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Craig TJ, Levy DS, Reshef A, Lumry WR, Martinez-Saguer I, Jacobs JS, Yang WH, Ritchie B, Aygören-Pürsün E, Keith PK, Busse P, Feuersenger H, Alexandru Bica M, Jacobs I, Pragst I, Magerl M. Garadacimab for hereditary angioedema attack prevention: long-term efficacy, quality of life, and safety data from a phase 2, randomised, open-label extension study. Lancet Haematol 2024:S2352-3026(24)00081-4. [PMID: 38710185 DOI: 10.1016/s2352-3026(24)00081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Garadacimab is a fully human immunoglobulin G4 monoclonal antibody targeting activated factor XII. This study evaluated long-term efficacy, health-related quality of life (HRQoL), and safety data for garadacimab in adults with hereditary angioedema. METHODS This global phase 2 study comprised a treatment period 1 (TP1: 12 weeks, double-blind, placebo-controlled) and a treatment period 2 (TP2: ≥44-week open-label extension). Patients aged 18-65 years with clinically confirmed hereditary angioedema were eligible. In TP1, 32 patients were randomly assigned (1:1:1:1) to receive subcutaneous garadacimab (75 mg, 200 mg, or 600 mg) or placebo every 4 weeks (once monthly). Randomisation was done using interactive response technology via block randomisation (block sizes 1-4). Subsequently, six additional patients in TP1 were assigned to open-label garadacimab 400 mg every 2 weeks. At the start of TP2, patients were re-randomised (if receiving placebo, garadacimab 75 mg, or garadacimab 400 mg) or continued to receive garadacimab 200 mg or garadacimab 600 mg once monthly. After a protocol amendment on March 20, 2020, patients originally assigned to the 600 mg dose were down-titrated to 200 mg at their next visit. The primary endpoint (published previously) was monthly attack rate for patients receiving 200 mg or 600 mg garadacimab in TP1 in the intention-to-treat population. Here, we assessed the impact of garadacimab on patient-reported and investigator-reported outcomes and HRQoL as well as long-term efficacy and safety. This trial is registered with ClinicalTrials.gov, NCT03712228, and is completed. FINDINGS Of 54 patients screened between Oct 29, 2018, and Aug 28, 2019, 32 randomised and six open-label patients completed TP1 and entered TP2 (20 in the garadacimab 200 mg group; 18 in the garadacimab 600 mg group; total 38 patients). Median age was 39·0 years (IQR 27·0-53·0), and 21 patients (55%) were female and 17 (45%) were male. In TP2, the median garadacimab exposure was 87·9 weeks (IQR 50·0-106·6) in the garadacimab 200 mg group and 44·1 weeks (24·1-56·1) in the garadacimab 600 mg group. Median monthly attack rates were 0·0 (IQR 0·0-0·1) in the garadacimab 200 mg group and 0·1 (0·0-0·4) in the garadacimb 600 mg group. Median reduction in monthly attack rate versus run-in was 100% (IQR 98-100) with garadacimab 200 mg. HRQoL improvements observed during TP1 with garadacimab were sustained throughout TP2. TP2 safety signals were consistent with TP1. Two patients experienced serious adverse events of diverticular perforation and asthma (not garadacimab-related). Treatment-emergent adverse events were mostly mild or moderate in severity. The most common adverse events were headache (nine of 38, 24%) and abdominal pain (seven of 38, 18%). There were no treatment-related deaths. INTERPRETATION Once-monthly garadacimab for more than 2 years in patients with hereditary angioedema was well tolerated and efficacious in reducing monthly attack rate and improving HRQoL. These results reveal the potential of long-term prophylactic treatment with 200 mg once-monthly garadacimab towards complete disease control of patients with hereditary angioedema. FUNDING CSL Behring.
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Affiliation(s)
- Timothy J Craig
- Allergy, Asthma and Immunology, Department of Medicine, Pediatrics and Biomedical Sciences, Penn State University, Hershey, PA, USA; Vinmec International Hospital, Hanoi, Vietnam.
| | - Donald S Levy
- Division of Allergy and Immunology, University of California, Irvine, CA, USA
| | - Avner Reshef
- Allergy, Immunology and Angioedema Center, Barzilai University Hospital, Ashkelon, Israel
| | | | | | | | - William H Yang
- Ottawa Allergy Research Corporation, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emel Aygören-Pürsün
- Department of Pediatrics, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Paul K Keith
- McMaster University Medical Centre Site, Hamilton, ON, Canada
| | | | | | | | | | - Ingo Pragst
- CSL Behring Innovation GmbH, Marburg, Germany
| | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin, Berlin, Germany; Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Petersen RS, Bordone L, Riedl MA, Tachdjian R, Craig TJ, Lumry WR, Manning ME, Bernstein JA, Raasch J, Zuraw BL, Deng Y, Newman KB, Alexander VJ, Lui C, Schneider E, Cohn DM. A phase 2 open-label extension study of prekallikrein inhibition with donidalorsen for hereditary angioedema. Allergy 2024; 79:724-734. [PMID: 38009241 DOI: 10.1111/all.15948] [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: 08/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a potentially fatal disease characterized by unpredictable, recurrent, often disabling swelling attacks. In a randomized phase 2 study, donidalorsen reduced HAE attack frequency and improved patient quality-of-life (ISIS721744-CS2, NCT04030598). We report the 2-year interim analysis of the phase 2 open-label extension (OLE) study (ISIS 721744-CS3, NCT04307381). METHODS In the OLE, the on-treatment study period consisted of fixed (weeks 1-13, donidalorsen 80 mg subcutaneously every 4 weeks [Q4W]) and flexible (weeks 17-105, donidalorsen 80 mg Q4W, 80 mg every 8 weeks [Q8W], or 100 mg Q4W) dosing periods. The primary outcome was incidence and severity of treatment-emergent adverse events (TEAEs). The secondary outcomes included efficacy, pharmacodynamic, and quality-of-life assessments. RESULTS Seventeen patients continued in the OLE study. No serious TEAEs or TEAEs leading to treatment discontinuation were reported. Mean monthly HAE attack rate was 96% lower than the study run-in baseline rate (mean, 0.06/month; 95% confidence interval [CI], 0.02-0.10; median, 0.04 on-treatment vs. mean, 2.70/month; 95% CI, 1.94-3.46; median, 2.29 at baseline). Mean monthly attack rate for Q8W dosing (n = 8) was 0.29 (range, 0.0-1.7; 95% CI, -0.21 to 0.79; median, 0.00). Mean plasma prekallikrein and D-dimer concentrations decreased, and Angioedema Quality of Life Questionnaire total score improved from baseline to week 105 with donidalorsen. CONCLUSION The 2-year interim results of this phase 2 OLE study of donidalorsen in patients with HAE demonstrated no new safety signals; donidalorsen was well tolerated. There was durable efficacy with a 96% reduction in HAE attacks.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Bordone
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Marc A Riedl
- University of California San Diego, La Jolla, California, USA
| | - Raffi Tachdjian
- Department of Pediatrics, University of California, Los Angeles, California, USA
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
- Vinmec International Hospital, Times City, Hanoi, Vietnam
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, Texas, USA
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Jason Raasch
- Midwest Immunology Clinic, Plymouth, Minnesota, USA
| | - Bruce L Zuraw
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Yiwen Deng
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | | | - Cindy Lui
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Al-Shaikhly T, Norris MR, Dennis EH, Liu G, Craig TJ. Comparative Impact of Asthma Biologics: A Nationwide US Claim-Based Analysis. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00203-4. [PMID: 38423294 DOI: 10.1016/j.jaip.2024.02.029] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Biologic modifiers targeting type 2 (T2) airway inflammation are effective in reducing asthma exacerbation. However, real-world and comparative effectiveness studies remain limited. OBJECTIVE To examine and compare the real-world impact of anti-T2 asthma biologics. METHODS In this retrospective, new user cohort study, we used the MarketScan, a Commercial Claims and Encounters Database, to identify adult patients with asthma who began to receive an anti-T2 biologic agent (anti-IL-5s, dupilumab, or omalizumab). We examined the influence of the biologic class on asthma exacerbation by comparing the average number of asthma exacerbation 1 year before and after biologic initiation. We conducted multivariable regression analyses to compare the effectiveness of these asthma biologics on reducing the incidence of asthma exacerbations within 18 months of the initial administration of biologics while controlling for demographic variables, comorbidities, and asthma severity. RESULTS We identified 5,538 asthma patients who were new to taking an anti-T2 biologic [mean age [±SD], 45.6 (12.78) years; 65.8% female). Asthma biologics reduced asthma exacerbation by 11% to 47%, particularly among patients with two or more asthma exacerbations in the year preceding biologic initiation (31% to 65% reduction). Biologics were especially effective in reducing asthma-related hospitalizations (44.6% to 60%). After adjusting for baseline demographics, asthma medication, and comorbidities, dupilumab was associated with a lower estimated mean number of asthma exacerbation per year and lower adjusted odds ratio for developing an asthma exacerbation relative to other biologics (50% to 80% less likely). CONCLUSIONS Anti-T2 asthma biologics reduced asthma exacerbation in real-word settings. Evidence supports growing literature reporting that dupilumab might have a more favorable impact on asthma exacerbation relative to other asthma biologics.
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Affiliation(s)
- Taha Al-Shaikhly
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa.
| | - Matthew R Norris
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Emily H Dennis
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Timothy J Craig
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa
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Zybaczynska J, Norris M, Modi S, Brennan J, Jhaveri P, Craig TJ, Al-Shaikhly T. Artificial Intelligence-Generated Scientific Literature: A Critical Appraisal. J Allergy Clin Immunol Pract 2024; 12:106-110. [PMID: 37832818 DOI: 10.1016/j.jaip.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/14/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Review articles play a critical role in informing medical decisions and identifying avenues for future research. With the introduction of artificial intelligence (AI), there has been a growing interest in the potential of this technology to transform the synthesis of medical literature. Open AI's Generative Pre-trained Transformer (GPT-4) (Open AI Inc, San Francisco, CA) tool provides access to advanced AI that is able to quickly produce medical literature following only simple prompts. The accuracy of the generated articles requires review, especially in subspecialty fields like Allergy/Immunology. OBJECTIVE To critically appraise AI-synthesized allergy-focused minireviews. METHODS We tasked the GPT-4 Chatbot with generating 2 1,000-word reviews on the topics of hereditary angioedema and eosinophilic esophagitis. Authors critically appraised these articles using the Joanna Briggs Institute (JBI) tool for text and opinion and additionally evaluated domains of interest such as language, reference quality, and accuracy of the content. RESULTS The language of the AI-generated minireviews was carefully articulated and logically focused on the topic of interest; however, reviewers of the AI-generated articles indicated that the AI-generated content lacked depth, did not appear to be the result of an analytical process, missed critical information, and contained inaccurate information. Despite being provided instruction to utilize scientific references, the AI chatbot relied mainly on freely available resources, and the AI chatbot fabricated references. CONCLUSIONS The AI holds the potential to change the landscape of synthesizing medical literature; however, apparent inaccurate and fabricated information calls for rigorous evaluation and validation of AI tools in generating medical literature, especially on subjects associated with limited resources.
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Affiliation(s)
- Justyna Zybaczynska
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Matthew Norris
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Sunjay Modi
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Jennifer Brennan
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Pooja Jhaveri
- Division of Allergy & Immunology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Timothy J Craig
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Taha Al-Shaikhly
- Section of Allergy, Asthma & Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa.
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Al-Obaydi S, Ssentongo P, Cherneskie JJ, Craig TJ, Al-Shaikhly T. Outcomes of acute pyelonephritis in patients with a penicillin allergy label in the United States. Ann Allergy Asthma Immunol 2024; 132:97-99. [PMID: 37778455 PMCID: PMC10842634 DOI: 10.1016/j.anai.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Sarah Al-Obaydi
- Division of Hospitalist Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Division of Infectious Diseases, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - John J Cherneskie
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Timothy J Craig
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Taha Al-Shaikhly
- Section of Allergy, Asthma & Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
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Craig TJ, Corbett ML, Meadows JA. Improving Detection of Alpha-1 Antitrypsin Deficiency: Role of the Allergist. J Allergy Clin Immunol Pract 2023; 11:2348-2354. [PMID: 37146883 DOI: 10.1016/j.jaip.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that manifests as lung and/or liver disease. Because symptoms of AATD overlap with those of common pulmonary and hepatic conditions, AATD is often misdiagnosed, which has resulted in substantial underdiagnosis of AATD worldwide. Although screening patients for AATD is recommended, the lack of procedures to facilitate testing remains a barrier to accurate diagnosis of AATD. Delays in AATD diagnosis can worsen outcomes for patients by postponing appropriate disease-modifying treatments. Patients with AATD-related lung disease experience symptoms similar to other obstructive lung disorders and are often misdiagnosed for years. In addition to existing screening guidelines, we recommend that screening for AATD become a standard part of allergists' workups of patients with asthma and fixed obstructive disease, chronic obstructive pulmonary disease, bronchiectasis without known origin, and patients under consideration for treatment with biologics. This Rostrum article reviews screening and diagnostic tests available in the United States and emphasizes evidence-based strategies to increase testing frequency and improve AATD detection rates. We underscore the pivotal role of allergists in managing care for patients with AATD. Finally, we urge health care providers to be aware of potentially poor clinical outcomes among patients with AATD during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Timothy J Craig
- Penn State Health Allergy, Asthma, and Immunology, Hershey, Pa.
| | | | - J Allen Meadows
- Alabama College of Osteopathic Medicine, AllerVie Health, Montgomery, Ala
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Al-Obaydi S, Craig TJ, Al-Shaikhly T. Racial and ethnic disparities in the treatment of patients with atopic dermatitis in the United States: A retrospective matched cohort study. J Allergy Clin Immunol Pract 2023; 11:2602-2604.e1. [PMID: 37225123 PMCID: PMC10524630 DOI: 10.1016/j.jaip.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Sarah Al-Obaydi
- Division of Hospital Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Timothy J Craig
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Taha Al-Shaikhly
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa.
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Modi S, Norris MR, Nguyen V, Bower R, Craig TJ, Al-Shaikhly T. Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis. J Allergy Clin Immunol Pract 2023; 11:1528-1535.e2. [PMID: 36736954 PMCID: PMC10164679 DOI: 10.1016/j.jaip.2023.01.034] [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] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Racial and ethnic differences exist in the severity of various atopic diseases including allergic rhinitis (AR). Patients of under-represented races and ethnicities may be subjected to disparate subcutaneous allergen immunotherapy (SCIT) prescription practices. OBJECTIVE To explore the racial and ethnic disparities in the use of SCIT among patients with AR. METHODS In this retrospective matched cohort study, we used the TriNetX US Collaborative Network, a multicenter electronic health record-based database to identify patients with AR 18 years and older. Patients were grouped according to their racial and ethnic identification. Study groups were matched for baseline demographics, atopic comorbidities, heart diseases and utilization of β-blockers, and angiotensin-converting enzyme inhibitors. The proportion of patients of under-represented racial and ethnic groups started on SCIT was contrasted to the non-Hispanic White cohort. RESULTS We identified 1,038,000 patients with AR; the mean age (±standard deviation) at the index was 49.7 (±16.1) years, and 64.6% were female. Ethnicity information was available from 87.3% of patients, and the majority (92.3%) were non-Hispanic. Over a 3-year observation period, fewer Black patients (relative risk [RR], 0.40; 95% confidence interval [CI], 0.33-0.48) and Hispanic patients (RR, 0.80; 95% CI, 0.64-0.99) were started on SCIT compared with non-Hispanic White patients. The proportions of Asian patients who were initiated on SCIT tended to be lower when compared with non-Hispanic White patients (RR, 0.69; 95% CI, 0.47-1.009). CONCLUSIONS In the United States, differences in SCIT prescription exist between Black and Hispanic patients relative to White patients. Barriers to treatment should be explored and mitigated.
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Affiliation(s)
- Sunjay Modi
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Matthew R. Norris
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Victoria Nguyen
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Robert Bower
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Timothy J. Craig
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Taha Al-Shaikhly
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
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Craig TJ, Reshef A, Li HH, Jacobs JS, Bernstein JA, Farkas H, Yang WH, Stroes ESG, Ohsawa I, Tachdjian R, Manning ME, Lumry WR, Saguer IM, Aygören-Pürsün E, Ritchie B, Sussman GL, Anderson J, Kawahata K, Suzuki Y, Staubach P, Treudler R, Feuersenger H, Glassman F, Jacobs I, Magerl M. Efficacy and safety of garadacimab, a factor XIIa inhibitor for hereditary angioedema prevention (VANGUARD): a global, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023; 401:1079-1090. [PMID: 36868261 DOI: 10.1016/s0140-6736(23)00350-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Hereditary angioedema is a rare and potentially life-threatening genetic disease that is associated with kallikrein-kinin system dysregulation. Garadacimab (CSL312), a novel, fully-human monoclonal antibody that inhibits activated factor XII (FXIIa), is being studied for the prevention of hereditary angioedema attacks. The aim of this study was to evaluate the efficacy and safety of once-monthly subcutaneous administrations of garadacimab as prophylaxis for hereditary angioedema. METHODS VANGUARD was a pivotal, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial that recruited patients (aged ≥12 years) with type I or type II hereditary angioedema across seven countries (Canada, Germany, Hungary, Israel, Japan, the Netherlands, and the USA). Eligible patients were randomly assigned (3:2) to receive garadacimab or placebo for 6 months (182 days) by an interactive response technology (IRT) system. Randomisation was stratified by age (≤17 years vs >17 years) and baseline attack rate (1 to <3 attacks per month vs ≥3 attacks per month) for the adult group. The randomisation list and code were kept by the IRT provider during the study, with no access by site staff and funding representatives. All patients and investigational site staff, and representatives from the funder (or their delegates) with direct interaction with the study sites or patients, were masked to treatment assignment in a double-blind fashion. Randomly assigned patients received a 400-mg loading dose of subcutaneous garadacimab as two 200-mg injections or volume-matched placebo on day 1 of the treatment period, followed by five additional self-administered (or caregiver-administered) monthly doses of 200-mg subcutaneous garadacimab or volume-matched placebo. The primary endpoint was the investigator-assessed time-normalised number of hereditary angioedema attacks (number of hereditary angioedema attacks per month) during the 6-month treatment period (day 1 to day 182). Safety was evaluated in patients who received at least one dose of garadacimab or placebo. The study is registered with the EU Clinical Trials Register, 2020-000570-25 and ClinicalTrials.gov, NCT04656418. FINDINGS Between Jan 27, 2021, and June 7, 2022, we screened 80 patients, 76 of whom were eligible to enter the run-in period of the study. Of 65 eligible patients with type I or type II hereditary angioedema, 39 were randomly assigned to garadacimab and 26 to placebo. One patient was randomly assigned in error and did not enter the treatment period (no dose of study drug received), resulting in 39 patients assigned to garadacimab and 25 patients assigned to placebo being included. 38 (59%) of 64 participants were female and 26 (41%) were male. 55 (86%) of 64 participants were White, six (9%) were Asian (Japanese), one (2%) was Black or African American, one (2%) was Native Hawaiian or Other Pacific Islander, and one (2%) was listed as other. During the 6-month treatment period (day 1 to day 182), the mean number of investigator-confirmed hereditary angioedema attacks per month was significantly lower in the garadacimab group (0·27, 95% CI 0·05 to 0·49) than in the placebo group (2·01, 1·44 to 2·57; p<0·0001), corresponding to a percentage difference in means of -87% (95% CI -96 to -58; p<0·0001). The median number of hereditary angioedema attacks per month was 0 (IQR 0·00-0·31) for garadacimab and 1·35 (1·00-3·20) for placebo. The most common treatment-emergent adverse events were upper-respiratory tract infections, nasopharyngitis, and headaches. FXIIa inhibition was not associated with an increased risk of bleeding or thromboembolic events. INTERPRETATION Monthly garadacimab administration significantly reduced hereditary angioedema attacks in patients aged 12 years and older compared with placebo and had a favourable safety profile. Our results support the use of garadacimab as a potential prophylactic therapy for the treatment of hereditary angioedema in adolescents and adults. FUNDING CSL Behring.
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Affiliation(s)
- Timothy J Craig
- Allergy, Asthma and Immunology, Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA.
| | - Avner Reshef
- Allergy, Immunology & Angioedema Center, Barzilai University Hospital, Ashkelon, Israel
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | | | - Jonathan A Bernstein
- University of Cincinnati, Department of Internal Medicine Division of Rheumatology, Allergy and Immunology and the Bernstein Clinical Research Center Cincinnati, Cincinnati, OH, USA
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - William H Yang
- Ottawa Allergy Research Corporation, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Isao Ohsawa
- Department of Nephrology, Saiyu Soka Hospital, Saitama, Japan
| | - Raffi Tachdjian
- Division of Allergy & Clinical Immunology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Michael E Manning
- Allergy, Asthma & Immunology Associates, Ltd, Internal Medicine, UA College of Medicine, Phoenix, Phoenix, AZ, USA
| | | | | | - Emel Aygören-Pürsün
- Klinikum der Johann Wolfgang-Goethe Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gordon L Sussman
- Gordon Sussman Clinical Research Inc and Department of Clinical Immunology and Allergy, St Michael's Hospital, Toronto, ON, Canada
| | | | - Kimito Kawahata
- St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Regina Treudler
- University Leipzig Medical Faculty, Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology-CAC, Leipzig, Germany
| | | | | | | | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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10
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Craig TJ, Zaragoza-Urdaz RH, Li HH, Yu M, Ren H, Juethner S, Anderson J. Effectiveness and safety of lanadelumab in ethnic and racial minority subgroups of patients with hereditary angioedema: results from phase 3 studies. Allergy Asthma Clin Immunol 2022; 18:85. [PMID: 36153561 PMCID: PMC9508782 DOI: 10.1186/s13223-022-00721-y] [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: 03/31/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic has highlighted disparities in healthcare, particularly in the United States, even though disparities have existed since the organization of the modern healthcare system. Recruitment of patients from racial and ethnic minority groups is often minimal in phase 3 clinical trials, and is further exacerbated in the case of trials for rare diseases such as hereditary angioedema (HAE). This can lead to a gap in the understanding of minority patients’ experiences with these diseases and their response to potential treatment options. Methods We reviewed data from phase 3 double-blind (HELP) and open-label extension (HELP OLE) trials of lanadelumab, a monoclonal antibody developed for long-term prophylaxis against attacks of HAE. Efficacy (attack rate reduction) and safety (adverse events) results from White patients were compared descriptively to those from Hispanic/Latino patients, Black/African Americans, and other minority Americans. Results Not surprisingly, few minorities were recruited across both studies: 9.5% Black, 2.4% Asian, and 7.1% Hispanic/Latino versus 88.1% White and 91.7% non-Hispanic/non-Latino received lanadelumab in HELP, and 4.7% Black, 0.9% Asian, 0.9% other, and 6.1% Hispanic/Latino versus 93.4% White and 93.4% non-Hispanic/non-Latino were enrolled in HELP OLE. Although these studies were conducted in the United States, Canada, Europe, and Jordan, all minorities were from the United States. Despite the number of minority patients being far less than expected for the population, there was no evidence that either efficacy or adverse event profiles differed between ethnic or racial groups. Conclusions The HELP and HELP OLE studies described herein recruited far fewer minorities than would be ideal to represent these populations. However, evidence suggests that the effectiveness and tolerance of lanadelumab are similar between the groups. Nonetheless, the disparity in recruitment into research for minorities has significant room for improvement. Trial registration NCT02586805, registered 26 October 2015, https://clinicaltrials.gov/ct2/show/record/NCT02586805. NCT02741596, registered 18 April 2016, https://clinicaltrials.gov/ct2/show/NCT02741596.
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11
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Grivcheva-Panovska V, Craig TJ, Longhurst H, Bara N, Panovska I. Global perceptions of the current and future impacts of COVID-19 on hereditary angioedema management. Allergy Asthma Proc 2022; 43:e1-e10. [PMID: 34983717 DOI: 10.2500/aap.2022.43.210099] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected health-care provision across the globe. Management of chronic ailments has become challenging because of the strained health-care resources and social distancing measures that prevent on-site clinical visits and treatments. Hereditary angioedema (HAE) is a debilitating, chronic disease characterized by unpredictable swelling attacks in various parts of the body. Controlling HAE symptoms often requires long-term prophylactic medication use and regular medical care; however, limited scientific information has been published about HAE medical care during the COVID-19 pandemic. Objective: To gather patient and health-care professional (HCP) perspectives on the global impact that COVID-19 has had, and the future impact it will have on HAE medical care and to identify differences in perceptions across economic and geographic boundaries. Methods: We conducted two independent but similar online global surveys to capture patient and HCP perspectives on the impact that COVID-19 has had, and the future impact it will have on HAE medical care. Results: Both patients and HCPs globally reported that the pandemic has limited the availability of HAE medical care, and they expect the restrictions to continue far beyond the pandemic. In addition, the results of our study suggested that telehealth use has increased across the globe but has been more successfully implemented in high-income countries. Conclusion: Patients and HCPs expect that HAE-related care will be negatively impacted by the pandemic for many years. Disparities in medical care and technologic infrastructure may exacerbate these challenges in non-high-income countries. Supportive tools and global infrastructure should be established to provide aid to non-high-income countries throughout the pandemic and several years after.
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Affiliation(s)
- Vesna Grivcheva-Panovska
- From the Public Health Institution University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodius, Skopje, North Macedonia
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | - Hilary Longhurst
- Department of Immunology, University of Auckland, Auckland, New Zealand
| | - Noémi Bara
- Hereditary Angioedema Expertise Centre, Sângeorgiu de Mure, Romania
| | - Irina Panovska
- School of Economic, Political, and Policy Sciences, the University of Texas at Dallas, Richardson, Texas
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12
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Geng B, Craig TJ. Small molecule drugs for atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. Ann Allergy Asthma Immunol 2021; 128:263-268. [PMID: 34673223 DOI: 10.1016/j.anai.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review recent trends in the development of targeted small molecule drugs (SMDs) for the treatment of immunologically driven disorders, including atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. DATA SOURCES Data sources included peer-reviewed published literature from the PubMed database, published abstracts from scientific and medical meetings, and medication information from the Drugs@FDA database. STUDY SELECTIONS Articles with primary or retrospective trial results, articles with patient or physician survey results, articles providing expert perspectives, and commentary on chronic immunologic disorders, Food and Drug Administration package inserts, and abstracts from scientific meetings were selected. RESULTS Targeted biological therapies have greatly improved response rates and symptom relief for patients with long-term immunologically driven disorders over the past 2 decades. However, recent advances in the understanding of molecular pathways involved in the pathogenesis of these disorders have led to the development of novel targeted SMDs, such as tofacitinib and berotralstat, that can be delivered orally or topically. Few head-to-head studies that compare the safety and efficacy of biologics to SMDs in immunologically driven disorders exist, although some studies suggest that oral and topical modes of administration are preferred by patients and may improve patient quality of life over time. CONCLUSION Scientific advances have led to an increase in the development of targeted SMDs for the treatment of chronic immunologic disorders, which may revolutionize the management of these diseases. Head-to-head studies and real-world evidence are needed to fully compare treatment attributes between biologics and SMDs, including safety, efficacy, adherence, impact on quality of life, and cost-effectiveness.
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Affiliation(s)
- Bob Geng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State University, Hershey Medical Center, Hershey, Pennsylvania.
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13
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Banerji A, Riedl MA, Craig TJ, Radojicic C. Insights into the treatment burden of hereditary angioedema in the evolving treatment landscape. Allergy Asthma Proc 2021; 42:S1-S3. [PMID: 33980326 DOI: 10.2500/aap.2021.42.210018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Aleena Banerji
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marc A. Riedl
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania, and
| | - Cristine Radojicic
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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14
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Radojicic C, Riedl MA, Craig TJ, Best JM, Rosselli J, Hahn R, Banerji A. Patient perspectives on the treatment burden of injectable medication for hereditary angioedema. Allergy Asthma Proc 2021; 42:S4-S10. [PMID: 33980327 DOI: 10.2500/aap.2021.42.210025] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hereditary angioedema (HAE) is a rare, chronic disease characterized by debilitating swelling episodes in various parts of the body. Patients experience significant burdens related to the symptoms and management of HAE, which can affect their daily lives and reduce their overall quality of life. Prophylactic treatment options have expanded in the past decade to the benefit of patients; however, these therapies require scheduled injections, which can be painful, burdensome, and time consuming. We conducted an online survey of patients with HAE in the USA to better understand their experiences with available prophylactic medications and the associated treatment burdens. Our survey results suggest that most patients are satisfied with their current therapies but desire novel medications with a simpler route of administration and that, although most patients experience significant treatment-related burdens, they learn to cope with these challenges over time.
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Affiliation(s)
- Cristine Radojicic
- From the Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Marc A. Riedl
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | - Aleena Banerji
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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15
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Riedl MA, Craig TJ, Banerji A, Aggarwal K, Best JM, Rosselli J, Hahn R, Radojicic C. Physician and patient perspectives on the management of hereditary angioedema: a survey on treatment burden and needs. Allergy Asthma Proc 2021; 42:S17-S25. [PMID: 33980329 DOI: 10.2500/aap.2021.42.210017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hereditary angioedema (HAE) is a rare disorder caused by genetic mutations that lead to recurrent episodes of swelling in various parts of the body. Prophylactic treatment is common for patients with HAE, and the therapeutic options have expanded in recent years. The current standard of care for prophylactic HAE therapies is subcutaneous treatment, which can be self-administered at home, greatly improving patient quality of life. As new therapies emerge, it is important for patients and physicians to discuss the risks and benefits associated with each treatment to develop an individualized approach to HAE management. We conducted surveys of patients with HAE and physicians who treat patients with HAE to identify prescribing trends for prophylactic HAE treatments and the impact that such treatments has on patients. Our results confirmed that newer, subcutaneous therapies are prescribed for HAE prophylaxis more frequently than other therapies in the United States and that treatment burdens still exist for patients with HAE. We found that physicians and patients were not always aligned on how treatment choices affect patients' lives, which may mean that there are opportunities for enhanced patient-physician dialog and shared decision-making in HAE management in the United States.
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Affiliation(s)
- Marc A. Riedl
- From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | - Aleena Banerji
- Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Cristine Radojicic
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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16
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Craig TJ, Banerji A, Riedl MA, Best JM, Rosselli J, Hahn R, Radojicic C. Caregivers' role in managing hereditary angioedema and perceptions of treatment-related burden. Allergy Asthma Proc 2021; 42:S11-S16. [PMID: 33980328 DOI: 10.2500/aap.2021.42.210029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hereditary angioedema (HAE) is a rare genetic disease that results in recurrent, debilitating, and potentially life-threatening swelling episodes in the extremities, genitals, gastrointestinal tract, and upper airway. Patients can experience significant burdens related to their disease. Informal or familial caregivers often support patients with HAE and likely share in the disease-related burdens, although there are limited HAE caregiver-focused reports in the scientific literature. In the United States, we conducted an online survey of adults caring for an individual with HAE to better understand their experiences with the disease and identify psychosocial impacts of providing care for a patient with HAE. Thirty caregivers provided responses to the survey. Most caregivers were family members of the care recipient and many had HAE themselves. Caregivers reported participating in a number of medical-related tasks and experiencing some burdens as a result of caring for a person with HAE.
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Affiliation(s)
- Timothy J. Craig
- From the Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | - Aleena Banerji
- Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marc A. Riedl
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | | | | | | | - Cristine Radojicic
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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17
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Johnston DT, Henry Li H, Craig TJ, Bernstein JA, Anderson J, Joseph K, Riedl MA. Androgen use in hereditary angioedema: A critical appraisal and approaches to transitioning from androgens to other therapies. Allergy Asthma Proc 2021; 42:22-29. [PMID: 33349293 DOI: 10.2500/aap.2021.42.200106] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Hereditary angioedema (HAE) is a rare genetic disorder clinically characterized by recurrent attacks of subcutaneous and mucosal swelling. Attenuated androgens have been a prophylactic treatment option to reduce the frequency of HAE attacks for > 4 decades. However, the advent of effective on-demand treatments and highly effective, more tolerable, long-term prophylactic therapies has led to a decline in the use of attenuated androgens for the management of HAE in regions where newer therapies are available. A consensus about the best approach for discontinuing or tapering off attenuated androgen therapy does not exist. Objective: To develop a consensus on androgen tapering for patients with HAE. Methods: We sent an open-ended survey about androgen tapering to 21 physicians who treat HAE, 12 of whom responded. We reviewed the collective experience of the participating physicians in combination with results from a literature review on the topic. Results: The survey and literature review underscored potential concerns related to rapid androgen withdrawal in patients with HAE, including physician and patient concerns that the frequency and severity of attacks would abruptly worsen. In addition, discontinuation of attenuated androgens may have the potential for transient adverse effects, such as an increase in the rate of attacks or effects related to hormone withdrawal. Our survey showed that physicians often taper androgens to prevent increases in HAE attacks and possible withdrawal complications. Conclusion: Based on both experiences of the physicians who responded to our survey and reports in the endocrine literature, we provided recommendations for androgen tapering. However, we noted that the likelihood of adverse effects due to androgen withdrawal in patients with HAE is poorly understood and requires further study.
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Affiliation(s)
| | - H. Henry Li
- Institute for Asthma and Allergy, Chevy Chase, Maryland
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey, Pennsylvania
| | - Jonathan A. Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, University of Cincinnati
| | - John Anderson
- Clinical Research Center of Alabama, Birmingham, Alabama
| | - Kusumam Joseph
- BioCryst Pharmaceuticals Inc., Durham, North Carolina; and
| | - Marc A. Riedl
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
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18
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Duong-Quy S, Le-Thi-Minh H, Nguyen-Thi-Bich H, Pham-Thu H, Thom VT, Pham-Thi-Hong N, Duong-Thi-Ly H, Nguyen-Huy B, Ngo-Minh X, Nguyen-Thi-Dieu T, Craig TJ. Correlations between exhaled nitric oxide, rs28364072 polymorphism of FCER2 gene, asthma control, and inhaled corticosteroid responsiveness in children with asthma. J Breath Res 2020; 15:016012. [PMID: 33108776 DOI: 10.1088/1752-7163/abc4ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In children with asthma, the responsiveness of inhaled corticosteroids (ICS) is depended on asthma endotype and phenotype. This study aimed to describe the clinical and biological characteristics, and its correlation with polymorphism of rs28364072 in FCER2 of asthmatic children. This work aimed to study the correlation between fractional concentration of exhaled nitric oxide (FENO) level and rs28364072 polymorphism of FCER2 gene with ICS responsiveness and disease control in children with asthma. This study was a prospective and descriptive study. All clinical characteristics, FENO, blood eosinophil counts (BEC), skin prick test (SPT), total IgE, asthma control test, and FCER2 gene polymorphism were performed for each patient. One hundred and seven asthmatic children who were over 5 years old (9.2 ± 2.6), were included. Patients with FENO > 20 ppb had higher percentage of positive SPT, total IgE level, and BEC (89.2 vs 80.0%, 851.1 vs 656.9 UI ml-1, and 785 ± 576 G L-1 vs 425 ± 364 G L-1; respectively). Among them, there were 54.2% of homozygous TT, 36.4% of heterozygous TC, and 9.4% of homozygous CC of rs28364072 polymorphism in FCER2. The percentage of patients with controlled asthma was increasing after 1 month and 3 months (47.1% and 58.8%; respectively). During the study, the ICS was decreasing as indicated by asthma control (348 ± 118 mcg at 1st month vs 329 ± 119 mcg at 3rd month; p < 0.05). CC genotype had the lowest level of increasing FEV1 compared to that in genotype TC and TT (8.4% vs 8.7% and 27.1%; p > 0.05 and p < 0.05; respectively). The percentage of polymorphism in rs28364072 of FCER2 was significant higher in patients with controlled asthma compared to uncontrolled asthma. Asthmatic children with high FENO and rs28364072 polymorphism in FCER2 gene are good responders to ICS; however, asthmatic children with homozygous variant CC of rs28364072 are poorly responsive to ICS.
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Affiliation(s)
- S Duong-Quy
- Department of Respiratory Immuno-Allergology, Bio-Medical Research Centre, Lam Dong Medical College, Dalat, Vietnam. Medical Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam. These authors are co-first authors
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19
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Kahwash BM, Deshpande DR, Guo C, Panganiban CM, Wangberg H, Craig TJ. Allergy/Immunology Trainee Experiences During the COVID-19 Pandemic: AAAAI Work Group Report of the Fellows-in-Training Committee. J Allergy Clin Immunol Pract 2020; 9:1-6.e1. [PMID: 33144147 PMCID: PMC7605747 DOI: 10.1016/j.jaip.2020.09.036] [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] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/01/2022]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) global pandemic, medical trainees have faced unique challenges and uncertainties. To capture the experiences of allergy and immunology fellows throughout the United States and Canada during this time, a 17-item electronic questionnaire was distributed to 380 fellow-in-training (FIT) members of the American Academy of Allergy, Asthma, and Immunology enrolled in US and Canadian allergy/immunology fellowship programs. Voluntary and anonymous responses were collected from April 15 to May 15, 2020. In addition to summary statistics, categorical data were compared using χ2 tests (Fisher's exact). Responses were obtained from FITs across all years of training and primary specialties (Internal Medicine, Pediatrics, and Medicine-Pediatrics) with a response rate of 32.6% (124 of 380). Reassignment to COVID-19 clinical responsibilities was reported by 12% (15 of 124) of FITs, with the largest proportion in the US northeast region. A majority of FITs used telehealth (95%) and virtual learning (82%) during the pandemic. Overall, 21% (25 of 120) of FITs expressed concern about potentially lacking clinical experience for independently practicing allergy and immunology. However, FITs using telehealth reported lower concern compared with those who did not (18.4% [21 of 114] vs 66.7% [4 of 6]; P = .01). The survey shows that allergy and immunology trainee experiences have varied considerably since the COVID-19 outbreak. Notably, the adoption of telehealth and virtual learning was commonly reported, and optimization of these virtual experiences will be helpful. Even outside of pandemics, training on the use of telemedicine may be a sound strategy in preparation for future health care delivery and unexpected events.
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Affiliation(s)
- Basil M Kahwash
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Deepti R Deshpande
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY.
| | - Canting Guo
- Department of Allergy and Immunology, Springfield Clinic, Springfield, Ill
| | - Christine M Panganiban
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, Orange, Calif
| | - Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Health, San Diego, Calif
| | - Timothy J Craig
- Department of Medicine, Pediatrics and Biomedical Sciences, Penn State University, Hershey, Pa
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20
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Daley AS, Naro GR, Craig TJ, Hussein RH, Banjade R, Jacobs JB, Ross IR. POPS case: A 30-year-old Filipino woman with fevers, lymphadenopathy, painful scalp lesions, and a neck mass. Allergy Asthma Proc 2020; 41:305-308. [PMID: 32605702 DOI: 10.2500/aap.2020.41.200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We described a case of a 30-year-old Filipino woman who presented with fevers, night sweats, left hip pain, painful scalp lesions, and a neck mass. Symptoms began 6 months earlier, with nasal drainage, fever, cough, and occasional hemoptysis, which did not resolve with outpatient antibiotics. A further workup revealed lymphadenopathy and several lytic bone lesions. Her hospital course was later further complicated by the development of a tracheoesophageal fistula secondary to an esophageal mass and, then later, aseptic meningitis. Extensive diagnostic workup and immunologic tests were performed and finally led to the diagnosis. Here, we discussed the diagnostic workup and pathophysiology of the underlying condition. This case illustrated the importance of appropriate immunologic workup to make the diagnosis of a rare condition that proves to be clinically significant and presents challenges in management.
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Affiliation(s)
- Aparna S. Daley
- From the Division of Allergy and Immunology, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Timothy J. Craig
- From the Division of Allergy and Immunology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Rezhan H.A. Hussein
- Division of Infectious Diseases and Epidemiology. Penn State College of Medicine, Hershey Pennsylvania; and
| | - Rashmi Banjade
- Division of Infectious Diseases and Epidemiology. Penn State College of Medicine, Hershey Pennsylvania; and
| | - Jennifer B. Jacobs
- Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian R. Ross
- Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Singh U, Lumry WR, Busse P, Wedner HJ, Banerji A, Craig TJ, Li HH, Tachdjian R, Jacobs JS, Riedl MA, Davis-Lorton M, Christiansen SC, Zuraw BL, Bernstein JA. Association Between Self-Reported Dental Hygiene Practices and Dental Procedure-Related Recurrent Angioedema Attacks in HAE Subjects: A Multicenter Survey. J Allergy Clin Immunol Pract 2020; 8:3162-3169.e5. [PMID: 32534150 DOI: 10.1016/j.jaip.2020.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) symptoms may be triggered by dental procedures, thereby complicating dental care in individuals affected by the condition. OBJECTIVE This study investigated the self-perceived dental care needs, perceived susceptibility to acute angioedema (AE) attacks after dental procedures, and dental care behavior of patients with HAE. METHODS A self-administered semistructured web-based questionnaire was distributed to 250 adult patients with HAE (type 1 or 2; 88% type 1) and 256 matched non-HAE controls. Data were analyzed using stratified χ2 tests, logistic regression, and classification trees. RESULTS A total of 46.4% of HAE versus 55.5% of control patients had dental visits within 6 months (P = .04). Dental insurance was a barrier to seeking routine dental visits among both groups. However, significantly fewer patients with HAE had routine dental visits within 6 months despite having dental insurance compared with control patients (48% vs 60%, P = .01). Within the HAE group, a significantly greater number of patients with dental visits at intervals greater than 6 months had a history of recurrent postprocedural AE attacks (odds ratio [OR]: 3.9 [1.7, 8.8], P = .0005) and used antibacterial toothpaste more frequently than those without recurrent AE attacks (OR: 4.7 [1.5, 15.4], P = .005). CONCLUSIONS These data support the hypothesis that patients with HAE who are predisposed to having AE episodes in response to medical or physical trauma visit the dentist less and engage in specific oral hygiene practices more frequently than matched control patients and patients with HAE who reported that they were less likely to swell after a dental procedure.
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Affiliation(s)
- Umesh Singh
- Division of Immunology/Allergy, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, Texas
| | - Paula Busse
- Division of Clinical Immunology, Mount Sinai, New York, NY
| | - H James Wedner
- Allergy and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Aleena Banerji
- Division of Rheumatology, Department of Allergy & Immunology, Massachusetts General Hospital, Boston, Mass
| | - Timothy J Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - H Henry Li
- Institute for Asthma and Allergy, PC, Chevy Chase, Md
| | - Raffi Tachdjian
- Division of Allergy and Immunology, UCLA School of Medicine, Los Angeles, Calif
| | - Joshua S Jacobs
- Allergy and Asthma Clinical Research, Inc., Walnut Creek, Calif
| | - Marc A Riedl
- Divison of Rheumatology, Allergy & Immunology, University of California, San Diego, La Jolla, Calif
| | | | - Sandra C Christiansen
- Divison of Rheumatology, Allergy & Immunology, University of California, San Diego, La Jolla, Calif
| | - Bruce L Zuraw
- Divison of Rheumatology, Allergy & Immunology, University of California, San Diego, La Jolla, Calif
| | - Jonathan A Bernstein
- Division of Immunology/Allergy, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Ngo-Minh X, Tang-Thi-Thao T, Doan-Thi-Quynh N, Craig TJ, Duong-Quy S. Study of the role of exhaled nitric oxide (NO) in predicting controlled or uncontrolled asthma in asthmatic children. Multidiscip Respir Med 2020; 15:656. [PMID: 32431811 PMCID: PMC7232017 DOI: 10.4081/mrm.2020.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background Exhaled nitric oxide (NO), especially fractional concentration of exhaled NO (FENO) has been used to predict the responsiveness to inhaled corticosteroid (ICS) in children with asthma. However, the use of exhaled NO for predicting asthma control in children is still controversial. Methods This was a perspective observational study. Asthmatic children who were naïve to inhaled corticosteroid (ICS) were included in the present study. The measurements of FENO and CANO (concentration of NO in the gas phase of the alveolar), spirometry, blood eosinophil counts (BEC), and total IgE levels were done for each asthmatic child. All study subjects started proper asthma treatment after the enrollment. Results Ninety three asthmatic children (9±3 years) with moderate (63.4%) to severe (36.6%) asthma were included and finished the 3-month study. The levels of FENO and CANO at inclusion were 37±11 ppb and 5.8±1.4 ppb, respectively; the mean of BEC was 617±258 cells/μL; the level of total IgE was 1563±576 UI/mL; 89% of subjects were positive for at least one respiratory allergen. The percentage of severe asthma was reduced significantly after 3 months (P<0.001). Well controlled asthma subjects at 3 months had higher levels of FENO and lower levels of CANO at inclusion (P<0.05 and P<0.05). FENO<20 ppb or CANO>5ppb had a risk of uncontrolled asthma at 3 months (OR: 1.7, CI 95% [(0.8) - (3.3)], P<0.05; OR: 1.9, CI 95% [(0.9) - (2.7)], P<0.05; respectively). FENO>35 ppb at inclusion had a positive predictive value for asthma control at 3 months (OR: 3.5, CI 95% [2.2-5.9], P<0.01). Conclusions Exhaled NO is a biomarker of asthma which may have a potential role to predict the control of asthma in short-term follow up in asthmatic children.
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Affiliation(s)
- Xuan Ngo-Minh
- Department of Medicine, Pham Ngoc Thach University, Ho Chi Minh city, Vietnam
| | | | | | - Timothy J Craig
- Division of Immuno-Allergology, Hershey Medical Center, Penn State Medical College, Hershey, PA, USA
| | - Sy Duong-Quy
- Department of Medicine, Pham Ngoc Thach University, Ho Chi Minh city, Vietnam.,Clinical Research Center, Lam Dong Medical College, Dalat city, Vietnam.,Division of Immuno-Allergology, Hershey Medical Center, Penn State Medical College, Hershey, PA, USA
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Smits W, Inglefield JT, Letz K, Lee R, Craig TJ. Improved Immunotherapy with a Rapid Allergen Vaccination Schedule: A Study of 137 Patients. Ear, Nose & Throat Journal 2019. [DOI: 10.1177/014556130308201116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Kevin Letz
- From the Allergy and Asthma Center, Fort Wayne, Ind
| | - Robert Lee
- Indiana University School of Medicine, Indianapolis
| | - Timothy J. Craig
- Department of Pulmonary Allergy and Critical Care Medicine, Pennsylvania State University College of Medicine, Hershey
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Bernstein JA, Li HH, Craig TJ, Manning ME, Lawo JP, Machnig T, Krishnarajah G, Fridman M. Indirect comparison of intravenous vs. subcutaneous C1-inhibitor placebo-controlled trials for routine prevention of hereditary angioedema attacks. Allergy Asthma Clin Immunol 2019; 15:13. [PMID: 30899278 PMCID: PMC6407188 DOI: 10.1186/s13223-019-0328-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/17/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction For prophylaxis of hereditary angioedema (HAE) attacks, replacement therapy with human C1-inhibitor (C1-INH) treatment is approved and available as intravenous [C1-INH(IV)] (Cinryze®) and subcutaneous [C1-INH(SC)] HAEGARDA® preparations. In the absence of a head-to-head comparative study of the two treatment modalities, an indirect comparison of data from 2 independent but similar clinical trials was undertaken. Methods Two similar randomized, double-blind, placebo-controlled, crossover studies were identified which evaluated either C1-INH(SC) (COMPACT; NCT01912456; 16 weeks) or C1-INH(IV) (CHANGE; NCT01005888; 14 weeks) vs. placebo (on-demand treatment only) for routine prevention of HAE attacks. Individual patient data from each trial were used to conduct an indirect comparison of treatment effects. Attack reductions (absolute and percent of mean/median number of monthly HAE attacks reduction over placebo) were compared between the two C1-INH formulations at approved/recommended doses: C1-INH(SC) 60 IU/kg twice weekly (n = 45) and 1000 U of C1-INH(IV) twice weekly (n = 22). Point estimates were adjusted using mixed and quantile regression models that controlled for study design. Results The absolute mean monthly numbers of HAE attack reductions were 3.6 (95% CI 2.9, 4.2) for C1-INH(SC) 60 IU/kg vs. placebo and 2.3 (1.4, 3.3) for C1-INH(IV) vs. placebo; between-product difference, 1.3 (0.1, 2.4; P = 0.034). The mean percent reduction in monthly attack rate was significantly greater with C1-INH(SC) as compared with C1-INH(IV) (84% vs. 51%; P < 0.001). The percentages of subjects experiencing ≥ 50%, ≥ 70%, and ≥ 90% reductions in monthly HAE attack rates versus placebo were significantly higher with C1-INH(SC) 60 IU/kg as compared to C1-INH(IV) 1000 U (≥ 50% reduction: 91% vs. 50%, odds ratio [OR] = 10.33, P = 0.003; ≥ 70% reduction: 84% vs. 46%, OR = 6.19, P = 0.005; ≥ 90% reduction: 57% vs. 18%, OR = 6.04, P = 0.007). Conclusion Within the limitations of an indirect study comparison, this analysis suggests greater attack reduction with twice-weekly C1-INH(SC) 60 IU/kg as compared to twice-weekly C1-INH(IV) 1000 U for the routine prevention of HAE attacks.
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Affiliation(s)
- Jonathan A Bernstein
- 1University of Cincinnati College of Medicine and Bernstein Clinical Research Center, 231 Albert Sabin Way ML #563, Cincinnati, OH 45267-0563 USA
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Li HH, Craig TJ, Longhurst H, Cicardi M, Feuersenger H, Pragst I, Mycroft S. Long-term Safety of Subcutaneous C1-Inhibitor in the Prophylactic Treatment of Hereditary Angioedema. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Singh U, Banerji A, Busse PJ, Christiansen SC, Craig TJ, Davis-Lorton M, Jacobs JS, Li HH, Lumry WR, Riedl MA, Tachdjian R, Wedner HJ, Zuraw BL, Bernstein JA. A Questionnaire Survey Study To Determine Association of Dental Hygiene Practices in Hereditary Angioedema Subjects with The Incidence of Post-Procedural Angioedema Attacks. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Stern HH, Craig TJ. Quality Assessment of the Care of Acquired Angioedema Patients at our Institution. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lumry WR, Craig TJ, Magerl MA, Farkas H, Lawo JP, Chiao J, Machnig T. Long-term Health-related Quality of Life in Patients Treated With Subcutaneous C1-Inhibitor Replacement Therapy for the Prevention of Hereditary Angioedema Attacks. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Craig TJ, Henao MP. Advances in managing COPD related to α 1 -antitrypsin deficiency: An under-recognized genetic disorder. Allergy 2018; 73:2110-2121. [PMID: 29984428 PMCID: PMC6282978 DOI: 10.1111/all.13558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/07/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 12/19/2022]
Abstract
α1 -Antitrypsin deficiency (AATD) predisposes individuals to chronic obstructive pulmonary disease (COPD) and liver disease. Despite being commonly described as rare, AATD is under-recognized, with less than 10% of cases identified. The following is a comprehensive review of AATD, primarily for physicians who treat COPD or asthma, covering the genetics, epidemiology, clinical presentation, screening and diagnosis, and treatments of AATD. For patients presenting with liver and/or lung disease, screening and diagnostic tests are the only methods to determine whether the disease is related to AATD. Screening guidelines have been established by organizations such as the World Health Organization, European Respiratory Society, and American Thoracic Society. High-risk groups, including individuals with COPD, nonresponsive asthma, bronchiectasis of unknown etiology, or unexplained liver disease, should be tested for AATD. Current treatment options include augmentation therapy with purified AAT for patients with deficient AAT levels and significant lung disease. Recent trial data suggest that lung tissue is preserved by augmentation therapy, and different dosing schedules are currently being investigated. Effective management of AATD and related diseases also includes aggressive avoidance of smoking and biomass burning, vaccinations, antibiotics, exercise, good diet, COPD medications, and serial assessment.
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Affiliation(s)
- Timothy J. Craig
- Department of Medicine and PediatricsCollege of MedicinePennsylvania State UniversityHersheyPennsylvania
| | - Maria Paula Henao
- Department of MedicineCollege of MedicinePennsylvania State UniversityHersheyPennsylvania
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Ledford DK, Craig TJ. Recurrent Angioedema. J Allergy Clin Immunol Pract 2018; 6:1427-1429. [PMID: 30033921 DOI: 10.1016/j.jaip.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Dennis K Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley VA Hospital, Tampa, Fla.
| | - Timothy J Craig
- Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa
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Duong-Quy S, Tran Van H, Vo Thi Kim A, Pham Huy Q, Craig TJ. Clinical and Functional Characteristics of Subjects with Asthma, COPD, and Asthma-COPD Overlap: A Multicentre Study in Vietnam. Can Respir J 2018; 2018:1732946. [PMID: 29808101 PMCID: PMC5901814 DOI: 10.1155/2018/1732946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Subjects with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) share common features of patients with asthma and COPD. Our study was planned to describe the clinical and functional features of subjects with ACO compared to asthma and COPD patients. Subjects and Methods Study subjects who met the inclusion criteria were classified into three different groups: asthma, COPD, and ACO groups. All study subjects underwent clinical examination and biological and functional testing. They were then followed for 6 months to evaluate the response to conventional treatment. Results From March 2015 to March 2017, 76 asthmatic (mean age: 41 ± 22 years), 74 COPD (59 ± 13 years), and 59 ACO (52 ± 14 years) subjects were included. The percentage of subjects with dyspnea on excretion in the ACO group was higher than that in asthma and COPD groups (P < 0.001 and P < 0.05, resp.). Subjects with COPD and ACO had significant airflow limitation (FEV1) compared to asthma (64 ± 17% and 54 ± 14% versus 80 ± 22%; P < 0.01 and P < 0.01, resp.). The levels of FENO in subjects with asthma and ACO were significantly higher than those in subjects with COPD (46 ± 28 ppb and 34 ± 12 ppb versus 15 ± 8 ppb; P < 0.001 and P < 0.001, resp.). VO2 max and 6MWD were improved in study subjects after 6 months of treatment. Increased CANO and AHI > 15/hour had a significant probability of risk for ACO (OR = 33.2, P < 0.001, and OR = 3.4, P < 0.05, resp.). Conclusion Subjects with ACO share the common clinical and functional characteristics of asthma and COPD but are more likely to have sleep apnea. The majority of patients with ACO have a favourable response to combined treatment.
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Affiliation(s)
- Sy Duong-Quy
- Bio-Medical Research Center, Lam Dong Medical College, Dalat, Vietnam
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Huong Tran Van
- Department of Health Science, Thang Long University, Hanoi, Vietnam
| | | | - Quyen Pham Huy
- Department of Clinical Immuno-Allergology, Hai Phong University, Haiphong, Vietnam
| | - Timothy J. Craig
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
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Zuraw BL, Cicardi M, Craig TJ, Longhurst HJ, Lumry WR, Bernstein JA, Zhang Y, Pawaskar DK. Subcutaneous (SC) vs Intravenous (IV) C1-esterase-inhibitor (C1-INH) Replacement Treatment For The Prevention Of Attacks Of Hereditary Angioedema (HAE): A Population-based Exposure-response Analysis. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baird D, Craig TJ, Miller JJ. Atypical presentation of acquired angioedema. Cutis 2018; 101:E14-E16. [PMID: 29554170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- David Baird
- Department of Dermatology, Penn State Hershey Medical Center, USA
| | - Timothy J Craig
- Department of Medicine and Pediatrics, Penn State Hershey Medical Center, USA
| | - Jeffrey J Miller
- Department of Dermatology, Penn State Hershey Medical Center, USA
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Carpenter T, Craig TJ, Jones RA, Shaeffer S, Yoder M. Restarting Venom Immunotherapy After the Recent Venom Extract Shortage: Our Experience as a Tertiary Center. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Duong-Quy S, Vu-Minh T, Hua-Huy T, Tang-Thi-Thao T, Le-Quang K, Tran-Thanh D, Doan-Thi-Quynh N, Le-Dong NN, Craig TJ, Dinh-Xuan AT. Study of nasal exhaled nitric oxide levels in diagnosis of allergic rhinitis in subjects with and without asthma. J Asthma Allergy 2017; 10:75-82. [PMID: 28356764 PMCID: PMC5367560 DOI: 10.2147/jaa.s129047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The measure of fractional exhaled nitric oxide (FENO) in the airways is a useful tool to guide the diagnosis and titration of inhaled corticosteroids in patients with asthma. However, its role in diagnosis of allergic rhinitis (AR), especially in subjects with asthma, is not well established. Objective To study the cutoff of nasal FENO in the diagnosis of subjects with AR and AR-asthma compared to age-matched subjects without AR or asthma and its correlations with the clinical and functional characteristics. Methods The study was cross sectional and descriptive. Subjects were grouped into control subjects, AR, and AR-asthma, based on the inclusion criteria. Exhaled NO (nasal FENO, bronchial FENO, and alveolar concentration of NO) was measured by multiple flow electro-luminescence device. Results Six hundred twenty-eight subjects were included: 217 control subjects (children: n=98, 10±4 years; adults: n=119, 50±16 years), 168 subjects with AR (children: n=54, 10±3 years; adults: n=114, 49±15 years), and 243 subjects with AR-asthma (children: n=115, 10±3 years; adults: n=128, 51±14 years). Nasal peak inspiratory flow and peak expiratory flow were lower in subjects with AR and AR-asthma than in control subjects (P<0.01 and P<0.01; and P<0.05 and P<0.01, respectively). Nasal FENO levels were significantly higher in subjects with AR and AR-asthma than in control subjects (1614±629 and 1686±614 ppb vs 582±161 ppb; P<0.001 and P<0.001, respectively). In subjects with AR non-asthma, the cutoffs of nasal FENO for those diagnosed with AR were 775 ppb in children, 799 ppb in adults, and 799 in the general population (sensitivity: 92.68%, 92.63%, and 92.65%, respectively; specificity: 91.67%, 95.00%, and 96.87%, respectively). In subjects with AR-asthma, the cutoffs of nasal FENO were higher, especially in asthma children (1458 ppb; sensitivity: 72.97% and specificity: 95.83%). Conclusion Nasal FENO measurement is a useful technique for the diagnosis of AR in subjects with and without asthma.
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Affiliation(s)
- Sy Duong-Quy
- Department of Respiratory Physiology, Cochin Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Medicine, Penn State University, Hershey, PA, USA; Bio-Medical Research Center, Lam Dong Medical College, Dalat
| | - Thuc Vu-Minh
- Department of Immuno-Allergology, ENT National Institute, Hanoi, Vietnam
| | - Thong Hua-Huy
- Department of Respiratory Physiology, Cochin Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Khiet Le-Quang
- Bio-Medical Research Center, Lam Dong Medical College, Dalat
| | - Dinh Tran-Thanh
- Bio-Medical Research Center, Lam Dong Medical College, Dalat
| | | | - Nhat-Nam Le-Dong
- Department of Pulmonology, St Elisabeth Hospital, Namur, Belgium
| | - Timothy J Craig
- Department of Medicine, Penn State University, Hershey, PA, USA
| | - Anh-Tuan Dinh-Xuan
- Department of Respiratory Physiology, Cochin Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Abstract
Alpha-1 antitrypsin (AAT) is the prototypical protease inhibitor from the serine protease inhibitor (serpin) superfamily that protects lung tissue from proteolytic damage by inhibiting neutrophil elastase. Approximately 1 in 2750 to 1 in 4500 individuals have an autosomal codominant condition that leads to a deficiency of circulating AAT. In individuals with AAT deficiency (AATD), AAT is retained in liver cells, which predisposes them to liver disease, and does not reach lung tissues through circulation, where it normally acts as the primary natural regulator of proteolytic activity in the pulmonary tissues, which thus leads to lung disease. Despite being commonly labeled as a rare disease, AATD is one of the most common autosomal genetic disorders and is considered highly underrecognized, with ≤10% of individuals suspected with AATD identified. Screening guidelines have been established, and the diagnosis is easy to confirm when the condition is suspected. Early recognition is key to prevent morbidity and mortality associated with the disease. For this reason, all patients with chronic obstructive pulmonary disease and patients with asthma and fixed obstruction should be tested to exclude the diagnosis of AATD. Augmentation therapy of the deficient protein is available for those with significant lung disease and protein deficiency, and analysis of recent data supported preservation of lung tissue with this treatment. In this review, oriented toward specialists in allergy and immunology, we focused our discussion on the presentation, diagnosis, and treatment of pulmonary symptoms of AATD.
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Otani IM, Lumry WR, Hurwitz S, Li HH, Craig TJ, Holtzman NS, Iandoli MI, Tucker J, Riedl MA, Zuraw BL, Banerji A. Subcutaneous Icatibant for the Treatment of Hereditary Angioedema Attacks: Comparison of Home Self-Administration with Administration at a Medical Facility. J Allergy Clin Immunol Pract 2017; 5:442-447.e1. [PMID: 27818136 DOI: 10.1016/j.jaip.2016.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/03/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a life-threatening disorder characterized by recurrent angioedema. Icatibant, a subcutaneous bradykinin-B2-receptor antagonist, is an effective on-demand therapy. Data outside the United States suggest that self-administration is tolerated and patient-preferred compared with administration by health care professionals at medical facilities (HCP-administration). OBJECTIVE A prospective, multicenter study was conducted in the United States to compare icatibant self-administration and HCP-administration. METHODS Subjects 18 years or older with type I or II HAE were recruited. The first 2 HAE attacks after enrollment were treated at medical facilities. Subjects were instructed by a health care professional on self-administration during icatibant treatment for the second HAE attack. Icatibant was self-administered for all subsequent attacks. For each treated HAE attack, efficacy, safety, and tolerability data were recorded. RESULTS Nineteen patients with HAE received icatibant for 79 distinct HAE attacks. Mean attack duration was significantly shorter with self-administration (n = 50; 547 ± 510 minutes) than with HCP-administration (n = 29; 968 ± 717 minutes; P = .006). Mean time to treatment was significantly shorter with self-administration (143 ± 226 minutes) than with HCP-administration (361 ± 503 minutes; P < .0001). Shorter times to treatment were associated with shorter time from treatment to symptom resolution (r = 0.35; P = .02). Improvements in visual analog scale score and patient symptom score from pretreatment to 4 hours postinjection were comparable between self-administration and HCP-administration. There were no serious adverse events or discontinuations due to adverse events with self-administration or HCP-administration. CONCLUSIONS Icatibant self-administration shortened attack duration and time to treatment, with no difference in safety or local tolerability compared with HCP-administration. These findings support icatibant as an effective on-demand option for home-based treatment.
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Affiliation(s)
- Iris M Otani
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - William R Lumry
- Allergy Asthma Research Associates Research Center, Dallas, Texas; Allergy and Asthma Specialists, Dallas, Texas
| | - Shelley Hurwitz
- Biostatistics Core, Center for Clinical Investigation, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | | | - Timothy J Craig
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Niki S Holtzman
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Matthew I Iandoli
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Julie Tucker
- Allergy Asthma Research Associates Research Center, Dallas, Texas; Allergy and Asthma Specialists, Dallas, Texas
| | - Marc A Riedl
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, Calif
| | - Bruce L Zuraw
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, Calif
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Pool AC, Kraschnewski JL, Poger JM, Smyth J, Stuckey HL, Craig TJ, Lehman EB, Yang C, Sciamanna CN. Impact of online patient reminders to improve asthma care: A randomized controlled trial. PLoS One 2017; 12:e0170447. [PMID: 28158200 PMCID: PMC5291361 DOI: 10.1371/journal.pone.0170447] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/06/2017] [Indexed: 12/05/2022] Open
Abstract
Importance Asthma is one of the most burdensome chronic illnesses in the US. Despite widespread dissemination of evidence-based guidelines, more than half of the adults with asthma have uncontrolled symptoms. Objective To examine the efficacy of an online tool designed to improve asthma control. Design 12-month single blind randomized controlled trial of the online tool (Intervention condition, IC) versus an active control tool (CC). Setting Patients enrolled in an insurance plan. Participants Participants were 408 adults (21–60 years of age) with persistent asthma. Intervention At least once each month and before provider visits, participants in the IC answered questions online about their asthma symptoms, asthma medications and asthma care received from providers, such as an asthma management plan. The tool then provided tailored feedback to remind patients 1) to ask health care providers specific questions that may improve asthma control (e.g., additional controller medications) and 2) to consistently perform specific self-care behaviors (e.g., proper inhaler technique). Participants in the CC received similar questions and feedback, yet focused instead on preventive services unrelated to asthma control (e.g., cancer screening). Main outcome measures The main outcome measure was asthma control, as assessed by the 5-question Asthma Control Test (ACT). Secondary outcomes included quality of life, medication use and healthcare utilization (e.g., emergency department visits). Results After 12 months, 323 participants completed follow-up measures (79.2%). Participants in the IC reported a greater mean improvement in the ACT score than participants in the CC (2.3 vs. 1.2; p = 0.02) and 9 of 11 individual asthma control survey items showed non-significant improvements favoring the IC. No differences were observed in medication adherence, number of asthma controller medications or health care utilization. Conclusion and relevance Simple and brief online patient reminders improved asthma control among insured patients. Although future studies are needed to understand the mechanism of the improvement, the magnitude of the effect on asthma control was similar to the addition of an additional controller medication. Given the widespread use of the Internet, simple tools such as this may be useful for improving the control of other chronic diseases as well. Trial registration This study is registered at clinicaltrials.gov, NCT00921401, “Improving the Quality of Asthma Care Using the Internet”
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Affiliation(s)
- Andrew C. Pool
- Department of Public Health, Temple University College of Health Professions and Social Work Philadelphia, Pennsylvania, United States of America
- Center for Obesity Research and Education (CORE), Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jennifer L. Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jennifer M. Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Joshua Smyth
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Heather L. Stuckey
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Timothy J. Craig
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Erik B. Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Chengwu Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Christopher N. Sciamanna
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- * E-mail:
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Longhurst HJ, Li HH, Riedl MA, Craig TJ, Reshef A, Farkas H, Feuersenger H, Wood D, Watson D, Pragst I. Subcutaneous C1-Esterase Inhibitor [C1-INH(SC)] to Prevent Hereditary Angioedema (HAE) Attacks: Subject and Investigator Assessments from the Compact Trial. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bernstein JA, Li HH, Craig TJ, Longhurst HJ, Farkas H, Manning ME, Machnig T, Lawo JP, Pawaskar D, Jacobs I. Placebo-Controlled Trials of C1-Inhibitor (C1-INH) Replacement Therapy for Routine Prevention of Attacks in Patients with Hereditary Angioedema (HAE). J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Craig TJ, Baker JW, Lumry WR, Farkas H, Feuersenger H, Jacobs I. Switch from Intravenous C1-Inhibitor C1-INH(IV) to Subcutaneous C1-Inhibitor [C1 INH(SC)] for Routine Prevention of Hereditary Angioedema (HAE) Attacks: Subgroup Findings from the Compact Trial. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duong-Thi-Ly H, Nguyen-Thi-Thu H, Nguyen-Hoang L, Nguyen-Thi-Bich H, Craig TJ, Duong-Quy S. Effects of genetic factors to inhaled corticosteroid response in children with asthma: a literature review. J Int Med Res 2017; 45:1818-1830. [PMID: 29251255 PMCID: PMC5805193 DOI: 10.1177/0300060516683877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Numerous studies have examined the association between pharmacogenetic effects
and the response to inhaled corticosteroids (ICS) in patients with asthma. In
fact, several single nucleotide polymorphisms of a number of candidate genes
have been identified that might influence the clinical response to ICS in
children with asthma. Their direct or indirect effects depend on their role in
the inflammatory process in asthma or the anti-inflammatory action of
corticosteroids, respectively. Among the genes identified, variants in T-box 21
(TBX21) and Fc fragment of IgE receptor II
(FCER2) contribute indirectly to the variability in the
response to ICS by altering the inflammatory mechanisms in asthma, while other
genes such as corticotropin releasing hormone receptor 1
(CRHR1), nuclear receptor subfamily 3 group C member 1
(NR3C1), stress induced phosphoprotein 1
(STIP1), dual specificity phosphatase 1
(DUSP1), glucocorticoid induced 1
(GLCCI1), histone deacetylase 1 (HDAC),
ORMDL sphingolipid biosynthesis regulator 3 (ORMDL3), and
vascular endothelial growth factors (VEGF) directly affect this
variability through the anti-inflammatory mechanisms of ICS. The results to date
indicate various potential genetic factors associated with the response to ICS,
which could be utilized to predict the individual therapeutic response of
children with asthma to ICS. Clinical trials are underway and their results are
greatly anticipated. Further pharmacogenetic studies are needed to fully
understand the effects of genetic variation on the response to ICS in children
with asthma.
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Affiliation(s)
- Huong Duong-Thi-Ly
- 1 School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ha Nguyen-Thi-Thu
- 1 School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Long Nguyen-Hoang
- 1 School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Hanh Nguyen-Thi-Bich
- 2 Department of Immunology, Allergology, and Rheumatology, National Hospital of Paediatrics, Hanoi, Vietnam
| | - Timothy J Craig
- 3 Department of Medicine, Penn State University, Hershey, PA, USA
| | - Sy Duong-Quy
- 3 Department of Medicine, Penn State University, Hershey, PA, USA.,4 Department of Pulmonology, Hospital Cochin, Paris Descartes University, Paris, France.,5 Department of Respiratory Diseases, Medical-Biological Research Centre, Lam Dong Medical College, Dalat, Vietnam
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Nguyen Thi Dieu T, Pham Nhat A, Craig TJ, Duong-Quy S. Clinical characteristics and cytokine changes in children with pneumonia requiring mechanical ventilation. J Int Med Res 2017; 45:1805-1817. [PMID: 28703632 PMCID: PMC5805188 DOI: 10.1177/0300060516672766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess clinical characteristics and cytokine levels in children with
severe pneumonia who required ventilatory support. Methods In this prospective, descriptive, cross-sectional study, blood and
endotracheal fluid samples were obtained from patients with severe
pneumonia, aged <5 years, within 24 h following intubation. Blood samples
were also obtained from age-matched healthy controls. Cytokine levels were
investigated using flow cytometry-assisted immunoassay. Results Forty-five patients with severe pneumonia requiring mechanical ventilation
(aged 10 ± 5 months) and 35 healthy age-matched controls were included.
Patients with severe pneumonia had significantly increased serum interleukin
(IL)-6, IL-8, and granulocyte/macrophage colony-stimulating factor
concentrations compared with controls (80.84 pg/ml versus 2.06 pg/ml,
90.03 pg/ml versus 6.62 pg/ml, and 115.58 pg/ml versus 11.47 pg/ml,
respectively). In the severe pneumonia group, serum IL-10 levels were
significantly higher in patients aged <6 months versus those aged 6–12
months. Age-group differences in serum cytokine levels did not correspond to
age-group differences in endotracheal-fluid cytokine levels. Serum IL-6
levels were significantly higher in patients who subsequently died versus
those who survived (267.12 pg/ml versus 20.75 pg/ml, respectively). Conclusion High IL-6 concentrations were associated with mortality in patients <5
years of age with severe pneumonia requiring mechanical ventilation.
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Affiliation(s)
- Thuy Nguyen Thi Dieu
- 1 Department of Immunology, Allergology and Rheumatology, National Hospital of Paediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - An Pham Nhat
- 1 Department of Immunology, Allergology and Rheumatology, National Hospital of Paediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Timothy J Craig
- 2 Department of Pulmonary, Allergy and Critical Care Medicine, Penn State University, Hershey, PA, USA
| | - Sy Duong-Quy
- 2 Department of Pulmonary, Allergy and Critical Care Medicine, Penn State University, Hershey, PA, USA.,3 Department of Respiratory Diseases, Bio-Medical Research Centre, Lam Dong Medical College, Dalat, Vietnam.,4 Department of Respiratory and Lung Functional Exploration, Cochin Hospital, Paris Descartes University, Paris, France
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Abstract
INTRODUCTION Alpha-1-antitrypsin deficiency (AATD) is an orphan disease that predisposes individuals to COPD and liver disease. The following is a comprehensive review of AATD from epidemiology to treatment for physicians who treat COPD or asthma. Areas covered: In this comprehensive review of alpha-1-antitrypsin deficiency, we describe the historical perspective, genetics, epidemiology, clinical presentation and symptoms, screening and diagnosis, and treatments of the condition. Expert commentary: The two most important directions for advancing the understanding of AATD involve improving detection of the condition, especially in asymptomatic patients, and advancing knowledge of treatments directed specifically at AATD-related conditions. With regard to treatment for AATD-related conditions, research must continue to explore the implications and importance of augmentation therapy as well as consider new implementations that may prove more successful taking into consideration not only factors of pulmonary function and liver health, but also product availability and financial viability.
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Affiliation(s)
- Maria Paula Henao
- a Department of Medicine , Pennsylvania State University College of Medicine at Hershey Medical Center , Hershey , PA , USA
| | - Timothy J Craig
- b Department of Medicine , Pediatrics Pennsylvania State University College of Medicine at Hershey Medical Center , Hershey , PA , USA
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Abstract
US, Taiwanese and PRC employees responded to two vignettes in which they decided whether to accept the direction of a supervisor. Multiple versions of the vignettes which varied systematically with respect to the workplace circumstances surrounding the decisions (company policy, peer consensus and independent assessment) were distributed to create a factorial research design. In most circumstances, PRC employees demonstrated the strongest tendency to accept, followed by Taiwanese employees, and finally by US employees. The tendency to accept a supervisor's direction is influenced by peer consensus to a greater extent among US employees than among Taiwanese and PRC employees. Compared with US and Taiwanese employees, PRC employees were more sensitive to a supervisory direction's consistency with company policies and less responsive to their own assessment of the direction's merit. Both cultural traditions and modern developments appear to influence employees' reaction to supervisory authority.
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Abstract
OBJECTIVES Assess factors that increase the odds of 30-day asthma readmissions to hospitals. METHODS Retrospective chart review between 1/1/2002 to 12/31/2012 of pediatric and adult patients with the primary diagnosis of asthma readmitted within 30 days after the index admission was performed. Patients were identified from billing database for asthma ICD 9 code (493.9). Inclusion criteria were: physician confirmed asthma diagnosis, one or more asthma admissions and accessible medical records. RESULTS A total of 95 patients with multiple asthma readmissions were included in the final analysis. Thirty-seven patients (39%) were readmitted for asthma within 30 days and 58 patients (61%) had readmission in a 30-365-day period. Demographic characteristics were not significantly different between groups. Bivariate analysis showed that factors associated with higher likelihood of readmissions were a higher frequency of previous admissions, ED visits, inpatient hospitalizations, ICU stays, intubations, chest X-rays, history of chronic sinusitis, gastroesophageal reflux disease, anxiety, and the use of tiotropium or a long-acting beta-agonist (LABA). Multivariable analysis confirmed that prior hospital admissions and a history of GERD are the strongest predictive factors for early asthma readmissions, yet a history of environmental allergies might be a protective factor (p = 0.053). CONCLUSIONS Non-allergic asthma patients with multiple prior admissions, ED visits and inpatient hospitalizations, on multiple medications with history of GERD, sinusitis, and anxiety are more likely to be readmitted within 30 days irrespective of other factors. Patients with these characteristics should be assessed for interventions in an effort to reduce early readmissions.
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Affiliation(s)
- Larisa V Buyantseva
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Joel Brooks
- b Heart of Lancaster Regional Medical Center , Lititz , PA , USA
| | - Melissa Rossi
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Erik Lehman
- c Division of Biostatistics in the Department of Public Health Sciences , Penn State University , Hershey , PA , USA
| | - Timothy J Craig
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
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Henao MP, Kraschnewski JL, Kelbel T, Craig TJ. Diagnosis and screening of patients with hereditary angioedema in primary care. Ther Clin Risk Manag 2016; 12:701-11. [PMID: 27194914 PMCID: PMC4859422 DOI: 10.2147/tcrm.s86293] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease that commonly manifests with episodes of cutaneous or submucosal angioedema and intense abdominal pain. The condition usually presents due to a deficiency of C1 esterase inhibitor (C1-INH) that leads to the overproduction of bradykinin, causing an abrupt increase in vascular permeability. A less-understood and less-common form of the disease presents with normal C1-INH levels. Symptoms of angioedema may be confused initially with mast cell-mediated angioedema, such as allergic reactions, and may perplex physicians when epinephrine, antihistamine, or glucocorticoid therapies do not provide relief. Similarly, abdominal attacks may lead to unnecessary surgeries or opiate dependence. All affected individuals are at risk for a life-threatening episode of laryngeal angioedema, which continues to be a source of fatalities due to asphyxiation. Unfortunately, the diagnosis is delayed on average by almost a decade due to a misunderstanding of symptoms and general lack of awareness of the disease. Once physicians suspect HAE, however, diagnostic methods are reliable and available at most laboratories, and include testing for C4, C1-INH protein, and C1-INH functional levels. In patients with HAE, management consists of acute treatment of an attack as well as possible short- or long-term prophylaxis. Plasma-derived C1-INH, ecallantide, icatibant, and recombinant human C1-INH are new treatments that have been shown to be safe and effective in the treatment of HAE attacks. The current understanding of HAE has greatly improved in recent decades, leading to growing awareness, new treatments, improved management strategies, and better outcomes for patients.
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Affiliation(s)
- Maria Paula Henao
- Department of Medicine, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Theodore Kelbel
- Division of Allergy and Immunology, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Timothy J Craig
- Department of Medicine and Pediatrics, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
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Panganiban RP, Wang Y, Howrylak J, Chinchilli VM, Craig TJ, August A, Ishmael FT. Circulating microRNAs as biomarkers in patients with allergic rhinitis and asthma. J Allergy Clin Immunol 2016; 137:1423-32. [PMID: 27025347 DOI: 10.1016/j.jaci.2016.01.029] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 11/20/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND MicroRNAs (miRNAs) are emerging as important regulatory molecules that might be involved in the pathogenesis of various diseases. Circulating miRNAs might be noninvasive biomarkers to diagnose and characterize asthma and allergic rhinitis (AR). OBJECTIVE We sought to determine whether miRNAs are differentially expressed in the blood of asthmatic patients compared with those in the blood of nonasthmatic patients with AR and nonallergic nonasthmatic subjects. Furthermore, we sought to establish whether miRNAs could be used to characterize or subtype asthmatic patients. METHODS Expression of plasma miRNAs was measured by using real-time quantitative PCR in 35 asthmatic patients, 25 nonasthmatic patients with AR, and 19 nonallergic nonasthmatic subjects. Differentially expressed miRNAs were identified by using Kruskal-Wallis 1-way ANOVA with Bonferroni P value adjustment to correct for multiple comparisons. A random forest classification algorithm combined with a leave-one-out cross-validation approach was implemented to assess the predictive capacities of the profiled miRNAs. RESULTS We identified 30 miRNAs that were differentially expressed among healthy, allergic, and asthmatic subjects. These miRNAs fit into 5 different expression pattern groups. Among asthmatic patients, miRNA expression profiles identified 2 subtypes that differed by high or low peripheral eosinophil levels. Circulating miR-125b, miR-16, miR-299-5p, miR-126, miR-206, and miR-133b levels were most predictive of allergic and asthmatic status. CONCLUSIONS Subsets of circulating miRNAs are uniquely expressed in patients with AR and asthmatic patients and have potential for use as noninvasive biomarkers to diagnose and characterize these diseases.
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Affiliation(s)
- Ronaldo P Panganiban
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pa; Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Yanli Wang
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, Pa; Bioinformatics and Genomic Program, Pennsylvania State University, University Park, Pa
| | - Judie Howrylak
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pa
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Timothy J Craig
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pa
| | - Avery August
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY
| | - Faoud T Ishmael
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pa; Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, Pa.
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Heath JL, Saunders EF, Lehman E, Craig TJ. Anxiety and Depression in Adults with Primary Immunodeficiencies (PID's)--—How Much Do These Patients Experience and What Factors May Increase Patients' Risk? J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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