Methods: We investigated the association of smoking status with the level of gene expression of IL-33 in the airways in eight independent transcriptomic studies of lung airways. Additionally, we performed Western blot analysis and immunohistochemistry for IL-33 in lung tissue to assess protein levels. Measurements and Main Results: Across the bulk RNA-sequencing datasets, IL-33 gene expression and its signaling pathway were significantly lower in current versus former or never-smokers and increased upon smoking cessation (P < 0.05). Single-cell sequencing showed that IL-33 is predominantly expressed in resting basal epithelial cells and decreases during the differentiation process triggered by smoke exposure. We also found a higher transitioning of this cellular subpopulation into a more differentiated cell type during chronic smoking, potentially driving the reduction of IL-33. Protein analysis demonstrated lower IL-33 levels in lung tissue from current versus former smokers with COPD and a lower proportion of IL-33-positive basal cells in current versus ex-smoking controls. Conclusions: We provide strong evidence that cigarette smoke leads to an overall reduction in IL-33 expression in transcriptomic and protein level, and this may be due to the decrease in resting basal cells. Together, these findings may explain the clinical observation that a recent antibody-based anti-IL-33 treatment is more effective in former than current smokers with COPD.
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Affiliation(s)
- Alen Faiz
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
| | - Rashad M. Mahbub
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fia Sabrina Boedijono
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- Centre for Inflammation, Faculty of Science, Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
| | - Milan I. Tomassen
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wierd Kooistra
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wim Timens
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn Nawijn
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Philip M. Hansbro
- Centre for Inflammation, Faculty of Science, Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
| | - Matt D. Johansen
- Centre for Inflammation, Faculty of Science, Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
| | - Simon D. Pouwels
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
| | - Irene H. Heijink
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Florian Massip
- Centre for Computational Biology, Mines ParisTech, Paris Sciences et Lettres Research University, Paris, France
- Cancer and Genome: Bioinformatics, Biostatistics and Epidemiology of Complex Systems Institut Curie, Paris, France
- Institut Nationale de la Santé et de la Recherche Médicale U900, Paris, France
| | - Maria Stella de Biase
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Roland F. Schwarz
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Institute for Computational Cancer Biology, Center for Integrated Oncology, Cancer Research Center Cologne Essen, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
| | - Ian M. Adcock
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Kian F. Chung
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Anne van der Does
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter S. Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | - Sivan Harel
- Regeneron Pharmaceuticals, Tarrytown, New York
| | | | | | - Peter A. Wark
- Centre for Asthma & Respiratory Disease, The University of Newcastle, Newcastle, New South Wales, Australia; and
- Hunter Medical Research Institute, Vaccines, Infection, Viruses & Asthma Newcastle, New South Wales, Australia
| | - Huib A. M. Kerstjens
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
| | - Machteld N. Hylkema
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Corry-Anke Brandsma
- Groningen Research Institute for Asthma and COPD
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
| | - the Cambridge Lung Cancer Early Detection Programme
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- Groningen Research Institute for Asthma and COPD
- Department of Pulmonary Diseases, and
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Centre for Inflammation, Faculty of Science, Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
- Centre for Computational Biology, Mines ParisTech, Paris Sciences et Lettres Research University, Paris, France
- Cancer and Genome: Bioinformatics, Biostatistics and Epidemiology of Complex Systems Institut Curie, Paris, France
- Institut Nationale de la Santé et de la Recherche Médicale U900, Paris, France
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Institute for Computational Cancer Biology, Center for Integrated Oncology, Cancer Research Center Cologne Essen, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
- Sanofi, Chilly-Mazarin, France
- Sanofi, Cambridge, Massachusetts
- Regeneron Pharmaceuticals, Tarrytown, New York
- Centre for Asthma & Respiratory Disease, The University of Newcastle, Newcastle, New South Wales, Australia; and
- Hunter Medical Research Institute, Vaccines, Infection, Viruses & Asthma Newcastle, New South Wales, Australia
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2
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Schmidt WA, Dasgupta B, Sloane J, Giannelou A, Xu Y, Unizony SH, Mackie SL, Gonzalez-Gay MA, Spiera R, Warrington KJ, Villiger PM, Nivens MC, Akinlade B, Lin Y, Buttgereit F, Stone JH. A phase 3 randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of sarilumab in patients with giant cell arteritis. Arthritis Res Ther 2023; 25:199. [PMID: 37840134 PMCID: PMC10577982 DOI: 10.1186/s13075-023-03177-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is primarily treated with glucocorticoids (GCs), which have substantial toxicity. Tocilizumab, an interleukin-6-receptor inhibitor (IL-6Ri), showed beneficial effects in GCA, leading to its approval. This study investigated the efficacy and safety of sarilumab (another IL-6Ri) in GCA. METHODS This Phase 3, double-blind study comprised a 52-week treatment period and a 24-week follow-up phase. Eligible GCA patients were randomized to receive sarilumab 200 mg (SAR200 + 26W) or 150 mg (SAR150 + 26W) with a 26-week GC taper, or placebo with a 52-week (PBO + 52W) or 26-week (PBO + 26W) GC taper. The primary efficacy endpoint was sustained remission (SR) at week 52. Additional endpoints were SR at week 24, cumulative GC dose, and safety. The study was discontinued prematurely due to protracted recruitment timelines, because of the impact of COVID-19. Therefore, only descriptive statistics were summarized. RESULTS Of the planned 360 subjects, only 83 were randomized and 36 were included in the week 52 analysis. At week 52, 46% (n = 6/13) of patients in SAR200 + 26W, 43% (n = 3/7) in SAR150 + 26W, 30% (n = 3/10) in PBO + 52W, and 0 (n = 0/6) in PBO + 26W taper groups achieved SR. Sensitivity analyses, excluding acute-phase reactants from the SR definition, showed similar results for SAR groups, but 60% (n = 6/10) in PBO + 52W and 17% (n = 1/6) in PBO + 26W taper groups achieved SR at week 52. Similar findings were noted at week 24. The proportions of patients who adhered to GC taper from week 12 through week 52 in each group were as follows: 46% (n = 6/13, SAR200 + 26W), 43% (n = 3/7, SAR150 + 26W), 60% (n = 6/10, PBO + 52W), and 33% (n = 2/6, PBO + 26W). The median actual cumulative GC dose received in the SAR200 + 26W group was lower than other groups. Most patients (80-100%) experienced treatment-emergent adverse events, with similar incidences reported across groups. CONCLUSIONS Owing to the small sample size due to the early termination, it is difficult to draw clear conclusions from this study. There were no unexpected safety findings. TRIAL REGISTRATION ClinicalTrials.gov NCT03600805. Registered on July 26, 2018.
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Affiliation(s)
- Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Lindenberger Weg 19, Berlin, 13125, Germany.
| | - Bhaskar Dasgupta
- Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK
| | | | | | | | | | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Miguel A Gonzalez-Gay
- Rheumatology Division, IIS-Fundación Jiménez Díaz, Madrid, Spain
- University of Cantabria, IDIVAL, Santander, Spain
| | - Robert Spiera
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter M Villiger
- Rheumatology and Clinical Immunology, Medical Center Monbijou, Bern, Switzerland
| | | | | | | | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John H Stone
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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3
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Spiera RF, Unizony S, Warrington KJ, Sloane J, Giannelou A, Nivens MC, Akinlade B, Wong W, Bhore R, Lin Y, Buttgereit F, Devauchelle-Pensec V, Rubbert-Roth A, Yancopoulos GD, Marrache F, Patel N, Dasgupta B. Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper. N Engl J Med 2023; 389:1263-1272. [PMID: 37792612 DOI: 10.1056/nejmoa2303452] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 10/06/2023]
Abstract
BACKGROUND More than half of patients with polymyalgia rheumatica have a relapse during tapering of glucocorticoid therapy. Previous studies have suggested that interleukin-6 blockade may be clinically useful in the treatment of polymyalgia rheumatica. Sarilumab, a human monoclonal antibody, binds interleukin-6 receptor α and efficiently blocks the interleukin-6 pathway. METHODS In this phase 3 trial, we randomly assigned patients in a 1:1 ratio to receive 52 weeks of a twice-monthly subcutaneous injection of either sarilumab (at a dose of 200 mg) plus a 14-week prednisone taper or placebo plus a 52-week prednisone taper. The primary outcome at 52 weeks was sustained remission, which was defined as the resolution of signs and symptoms of polymyalgia rheumatica by week 12 and sustained normalization of the C-reactive protein level, absence of disease flare, and adherence to the prednisone taper from weeks 12 through 52. RESULTS A total of 118 patients underwent randomization (60 to receive sarilumab and 58 to receive placebo). At week 52, sustained remission occurred in 28% (17 of 60 patients) in the sarilumab group and in 10% (6 of 58 patients) in the placebo group (difference, 18 percentage points; 95% confidence interval, 4 to 32; P = 0.02). The median cumulative glucocorticoid dose at 52 weeks was significantly lower in the sarilumab group than in the placebo group (777 mg vs. 2044 mg; P<0.001). The most common adverse events with sarilumab as compared with placebo were neutropenia (15% vs. 0%), arthralgia (15% vs. 5%), and diarrhea (12% vs. 2%). More treatment-related discontinuations were observed in the sarilumab group than in the placebo group (12% vs. 7%). CONCLUSIONS Sarilumab showed significant efficacy in achieving sustained remission and reducing the cumulative glucocorticoid dose in patients with a relapse of polymyalgia rheumatica during glucocorticoid tapering. (Funded by Sanofi and Regeneron Pharmaceuticals; SAPHYR ClinicalTrials.gov number, NCT03600818.).
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Affiliation(s)
- Robert F Spiera
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Sebastian Unizony
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Kenneth J Warrington
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Jennifer Sloane
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Angeliki Giannelou
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Michael C Nivens
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bolanle Akinlade
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Wanling Wong
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Rafia Bhore
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Yong Lin
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frank Buttgereit
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Valerie Devauchelle-Pensec
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Andrea Rubbert-Roth
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - George D Yancopoulos
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frederic Marrache
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Naimish Patel
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bhaskar Dasgupta
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
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Sivapalasingam S, Lederer DJ, Bhore R, Hajizadeh N, Criner G, Hosain R, Mahmood A, Giannelou A, Somersan-Karakaya S, O’Brien MP, Boyapati A, Parrino J, Musser BJ, Labriola-Tompkins E, Ramesh D, Purcell LA, Gulabani D, Kampman W, Waldron A, Ng Gong M, Saggar S, Sperber SJ, Menon V, Stein DK, Sobieszczyk ME, Park W, Aberg JA, Brown SM, Kosmicki JA, Horowitz JE, Ferreira MA, Baras A, Kowal B, Thomas DiCioccio A, Akinlade B, Nivens MC, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM. Efficacy and Safety of Sarilumab in Hospitalized Patients With Coronavirus Disease 2019: A Randomized Clinical Trial. Clin Infect Dis 2022; 75:e380-e388. [PMID: 35219277 PMCID: PMC8903479 DOI: 10.1093/cid/ciac153] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Open-label platform trials and a prospective meta-analysis suggest efficacy of anti-interleukin (IL)-6R therapies in hospitalized patients with coronavirus disease 2019 (COVID-19) receiving corticosteroids. This study evaluated the efficacy and safety of sarilumab, an anti-IL-6R monoclonal antibody, in the treatment of hospitalized patients with COVID-19. METHODS In this adaptive, phase 2/3, randomized, double-blind, placebo-controlled trial, adults hospitalized with COVID-19 received intravenous sarilumab 400 mg or placebo. The phase 3 primary analysis population included patients with critical COVID-19 receiving mechanical ventilation (MV). The primary outcome was proportion of patients with ≥1-point improvement in clinical status from baseline to day 22. RESULTS There were 457 and 1365 patients randomized and treated in phases 2 and 3, respectively. In phase 3, patients with critical COVID-19 receiving MV (n = 298; 28.2% on corticosteroids), the proportion with ≥1-point improvement in clinical status (alive, not receiving MV) at day 22 was 43.2% for sarilumab and 35.5% for placebo (risk difference, +7.5%; 95% confidence interval [CI], -7.4 to 21.3; P =.3261), a relative risk improvement of 21.7%. In post hoc analyses pooling phase 2 and 3 critical patients receiving MV, the hazard ratio for death for sarilumab vs placebo was 0.76 (95% CI, .51 to 1.13) overall and 0.49 (95% CI, .25 to .94) in patients receiving corticosteroids at baseline. CONCLUSIONS This study did not establish the efficacy of sarilumab in hospitalized patients with severe/critical COVID-19. Post hoc analyses were consistent with other studies that found a benefit of sarilumab in patients receiving corticosteroids. CLINICAL TRIALS REGISTRATION NCT04315298.
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Affiliation(s)
| | | | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Negin Hajizadeh
- Institute for Clinical Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, New York, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Romana Hosain
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Anita Boyapati
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Janie Parrino
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bret J Musser
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Divya Ramesh
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Lisa A Purcell
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Daya Gulabani
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Wendy Kampman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Alpana Waldron
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Suraj Saggar
- Department of Infectious Disease, Holy Name Medical Center, Teaneck, New Jersey, USA
| | - Steven J Sperber
- Department of Infectious Disease, Hackensack Meridian School of Medicine and Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Vidya Menon
- Department of Medicine, NYC Health + Hospitals/Lincoln, Bronx, New York, USA
| | - David K Stein
- Department of Medicine, Jacobi Medical Center, Bronx, New York, USA
| | | | - William Park
- Pulmonary and Sleep Disorder Clinic, Valley Medical Center, Renton, Washington, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USAand
| | - Samuel M Brown
- Department of Internal Medicine, Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Aris Baras
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bari Kowal
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Ned Braunstein
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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5
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Lin N, Damask A, Boyapati A, Hamilton JD, Hamon S, Ternes N, Nivens MC, Penn J, Lopez A, Reid JG, Overton J, Shuldiner AR, Abecasis G, Baras A, Paulding C. UGT1A1 genetic variants are associated with increases in bilirubin levels in rheumatoid arthritis patients treated with sarilumab. Pharmacogenomics J 2022; 22:160-165. [PMID: 35149777 PMCID: PMC9151390 DOI: 10.1038/s41397-022-00269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 12/16/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022]
Abstract
Sarilumab is a human monoclonal antibody against interleukin (IL)-6Rα that has been approved for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) and an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). Mild liver function test abnormalities have been observed in patients treated with sarilumab. We describe a genome-wide association study of bilirubin elevations in RA patients treated with sarilumab. Array genotyping and exome sequencing were performed on DNA samples from 1075 patients. Variants in the UGT1A1 gene were strongly associated with maximum bilirubin elevations in sarilumab-treated patients (rs4148325; p = 2.88 × 10−41) but were not associated with aminotransferase elevations. No other independent loci showed evidence of association with bilirubin elevations after sarilumab treatment. These findings suggest that most bilirubin increases during sarilumab treatment are related to genetic variation in UGT1A1 rather than underlying liver injury.
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Boyapati A, Wipperman MF, Ehmann PJ, Hamon S, Lederer DJ, Waldron A, Flanagan JJ, Karayusuf E, Bhore R, Nivens MC, Hamilton JD, Sumner G, Sivapalasingam S. Baseline Severe Acute Respiratory Syndrome Viral Load Is Associated With Coronavirus Disease 2019 Severity and Clinical Outcomes: Post Hoc Analyses of a Phase 2/3 Trial. J Infect Dis 2021; 224:1830-1838. [PMID: 34496013 PMCID: PMC8522400 DOI: 10.1093/infdis/jiab445] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 05/28/2021] [Accepted: 09/15/2021] [Indexed: 01/19/2023] Open
Abstract
Background Elucidating the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and clinical outcomes is critical for understanding coronavirus disease 2019 (COVID-19). Methods The SARS-CoV-2 levels were analyzed by quantitative real-time polymerase chain reaction (RT-qPCR) of nasopharyngeal or oropharyngeal swab specimens collected at baseline, and clinical outcomes were recorded over 60 days from 1362 COVID-19 hospitalized patients enrolled in a multicenter, randomized, placebo-controlled phase 2/3 trial of sarilumab for COVID-19 (ClinicalTrials.gov NCT04315298). Results In post hoc analyses, higher baseline viral load, measured by both RT-qPCR cycle threshold and log10 copies/mL, was associated with greater supplemental oxygenation requirements and disease severity at study entry. Higher baseline viral load was associated with higher mortality, lower likelihood of improvement in clinical status and supplemental oxygenation requirements, and lower rates of hospital discharge. Viral load was not impacted by sarilumab treatment over time versus placebo. Conclusions These data support viral load as an important determinant of clinical outcomes in hospitalized patients with COVID-19 requiring supplemental oxygen or assisted ventilation.
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Affiliation(s)
- Anita Boyapati
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Peter J Ehmann
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Sara Hamon
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Alpana Waldron
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Elif Karayusuf
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | - Giane Sumner
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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7
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Wechsler ME, Ruddy MK, Pavord ID, Israel E, Rabe KF, Ford LB, Maspero JF, Abdulai RM, Hu CC, Martincova R, Jessel A, Nivens MC, Amin N, Weinreich DM, Yancopoulos GD, Goulaouic H. Efficacy and Safety of Itepekimab in Patients with Moderate-to-Severe Asthma. N Engl J Med 2021; 385:1656-1668. [PMID: 34706171 DOI: 10.1056/nejmoa2024257] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [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: 11/19/2022]
Abstract
BACKGROUND Monoclonal antibodies targeting IgE, interleukin-4 and -13, and interleukin-5 are effective in treating severe type 2 asthma, but new targets are needed. Itepekimab is a new monoclonal antibody against the upstream alarmin interleukin-33. The efficacy and safety of itepekimab as monotherapy, as well as in combination with dupilumab, in patients with asthma are unclear. METHODS In a phase 2 trial, we randomly assigned, in a 1:1:1:1 ratio, adults with moderate-to-severe asthma receiving inhaled glucocorticoids plus long-acting beta-agonists (LABAs) to receive subcutaneous itepekimab (at a dose of 300 mg), itepekimab plus dupilumab (both at 300 mg; combination therapy), dupilumab (300 mg), or placebo every 2 weeks for 12 weeks. After randomization, LABA was discontinued at week 4, and inhaled glucocorticoids were tapered over weeks 6 through 9. The primary end point was an event indicating a loss of asthma control, assessed in the itepekimab group and the combination group, as compared with the placebo group. Secondary and other end points included lung function, asthma control, quality of life, type 2 biomarkers, and safety. RESULTS A total of 296 patients underwent randomization. By 12 weeks, an event indicating a loss of asthma control occurred in 22% of the patients in the itepekimab group, 27% of those in the combination group, and 19% of those in the dupilumab group, as compared with 41% of those in the placebo group; the corresponding odds ratios as compared with placebo were as follows: in the itepekimab group, 0.42 (95% confidence interval [CI], 0.20 to 0.88; P = 0.02); in the combination group, 0.52 (95% CI, 0.26 to 1.06; P = 0.07); and in the dupilumab group, 0.33 (95% CI, 0.15 to 0.70). As compared with placebo, the forced expiratory volume in 1 second before bronchodilator use increased with the itepekimab and dupilumab monotherapies but not with the combination therapy. Itepekimab treatment improved asthma control and quality of life, as compared with placebo, and led to a greater reduction in the mean blood eosinophil count. The incidence of adverse events was similar in all four trial groups. CONCLUSIONS Interleukin-33 blockade with itepekimab led to a lower incidence of events indicating a loss of asthma control than placebo and improved lung function in patients with moderate-to-severe asthma. (Funded by Sanofi and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT03387852.).
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Affiliation(s)
- Michael E Wechsler
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Marcella K Ruddy
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Ian D Pavord
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Elliot Israel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Klaus F Rabe
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Linda B Ford
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Jorge F Maspero
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Raolat M Abdulai
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Chih-Chi Hu
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Renata Martincova
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Andreas Jessel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Michael C Nivens
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Nikhil Amin
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - David M Weinreich
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - George D Yancopoulos
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Helene Goulaouic
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
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Shankar-Hari M, Vale CL, Godolphin PJ, Fisher D, Higgins JPT, Spiga F, Savovic J, Tierney J, Baron G, Benbenishty JS, Berry LR, Broman N, Cavalcanti AB, Colman R, De Buyser SL, Derde LPG, Domingo P, Omar SF, Fernandez-Cruz A, Feuth T, Garcia F, Garcia-Vicuna R, Gonzalez-Alvaro I, Gordon AC, Haynes R, Hermine O, Horby PW, Horick NK, Kumar K, Lambrecht BN, Landray MJ, Leal L, Lederer DJ, Lorenzi E, Mariette X, Merchante N, Misnan NA, Mohan SV, Nivens MC, Oksi J, Perez-Molina JA, Pizov R, Porcher R, Postma S, Rajasuriar R, Ramanan AV, Ravaud P, Reid PD, Rutgers A, Sancho-Lopez A, Seto TB, Sivapalasingam S, Soin AS, Staplin N, Stone JH, Strohbehn GW, Sunden-Cullberg J, Torre-Cisneros J, Tsai LW, van Hoogstraten H, van Meerten T, Veiga VC, Westerweel PE, Murthy S, Diaz JV, Marshall JC, Sterne JAC. Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis. JAMA 2021; 326:499-518. [PMID: 34228774 PMCID: PMC8261689 DOI: 10.1001/jama.2021.11330] [Citation(s) in RCA: 397] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
Importance Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. Objective To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. Data Sources Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. Study Selection Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. Data Extraction and Synthesis In this prospective meta-analysis, risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. Main Outcomes and Measures The primary outcome measure was all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. Results A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P = .003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P < .001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P = .52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). Conclusions and Relevance In this prospective meta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality. Trial Registration PROSPERO Identifier: CRD42021230155.
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Affiliation(s)
- Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, England
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | - Claire L Vale
- University College London, MRC Clinical Trials Unit at UCL, London, England
| | - Peter J Godolphin
- University College London, MRC Clinical Trials Unit at UCL, London, England
| | - David Fisher
- University College London, MRC Clinical Trials Unit at UCL, London, England
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- NIHR Bristol Biomedical Research Centre, Bristol, England
- National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | | | - Jelena Savovic
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Jayne Tierney
- University College London, MRC Clinical Trials Unit at UCL, London, England
| | - Gabriel Baron
- Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Paris, France
- INSERM UMRS-1153, Centre de Recherche Epidémiologie et Statistique Université de Paris, METHODS Team, Paris, France
| | - Julie S Benbenishty
- Department of Nursing, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Niklas Broman
- Turku University Hospital, Department of Infectious Diseases, Turku, Finland
| | | | - Roos Colman
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Lennie P G Derde
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Ana Fernandez-Cruz
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Thijs Feuth
- Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clinic Barcelona-IDIBAPS, Barcelona, Spain
| | | | | | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, England
| | - Richard Haynes
- Nuffield Department of Population Health, University of Oxford, Oxford, England
- MRC Population Health Research Unit, University of Oxford, Oxford, England
| | - Olivier Hermine
- Department of Hematology, Necker Hospital, Paris, France
- Imagine Institute, University of Paris, INSERM U1153, Paris, France
| | - Peter W Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England
- International Severe Acute Respiratory and Emerging Infections Consortium, University of Oxford, Oxford, England
- Pandemic Sciences Centre, University of Oxford, Oxford, England
| | - Nora K Horick
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Kuldeep Kumar
- Medanta-The Medicity, Institute of Liver Transplantation and Regenerative Medicine, Gurugram, India
- Research Department, Medanta Institute of Education and Research, Gurugram, India
| | - Bart N Lambrecht
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Martin J Landray
- Nuffield Department of Population Health, University of Oxford, Oxford, England
- MRC Population Health Research Unit, University of Oxford, Oxford, England
| | - Lorna Leal
- Infectious Diseases Department, Hospital Clinic Barcelona-IDIBAPS, Barcelona, Spain
| | | | | | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, INSERM UMR1184, Le Kremlin-Bicêtre, Paris, France
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Le Le Kremlin-Bicêtre, Paris, France
| | - Nicolas Merchante
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Institute of Biomedicine of Sevilla, Seville, Spain
| | | | | | | | - Jarmo Oksi
- Turku University Hospital, Department of Infectious Diseases, Turku, Finland
| | - Jose A Perez-Molina
- Hospital Universitario Ramón y Cajal IRYCIS, Infectious Diseases Department, Madrid, Spain
| | - Reuven Pizov
- Department of Anesthesilogy Critical Care and Pain Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Raphael Porcher
- Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Paris, France
- INSERM UMRS-1153, Centre de Recherche Epidémiologie et Statistique Université de Paris, METHODS Team, Paris, France
- University de Paris, CRESS UMR1153, INSERM, INRA, Paris, France
| | - Simone Postma
- Department of Rheumatology and Clinical Immunology, University Hospital Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Reena Rajasuriar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, University Hospitals Bristol, NHS Foundation Trust, Bristol, England
| | - Philippe Ravaud
- Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Paris, France
- INSERM UMRS-1153, Centre de Recherche Epidémiologie et Statistique Université de Paris, METHODS Team, Paris, France
- University de Paris, CRESS UMR1153, INSERM, INRA, Paris, France
| | - Pankti D Reid
- Department of Medicine (Rheumatology), University of Chicago Medical Center, Chicago, Illinois
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Hospital Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aranzazu Sancho-Lopez
- Department of Clinical Pharmacology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Todd B Seto
- Center for Outcomes Research and Evaluation, Queen's Medical Center, Honolulu, Hawaii
| | | | - Arvinder Singh Soin
- Medanta-The Medicity, Institute of Liver Transplantation and Regenerative Medicine, Gurugram, India
| | - Natalie Staplin
- Nuffield Department of Population Health, University of Oxford, Oxford, England
- MRC Population Health Research Unit, University of Oxford, Oxford, England
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Department of Medicine (Rheumatology), Massachusetts General Hospital, Boston
| | - Garth W Strohbehn
- VA Ann Arbor, Center for Clinical Management and Research, Ann Arbor, Michigan
| | - Jonas Sunden-Cullberg
- Department of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Julian Torre-Cisneros
- Maimonides Institute for Biomedical Research of Cordoba/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain
| | | | | | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Janet V Diaz
- Clinical Unit, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - John C Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- NIHR Bristol Biomedical Research Centre, Bristol, England
- Health Data Research UK South-West, Bristol, England
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9
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Rabe KF, Celli BR, Wechsler ME, Abdulai RM, Luo X, Boomsma MM, Staudinger H, Horowitz JE, Baras A, Ferreira MA, Ruddy MK, Nivens MC, Amin N, Weinreich DM, Yancopoulos GD, Goulaouic H. Safety and efficacy of itepekimab in patients with moderate-to-severe COPD: a genetic association study and randomised, double-blind, phase 2a trial. Lancet Respir Med 2021; 9:1288-1298. [PMID: 34302758 DOI: 10.1016/s2213-2600(21)00167-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Genetic data implicate IL-33 in asthma susceptibility. Itepekimab, a monoclonal antibody targeting IL-33, demonstrated clinical activity in asthma, with potential in chronic obstructive pulmonary disease (COPD). In this study we first aimed to test the hypothesis that genetic variants in the IL-33 pathway were also associated with COPD. On the basis of the strong association of IL-33 pathway genes with pulmonary diseases like asthma and COPD, we conducted this phase 2a trial to assess the safety and efficacy of itepekimab in patients with moderate-to-severe COPD on a stable regimen of triple-inhaled or double-inhaled background maintenance therapy. METHODS In this two-part study, genetic analyses of loss-of-function and gain-of-function variants in the IL-33 pathway, previously associated with asthma risk, were initially characterised for COPD. We then did a double-blind, phase 2a trial comparing itepekimab with placebo in patients with moderate-to-severe COPD despite standard therapy, at 83 study sites in ten countries. Patients aged 40-75 years who were current or former smokers, had been diagnosed with COPD for at least 1 year, and were on a stable regimen of triple-inhaled or double-inhaled background maintenance therapy, were randomly assigned (1:1) to receive itepekimab 300 mg or placebo, administered as two subcutaneous injections every 2 weeks for 24-52 weeks. The primary endpoint of the phase 2a trial was annualised rate of moderate-to-severe acute exacerbations of COPD during the treatment period. The key secondary outcome was change in prebronchodilator FEV1 from baseline to weeks 16-24. Prespecified subgroup analyses were done for each of the endpoints, including by smoking status. Efficacy and safety analyses were done in all participants who received at least one dose of assigned treatment (modified intention-to-treat population). This trial is registered at ClinicalTrials.gov (NCT03546907). FINDINGS Genetic analyses demonstrated association of loss of function in IL33 with reduced COPD risk, and gain of function in IL33 and IL1RL1 variants with increased risk. Subsequent to this, in the phase 2 trial, 343 patients were randomly assigned to placebo (n=171) or itepekimab (n=172) from July 16, 2018, to Feb 19, 2020. Annualised rates of acute exacerbations of COPD were 1·61 (95% CI 1·32-1·97) in the placebo group and 1·30 (1·05-1·61) in the itepekimab group (relative risk [RR] 0·81 [95% CI 0·61-1·07], p=0·13), and least squares mean prebronchodilator FEV1 change from baseline to weeks 16-24 was 0·0 L (SD 0·02) and 0·06 L (0·02; difference 0·06 L [95% CI 0·01-0·10], p=0·024). When analysis was restricted to former smokers, treatment with itepekimab was associated with nominally significant reductions in acute exacerbations of COPD (RR 0·58 [95% CI 0·39-0·85], p=0·0061) and FEV1 improvement (least squares mean difference 0·09 L [0·02-0·15], p=0·0076) compared with placebo. Current smokers treated with itepekimab showed no treatment benefit versus placebo for exacerbations (RR 1·09 [0·74-1·61], p=0·65) or FEV1 (least squares mean difference 0·02 [-0·05 to 0·09], p=0·54). Treatment-emergent adverse events (TEAEs) occurred in 135 (78%) patients in the itepekimab group and 136 (80%) in the placebo group. The most common TEAEs were nasopharyngitis (28 [16%] in the itepekimab group vs 29 [17%] in the placebo group), bronchitis (18 [10%] vs 14 [8%]), headache (14 [8%] vs 23 [13%]), and upper respiratory tract infection (13 [8%] vs 15 [9%]). INTERPRETATION The primary endpoint in the overall population was not met, subgroup analysis showed that itepekimab reduced exacerbation rate and improved lung function in former smokers with COPD. Two phase 3 clinical studies are ongoing to confirm the efficacy and safety profile of itepekimab in former smokers with COPD. FUNDING Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Christian Albrechts University of Kiel, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Aris Baras
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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10
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Xu C, Rafique A, Potocky T, Paccaly A, Nolain P, Lu Q, Iglesias-Rodriguez M, St John G, Nivens MC, Kanamaluru V, Fairhurst J, Ishii T, Maldonado R, Choy E, Emery P. Differential Binding of Sarilumab and Tocilizumab to IL-6Rα and Effects of Receptor Occupancy on Clinical Parameters. J Clin Pharmacol 2021; 61:714-724. [PMID: 33314148 DOI: 10.1002/jcph.1795] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 07/06/2020] [Accepted: 11/27/2020] [Indexed: 01/21/2023]
Abstract
We evaluated interleukin-6 (IL-6) receptor-α subunit (IL-6Rα) signaling inhibition with sarilumab and tocilizumab, the association between IL-6Rα receptor occupancy (RO) and C-reactive protein (CRP), and the potential clinical relevance of any differences. For this, we measured IL-6Rα binding and signaling inhibition with sarilumab and tocilizumab in vitro, simulated soluble IL-6Rα RO over time for approved sarilumab subcutaneous (SC) and tocilizumab intravenous (IV) and SC doses, and assessed associations between calculated RO and CRP reduction, 28-joint Disease Activity Score based on CRP, and 20%/50%/70% improvement in American College of Rheumatology responses from clinical data. Sarilumab binds IL-6Rα in vitro with 15- to 22-fold higher affinity than tocilizumab, and inhibits IL-6-mediated classical and trans signaling via membrane-bound and soluble IL-6Rα. Sarilumab 200 and 150 mg SC every 2 weeks achieved >90% RO after first and second doses, respectively, maintained throughout the treatment period. At steady-state trough, RO was greater with sarilumab 200 mg (98%) and 150 mg SC every 2 weeks (94%), and tocilizumab 162 mg SC weekly (>99%) and 8 mg/kg IV every 4 weeks (99%), vs tocilizumab 162 mg SC every 2 weeks (84%) and 4 mg/kg IV every 4 weeks (60%). Higher RO was associated with greater CRP reduction and 28-joint Disease Activity Score based on CRP reduction, and more sarilumab patients achieving 20%/50%/70% improvement in American College of Rheumatology responses. The greatest reduction in CRP levels was observed with sarilumab (both doses) and tocilizumab 8 mg/kg IV every 4 weeks (reductions proportionally smaller with 4 mg/kg IV every 4 weeks). Higher IL-6Rα binding affinity translated into higher RO with sarilumab vs tocilizumab 4 mg/kg every 4 weeks or 162 mg every 2 weeks; tocilizumab required the higher dose or increased frequency to maintain the same degree of RO and CRP reduction. Higher RO was associated with clinical parameter improvements.
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Affiliation(s)
- Christine Xu
- Translational Medicine and Early Development, Sanofi, Bridgewater, New Jersey, USA
| | - Ashique Rafique
- Therapeutic Proteins, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Terra Potocky
- Bioassay Development, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Anne Paccaly
- Immunology, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Patrick Nolain
- Research and Development, Sanofi-Aventis, Montpellier, France
| | - Qiang Lu
- Modeling and Simulation, Pharmacokinetics, Dynamics, and Metabolism, Sanofi, Bridgewater, New Jersey, USA
| | | | - Gregory St John
- Immunology and Inflammation, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Michael C Nivens
- Strategic Program Direction, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Vanaja Kanamaluru
- Pharmacokinetics, Dynamics, and Metabolism, Sanofi, Bridgewater, New Jersey, USA
| | - Jeanette Fairhurst
- Therapeutic Proteins, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rafael Maldonado
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Ernest Choy
- Department of Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Paul Emery
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Kovalenko P, Paccaly A, Boyapati A, Xu C, St John G, Nivens MC, Davis JD, Rippley R, DiCioccio AT. Population Pharmacodynamic Model of Neutrophil Margination and Tolerance to Describe Effect of Sarilumab on Absolute Neutrophil Count in Patients with Rheumatoid Arthritis. CPT Pharmacometrics Syst Pharmacol 2020; 9:405-416. [PMID: 32453485 PMCID: PMC7376291 DOI: 10.1002/psp4.12534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
Abstract
Evidence suggests that effects of interleukin‐6 pathway inhibitors sarilumab, tocilizumab, and sirukumab on absolute neutrophil count (ANC) are due to margination of circulating neutrophils into rapidly mobilizable noncirculating pools. We developed a population pharmacodynamic model using compartments for neutrophil margination and ANC‐specific tolerance to describe rapid, transient ANC changes in blood following administration of subcutaneous sarilumab and intravenous/subcutaneous tocilizumab based on data from 322 patients with rheumatoid arthritis in two single‐dose (NCT02097524 and NCT02404558) and one multiple‐dose (NCT01768572) trials. The model incorporated a tolerance compartment to account for ANC nadir and beginning of recovery before maximal drug concentration after subcutaneous dosing, and absence of a nadir plateau when the ANC response is saturated after subcutaneous or intravenous dosing. The model effectively describes the ANC changes and supports neutrophil margination and tolerance as an explanation for the absence of increased infection risk associated with low ANC due to interleukin‐6 pathway inhibitor treatment.
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Affiliation(s)
| | - Anne Paccaly
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Anita Boyapati
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | | | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Ronda Rippley
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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Hall IP, Fowler AV, Gupta A, Tetzlaff K, Nivens MC, Sarno M, Finnigan HA, Bateman ED, Rand Sutherland E. Efficacy of BI 671800, an oral CRTH2 antagonist, in poorly controlled asthma as sole controller and in the presence of inhaled corticosteroid treatment. Pulm Pharmacol Ther 2015; 32:37-44. [DOI: 10.1016/j.pupt.2015.03.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/12/2015] [Accepted: 03/19/2015] [Indexed: 11/25/2022]
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13
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Feldman GJ, Bernstein JA, Hamilton A, Nivens MC, Korducki L, LaForce C. The 24-h FEV1 time profile of olodaterol once daily via Respimat® and formoterol twice daily via Aerolizer® in patients with GOLD 2-4 COPD: results from two 6-week crossover studies. Springerplus 2014; 3:419. [PMID: 25187881 PMCID: PMC4152473 DOI: 10.1186/2193-1801-3-419] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/22/2014] [Indexed: 11/22/2022]
Abstract
ABSTRACT These studies evaluated the 24-h forced expiratory volume in 1 sec (FEV1) profile of once-daily (QD) olodaterol compared to placebo and twice-daily (BID) formoterol in patients with moderate to very severe chronic obstructive pulmonary disease. In two replicate, randomized, double-blind, double-dummy, four-way crossover studies, patients received olodaterol 5 and 10 μg QD, formoterol 12 μg BID, or placebo for 6 weeks in addition to usual-care background maintenance therapy. Co-primary end points were FEV1 area under the curve from 0-12 h (AUC0-12) response (change from baseline) and FEV1 AUC from 12-24 h (AUC12-24) response after 6 weeks, with FEV1 AUC from 0-24 h response identified as a key secondary end point. Other secondary end points included FEV1 AUC from 0-3 h and trough FEV1 responses, as well as corresponding forced vital capacity responses. With both olodaterol doses, FEV1 increased to near-maximal 30 min post-morning dose, which was sustained over 24 h. FEV1 also increased within 30 min post-morning dose of formoterol and was sustained over 12 h; the second formoterol dose resulted in a further increase, sustained for an additional 12 h. FEV1 AUC0-12 and AUC12-24 responses with both QD olodaterol doses and BID formoterol were significantly greater than placebo at 6 weeks (P < .0001). Secondary end-point outcomes were consistent with those of the co-primary end points. These data, together with those from the wider phase III clinical program, provide evidence for the 24-h bronchodilator efficacy of olodaterol QD in this patient population. TRIAL REGISTRY ClinicalTrials.gov; NCT00931385 and NCT00932646.
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Affiliation(s)
- Gregory J Feldman
- />From S. Carolina Pharmaceutical Research, 141 Harold Fleming Court, North Grove Medical Park, Spartanburg, South Carolina 29303 USA
| | - Jonathan A Bernstein
- />Department of Internal Medicine, Bernstein Clinical Research Center, Cincinnati, Ohio USA
| | | | - Michael C Nivens
- />Boehringer Ingelheim Pharmaceuticals Inc, Biberach an der Riss, Germany
| | - Lawrence Korducki
- />Boehringer Ingelheim Pharma GmbH & Co. KG, Ridgefield, Connecticut USA
| | - Craig LaForce
- />North Carolina Clinical Research, Raleigh, North Carolina USA
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14
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Goossens LMA, Nivens MC, Sachs P, Monz BU, Rutten-van Mölken MPMH. Is the EQ-5D responsive to recovery from a moderate COPD exacerbation? Respir Med 2011; 105:1195-202. [PMID: 21439807 DOI: 10.1016/j.rmed.2011.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Received: 06/23/2010] [Revised: 12/16/2010] [Accepted: 02/22/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND To correctly estimate the cost-effectiveness of treatments that reduce COPD exacerbations, the utility gains from preventing exacerbations need to be measured. This requires utility measurement during exacerbations. AIM To assess the ability of the EQ-5D to detect the recovery from moderate COPD exacerbations. METHODS In the US, 65 COPD and/or chronic bronchitis patients (≥40 years old smokers or ex-smokers with a history of 10 pack-years) were enrolled within 48 h of symptom onset of the exacerbation. Patients completed the EQ-5D at enrollment and after 7, 14 and 42 days. Symptoms and medication use were recorded in diaries. Change over time and loss of quality-adjusted life years (QALYs) due to the exacerbation was estimated. Using standardized response mean (SRM) as the metric of responsiveness, we compared the responsiveness of the EQ-5D to the responsiveness of morning peak expiratory flow rate, rescue medication use and symptom scores. SRMs were also used to assess whether patients with greater improvements in peak expiratory flow rate, rescue medication use, symptom scores, clinician global impression of change, and patient global impression of change had a greater improvement in EQ-5D than patients with smaller improvement. RESULTS Mean utility index scores (standard deviation) using the US value set were 0.683 (0.209), 0.726 (0.216), 0.768 (0.169) and 0.760 (0.181) at days 1, 7, 14 and 42, respectively. The mean of each patient's lowest index score, either at visit 1 or visit 2, was 0.651 (0.213). Over the course of 6 weeks there was a highly significant improvement in mean utility. The greatest improvement was seen between day 7 and day 14. Patients lost on average 0.00896 QALY (0.0086) or 3.27 (3.13) quality-adjusted life days during the exacerbation. The EQ-5D (SRM: 0.653) was more responsive to change than peak expiratory flow (0.269), rescue medication use (0.343) and sputum symptom scores (0.322) and equally responsive as cough (0.587) and dyspnea (0.638) symptom scores. CONCLUSION The EQ-5D is responsive to the recovery from a moderate COPD exacerbation.
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Affiliation(s)
- Lucas M A Goossens
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
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15
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Woodruff PG, Wolff M, Hohlfeld JM, Krug N, Dransfield MT, Sutherland ER, Criner GJ, Kim V, Prasse A, Nivens MC, Tetzlaff K, Heilker R, Fahy JV. Safety and efficacy of an inhaled epidermal growth factor receptor inhibitor (BIBW 2948 BS) in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 181:438-45. [PMID: 20007923 DOI: 10.1164/rccm.200909-1415oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Epidermal growth factor receptor (EGFR) activation is implicated in mucin hypersecretion in chronic obstructive pulmonary disease (COPD). OBJECTIVES To investigate the safety and efficacy of an inhaled EGFR antagonist (BIBW 2948) in COPD. METHODS Multicenter, double-blind, placebo-controlled trial of 4 weeks of treatment with two doses of BIBW 2948 (15 and 30 mg twice a day) on safety and mucin-related outcomes in 48 patients with COPD. The effect of BIBW 2948 on EGFR activation in airway epithelial cells was assessed using an ex vivo assay. Efficacy measures included the volume of mucin in the airway epithelium (Vs mu,bala) in bronchial biopsies and the expression of mucin genes in bronchial brushings. MEASUREMENTS AND MAIN RESULTS Inhaled BIBW 2948 induced a dose-related inhibition of EGFR internalization (reflecting decreased EGFR activation) in epithelial cells from treated subjects. However, BIBW 2948 was associated with a dose-related increase in adverse events, including reversible liver enzyme elevation (n = 2), and reduction in FEV(1). The changes in mucin stores and mucin gene expression were not significantly different in the pooled BIBW 2948 group versus placebo (volume of mucin per surface area of basal lamina = 0.22 +/- 7.11 vs. 0.47 +/- 8.06 microm(3)/microm(2); P = 0.93). However, in the 30 mg twice a day group, the reduction in epithelial mucin stores was greatest in subjects with the greatest degree of EGFR inhibition (Pearson r = 0.98; 95% confidence interval, 0.71-0.99). CONCLUSIONS Four-week treatment with BIBW 2948 did not significantly decrease epithelial mucin stores and was poorly tolerated in patients with COPD. Ex vivo analyses suggest that higher doses may be more effective at both EGFR inhibition and decreases in mucin stores but that adverse events should be expected. Clinical trial registered with www.clinicaltrials.gov (NCT00423137).
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Affiliation(s)
- Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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16
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Nivens MC, Felder T, Galloway AH, Pena MMO, Pouliot JJ, Spencer HT. Engineered resistance to camptothecin and antifolates by retroviral coexpression of tyrosyl DNA phosphodiesterase-I and thymidylate synthase. Cancer Chemother Pharmacol 2004; 53:107-15. [PMID: 14605862 DOI: 10.1007/s00280-003-0717-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [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: 04/10/2003] [Accepted: 08/29/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE Gene transfer of cDNA sequences that confer drug resistance can be used (1) to protect hematopoietic cells against the toxic effects of chemotherapy, (2) for in vivo enrichment of genetically engineered cells and (3) to protect cytotoxic T lymphocytes in drug-resistant immunotherapy approaches for the treatment of cancer. We have previously developed strategies to confer resistance to agents targeting thymidylate synthase (TS) and have now expanded our drug resistance strategies to include retroviral expression of tyrosyl-DNA phosphodiesterase (TDP-I), an enzyme recently implicated in the repair of topoisomerase-I (Top-I)/DNA lesions induced by camptothecin (CPT). The combination of TS and Top-I inhibition has been shown to be an effective treatment for several types of cancer. MATERIALS AND METHODS Retroviral vectors were generated that individually encoded TS and TDP-I or that coexpressed both enzymes. Murine fibroblast and Chinese hamster lung transfectants were generated with the vectors and resistance to TS- and Top-I-directed inhibitors was tested. Murine bone marrow progenitor cells were also transduced using recombinant retroviruses encoding TS and TDP-I and the degree of drug resistance conferred to gene-modified cells was tested. RESULTS Enforced expression of TDP-I increased TDP-I activity in gene-modified cells and conferred up to threefold resistance to CPT. The degree of resistance was dependent on the duration of drug treatment. Simultaneous expression of the TS gene encoding E. coli TS optimized for expression in mammalian cells (optecTS) and TDP-I conferred extremely high-level resistance to concurrent treatment with the TS-inhibitor BW1843U89 and CPT. Furthermore, by direct analysis of DNA fragmentation using the comet assay, substantial protection was conferred (fourfold) against DNA fragmentation associated with combination drug treatments by dual enzyme expression compared to non-modified cells. Hematopoietic progenitor assays of murine bone marrow cells transduced with retroviral vectors encoding TS and TDP-I showed that bone marrow cells could be protected from the cytotoxic effects of TS and Top-I inhibition. CONCLUSIONS Enforced expression of optecTS and TDP-I conferred antifolate and CPT resistance to genetically modified cells. Additionally, this work further illustrated a role for TDP-I in the repair of dead-end Top-I complexes and implied that TDP-I expression analysis may aid in predicting the therapeutic effectiveness of the CPT class of compounds.
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Affiliation(s)
- Michael C Nivens
- Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Emory University School of Medicine, 2040 Ridgewood Dr. N.E., Atlanta, GA 30322, USA
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Phan J, Mahdavian E, Nivens MC, Minor W, Berger S, Spencer HT, Dunlap RB, Lebioda L. Catalytic cysteine of thymidylate synthase is activated upon substrate binding. Biochemistry 2000; 39:6969-78. [PMID: 10841779 DOI: 10.1021/bi000367g] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of Ser 167 of Escherichia coli thymidylate synthase (TS) in catalysis has been characterized by kinetic and crystallographic studies. Position 167 variants including S167A, S167N, S167D, S167C, S167G, S167L, S167T, and S167V were generated by site-directed mutagenesis. Only S167A, S167G, S167T, and S167C complemented the growth of thymidine auxotrophs of E. coli in medium lacking thymidine. Steady-state kinetic analysis revealed that mutant enzymes exhibited k(cat) values 1.1-95-fold lower than that of the wild-type enzyme. Relative to wild-type TS, K(m) values of the mutant enzymes for 2'-deoxyuridylate (dUMP) were 5-90 times higher, while K(m) values for 5,10-methylenetetrahydrofolate (CH(2)H(4)folate) were 1.5-16-fold higher. The rate of dehalogenation of 5-bromo-2'-deoxyuridine 5'-monophosphate (BrdUMP), a reaction catalyzed by TS that does not require CH(2)H(4)folate as cosubstrate, by mutant TSs was analyzed and showed that only S167A and S167G catalyzed the dehalogenation reaction and values of k(cat)/K(m) for the mutant enzymes were decreased by 10- and 3000-fold, respectively. Analysis of pre-steady-state kinetics of ternary complex formation revealed that the productive binding of CH(2)H(4)folate is weaker to mutant TSs than to the wild-type enzyme. Chemical transformation constants (k(chem)) for the mutant enzymes were lower by 1.1-6.0-fold relative to the wild-type enzyme. S167A, S167T, and S167C crystallized in the I2(1)3 space group and scattered X-rays to either 1.7 A (S167A and S167T) or 2.6 A (S167C). The high-resolution data sets were refined to a R(crys) of 19.9%. In the crystals some cysteine residues were derivatized with 2-mercaptoethanol to form S,S-(2-hydroxyethyl)thiocysteine. The pattern of derivatization indicates that in the absence of bound substrate the catalytic cysteine is not more reactive than other cysteines. It is proposed that the catalytic cysteine is activated by substrate binding by a proton-transfer mechanism in which the phosphate group of the nucleotide neutralizes the charge of Arg 126', facilitating the transfer of a proton from the catalytic cysteine to a His 207-Asp 205 diad via a system of ordered water molecules.
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Affiliation(s)
- J Phan
- Departments of Chemistry and Biochemistry, Biological Sciences, and Basic Pharmaceutical Sciences, University of South Carolina, Columbia, South Carolina 92908, USA
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