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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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2
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Granda P, Villamañán E, Heinz S, Laorden D, Romero D, Añón JM, Carpio C, Sobrino C, Collada V, Domínguez-Ortega J, Herrero A, Quirce S, Álvarez-Sala R. Compassionate Use of Reslizumab in a Life-threatening Asthma Exacerbation. J Investig Allergol Clin Immunol 2024; 34:60-61. [PMID: 37357596 DOI: 10.18176/jiaci.0920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- P Granda
- Pharmacy Department, Hospital Central de la Defensa Gómez- Ulla, Madrid, Spain
| | - E Villamañán
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
- IdiPAZ, Madrid, Spain
- Medicine Department, Universidad Autónoma de Madrid, Spain
| | - S Heinz
- Pharmacy Department, Hospital Central de la Defensa Gómez- Ulla, Madrid, Spain
| | - D Laorden
- IdiPAZ, Madrid, Spain
- Pulmonology Department, Hospital Universitario La Paz, Madrid, Spain
| | - D Romero
- IdiPAZ, Madrid, Spain
- Intensive Care Unit, Hospital Universitario La Paz, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Añón
- IdiPAZ, Madrid, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
- Allergy Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - C Carpio
- IdiPAZ, Madrid, Spain
- Medicine Department, Universidad Autónoma de Madrid, Spain
- Pulmonology Department, Hospital Universitario La Paz, Madrid, Spain
| | - C Sobrino
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - V Collada
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - J Domínguez-Ortega
- IdiPAZ, Madrid, Spain
- Allergy Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - A Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - S Quirce
- Allergy Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - R Álvarez-Sala
- IdiPAZ, Madrid, Spain
- Medicine Department, Universidad Autónoma de Madrid, Spain
- Pulmonology Department, Hospital Universitario La Paz, Madrid, Spain
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3
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Li W, Tang SC, Jin L. Adverse events of anti-IL-5 drugs in patients with eosinophilic asthma: a meta-analysis of randomized controlled trials and real-world evidence-based assessments. BMC Pulm Med 2024; 24:70. [PMID: 38308249 PMCID: PMC10837872 DOI: 10.1186/s12890-024-02885-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND We aimed to clarify comprehensively the safety profiles of anti-IL-5 drugs and pinpoint potential safety concerns that may arise in their post-marketing phase. METHODS Two researchers conducted comprehensive searches of PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to September 2022. Additionally, we investigated the FDA AE Reporting System for post-marketing adverse event (AE) reports related to anti-IL-5 drugs. The outcomes fulfilled the proportional reporting rate criteria and the Bayesian confidence propagation neural network. RESULTS We included 24 published studies in our analysis. The anti-IL-5 treatment group showed an incidence of AEs comparable to the placebo group, and it exhibited a significantly lower frequency of serious AEs. Common AEs were asthma, nasopharyngitis, headache, upper respiratory tract infection (URTI), and bronchitis. The post-marketing data included 28,478 case reports associated with the suspect drugs and 75 suspect safety observations affecting 16 system organ classes. New suspect observations included incomplete therapeutic product effect, URTIs, and pulmonary mass in reports related to mepolizumab. Reports associated with mepolizumab and benralizumab also indicated issues with incorrect technique in device usage and product issues. CONCLUSIONS Individual anti-IL-5 drugs' safety profiles largely matched their product inserts. We identified issues like improper device usage, product issue, and URTIs as potential concerns for mepolizumab and benralizumab. Additionally, all anti-IL-5 drugs showed signs of incomplete therapeutic effects.
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Affiliation(s)
- Wen Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shi-Chao Tang
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lei Jin
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
- Department of Rheumatology, Immunology & Allergy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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4
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Breslavsky A, Al Qaied A, Tsenter P, Mukaseev N, Alamor M, Cohen-Hagai K, Wand O. Comparison of clinical remission criteria for severe asthma patients receiving biologic therapy. Respir Med 2024; 222:107528. [PMID: 38199287 DOI: 10.1016/j.rmed.2024.107528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND The concept of remission on biological treatment has been suggested as a therapeutic target for patients with severe asthma, composed of 1. no chronic use of systemic steroids, 2. no exacerbations, 3. minimal symptoms, and 4. optimized lung function, for a significant time. However, the criteria for remission are not clearly defined. OBJECTIVE Our objective was to compare different criteria for remission in subjects receiving biologicals for severe asthma. METHODS A cross-sectional study of adult subjects who receive a stable regimen of a biological for severe asthma for at least 6-months. We compared the proportion of subjects who fulfilled different specific criteria in the four domains, as well as those who achieved different composite outcome measures of clinical remission. RESULTS Of 39 subjects, 28 were females (71.8%), mean age 60.4. Twelve were current or past smokers (30.8%). Twelve had prior different biological treatment (30.8%), and 3/39 had more than one previous treatment (7.7%). Current biological included mepolizumab 12/39 (30.8%), dupilumab 11/39 (28.2%), benralizumab 10/39 (25.6%), omalizumab 5/39 (12.8%), reslizumab 1/39 (2.6%). Different specific criteria were achieved in 39-80% of subjects, being highest for no chronic steroid use and lowest for symptoms control and lung function. Overall remission was obtained by 20-41%, depending on definition, with significant variability in agreement between different sets of remission criteria (Cohen's kappa 0.33-0.89). CONCLUSION Clinical remission is achievable in real-world severe asthmatics on biological therapies. The core criteria for remission should be better defined.
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Affiliation(s)
- Anna Breslavsky
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ahsen Al Qaied
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philip Tsenter
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nikita Mukaseev
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mohamed Alamor
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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5
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Giossi R, Pani A, Schroeder J, Scaglione F. Exploring the risk of infection events in patients with asthma receiving anti-IL-5 monoclonal antibodies: A rapid systematic review and a meta-analysis. Heliyon 2024; 10:e23725. [PMID: 38268596 PMCID: PMC10805771 DOI: 10.1016/j.heliyon.2023.e23725] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Benralizumab, mepolizumab, and reslizumab are novel monoclonal antibodies approved for asthma, targeting eosinophilic inflammation. Benralizumab is directed against IL-5 receptor (IL-5R), while mepolizumab and reslizumab are directed against IL-5. The three drugs cause a reduction in eosinophils, but benralizumab also causes a cytotoxic effect on eosinophils and basophils. Recently, it has been reported that suboptimal responders to benralizumab presented exacerbations associated with concomitant infections and sputum neutrophilia and the incidence of infections was greater in patients receiving benralizumab compared to mepolizumab and reslizumab. For this reason, we wanted to explore potential differences in terms of infectious adverse events between the three different anti-IL-5 antibodies. Methods We performed a rapid systematic review on PubMed up to April 28, 2022. We included randomized controlled trials (RCTs) evaluating benralizumab, mepolizumab, or reslizumab in patients with asthma. Included outcomes were the reporting of any respiratory tract infection and any emergency department (ED) or hospital admission for infection or asthma exacerbation. A Mantel-Haenszel meta-analysis was performed with Cochrane RevMan 5.4 to estimate pooled odds ratios (OR) with 95 % confidence intervals (CI). A subgroup analysis for the different active treatments was performed. Results From 163 references we included 21 studies reporting the results of 23 different RCTs for a total population of 9156 patients. All studies compared anti-IL-5 antibodies against placebo. Anti-IL-5 treatment resulted in non-significant differences compared to placebo in the odds for nasopharyngitis (OR = 0.90; 95 % CI from 0.76 to 1.07), pharyngitis (OR = 1.45; 95 % CI from 0.92 to 2.28), upper respiratory tract infection (URTI) (OR = 0.97; 95 % CI from 0.82 to 1.15), rhinitis (OR = 1.01; 95 % CI from 0.71 to 1.44), pneumonia (OR = 0.56; 95 % CI from 0.10 to 2.01), and influenza (OR = 0.84; 95 % CI from 0.65 to 1.09). We observed significant reductions in the reporting of sinusitis (OR = 0.75; 95 % CI from 0.53 to 1.06), bronchitis (OR = 0.71; 95 % CI from 0.59 to 0.86), and ED or hospital admission due to asthma exacerbation for overall anti-IL-5 antibodies compared to placebo (OR = 0.59; 95 % CI from 0.40 to 0.88). We were not able to discriminate whether exacerbations were associated with infections or to increased sputum eosinophilia. From the subgroup analysis, we observed differences in directions and magnitudes of the effect size in the reporting of some events. Benralizumab was associated with increased odds of pharyngitis (OR = 1.56; 95 % CI from 0.97 to 2.52) and a similar trend was observed for mepolizumab in the reporting of rhinitis (OR = 1.85; 95 % CI from 0.72 to 4.78), both non-statistically significant. In terms of effect size, benralizumab also showed higher odds for bronchitis and pneumonia in comparison to mepolizumab and reslizumab (OR = 0.76, OR = 0.69, and OR = 0.60 for bronchitis and OR = 0.80, OR = 0.20, and OR = 0.45, respectively, all non-significant). Conclusion Anti-IL-5 treatments might have different effects on the reporting of some infection events in patients with asthma. However, the evidence is limited by sample size and far than conclusive and suggest the need of future studies to evaluate the risk of infections in patients with asthma receiving anti-IL-5 treatments.
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Affiliation(s)
- Riccardo Giossi
- Chemical-Clinical Analyses Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Jan Schroeder
- Allergology and Immunology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical Analyses Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
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6
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Kuang FL, Khoury P, Weller PF, Wechsler ME, Klion AD. Biologics and Hypereosinophilic Syndromes: Knowledge Gaps and Controversies. J Allergy Clin Immunol Pract 2023; 11:2666-2671. [PMID: 37507068 PMCID: PMC10527987 DOI: 10.1016/j.jaip.2023.07.026] [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: 06/06/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Hypereosinophilic syndromes (HES) are a heterogeneous group of disorders defined by blood and/or tissue hypereosinophilia and clinical manifestations attributable to the eosinophilia. Although various clinical subtypes of HES have been described, the general approach to therapy in all subtypes has focused on the reduction of blood and tissue eosinophilia to improve symptoms and halt disease progression. Until recently, this typically involved the use of corticosteroids and/or other immunosuppressive or cytotoxic drugs with significant toxicity. Whereas imatinib, the first targeted therapy approved for treatment of HES, has dramatically changed the prognosis of patients with primary (myeloid) forms of HES, it is ineffective in patients with other HES subtypes. For these nonmyeloid patients with HES, the development of eosinophil-targeting biologics (most notably, mepolizumab, the first biologic approved for the treatment of HES) has been transformative. Nevertheless, important issues remain with respect to the efficacy and safety of these biologics in the treatment of the varied subtypes of HES. Moreover, with the increasing number of commercially available biologics with direct or indirect effects on eosinophils, questions related to the choice of initial biologic, potential reasons for biologic failure, and treatment options in the setting of incomplete response are becoming increasingly common.
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Affiliation(s)
- Fei Li Kuang
- Division of Allergy Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Paneez Khoury
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Peter F Weller
- Division of Allergy and Inflammation, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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7
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Kwon HJ, Kim KH, Yoon JH. Refractory Bullous Pemphigoid Successfully Treated with Reslizumab: A Possible Novel Therapeutic Modality. Ann Dermatol 2023; 35:S103-S106. [PMID: 37853878 PMCID: PMC10608355 DOI: 10.5021/ad.21.177] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/25/2021] [Accepted: 11/04/2021] [Indexed: 10/20/2023] Open
Abstract
Bullous pemphigoid (BP) is a chronic, autoimmune blistering disease that has concerning morbidity and mortality rates. Recently, several studies have focused on eosinophils due to their significant role in the pathogenesis of BP, considering that they are ubiquitous in the serum, tissue, and blister fluids of patients with BP. With this context, precision therapy that targets mediators of eosinophil activity could be a possible novel therapeutic strategy. Interleukin (IL)-5 is crucial for B-cell maturation, which consequently results in immunoglobulin production, and promotes eosinophil differentiation, proliferation, and activation. To our best knowledge, reslizumab has not yet been reported to treat BP. Herein, we report a case of steroid- and omalizumab-resistant BP treated successfully using reslizumab. Our data suggest that IL-5 could be a novel specific biologic target within the entire immunopathogenesis of BP, and reslizumab would be a novel therapeutic modality.
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Affiliation(s)
- Hyeok-Jin Kwon
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Ho Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Jung-Ho Yoon
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea.
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8
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Walsh GM. Recent developments in the use of monoclonal antibodies targeting the type 2 cytokines for severe asthma treatment. Advances in Pharmacology 2023; 98:31-54. [PMID: 37524491 DOI: 10.1016/bs.apha.2023.04.003] [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] [Indexed: 08/02/2023]
Abstract
Severe or refractory asthma is seen in approximately 5% of asthmatic subjects who have unsatisfactory symptom control despite adherence to high-dose inhaled glucocorticoid therapies resulting in significant morbidity, reduced quality of life with attendant implications for healthcare costs. Marked heterogeneity in symptoms and at the molecular phenotypic level are hallmarks of asthma resulting in the requirement of specifically targeted treatments to block the key pathways of the disease. Monoclonal antibody (mAb)-based biologics targeted at inhibition of the type 2 cytokines IL-4, IL-5 and IL-13 have become established as effective treatments for severe asthma, with significant clinical benefit seen in carefully selected patient populations that take asthma phenotypes and endotypes into account. The further development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these interventions.
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Affiliation(s)
- Garry M Walsh
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom.
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9
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Laorden D, Zamarrón E, Romero D, Domínguez-Ortega J, Villamañán E, Losantos I, Gayá F, Quirce S, Álvarez-Sala R. Evaluation of FEOS score and super-responder criteria in a real-life cohort treated with anti-IL5/IL5R. Respir Med 2023; 211:107216. [PMID: 36958514 DOI: 10.1016/j.rmed.2023.107216] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Daniel Laorden
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain.
| | - Ester Zamarrón
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - David Romero
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, Hospital La Paz, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | | | | | - Francisco Gayá
- Department of Biostatistics, Hospital La Paz, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - Rodolfo Álvarez-Sala
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
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Barroso B, Valverde-Monge M, Alobid I, Olaguibel JM, Rial MJ, Quirce S, Arismendi E, Barranco P, Betancor D, Bobolea I, Cárdaba B, Cruz Carmona MJ, Curto E, Domínguez-Ortega J, González-Barcala FJ, Martínez-Rivera C, Mahíllo-Fernández I, Muñoz X, Picado C, Plaza V, Rodrigo Muñoz JM, Soto-Retes L, Valero A, Del Pozo V, Mullol J, Sastre J. Improvement in Olfaction in Patients With CRSwNP and Severe Asthma Taking Anti-IgE and Anti-IL-5 Biologics: A Real-Life Study. J Investig Allergol Clin Immunol 2023; 33:37-44. [PMID: 35416154 DOI: 10.18176/jiaci.0812] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic rhinosinusitis with nasal polyps (CRSwNP), which is characterized by partial loss of smell (hyposmia) or total loss of smell (anosmia), is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD). CRSwNP worsens disease severity and quality of life. The objective of this real-world study was to determine whether biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare the improvement in in olfaction in N-ERD and non-N-ERD subgroups. METHODS We performed a multicenter, noninterventional, retrospective, observational study of 206 patients with severe asthma and CRSwNP undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab). RESULTS Olfaction improved after treatment with all 4 monoclonal antibodies (omalizumab [35.8%], mepolizumab [35.4%], reslizumab [35.7%], and benralizumab [39.1%]), with no differences between the groups. Olfaction was more likely to improve in patients with atopy, more frequent use of short-course systemic corticosteroids, and larger polyp size. The proportion of patients whose olfaction improved was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. CONCLUSIONS This is the first real-world study to compare improvement in olfaction among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in olfaction (with nonsignificant differences between biologic drugs). No differences were found for improved olfaction between the N-ERD and non-N-ERD groups.
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Affiliation(s)
- B Barroso
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M Valverde-Monge
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - I Alobid
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Barcelona, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - J M Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Allergy Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - M J Rial
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Allergy Department, Hospital Juan Canalejo, A Coruña, Spain
| | - S Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
| | - E Arismendi
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Allergy Unit and Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, Barcelona, Spain
| | - P Barranco
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
| | - D Betancor
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - I Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Allergy Unit and Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, Barcelona, Spain
| | - B Cárdaba
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - M J Cruz Carmona
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology Department, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - E Curto
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Domínguez-Ortega
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
| | - F J González-Barcala
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - C Martínez-Rivera
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - X Muñoz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology Department, Hospital Universitari Vall d´Hebron, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Picado
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Allergy Unit and Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, Barcelona, Spain
| | - V Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Rodrigo Muñoz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - L Soto-Retes
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.,Allergy Unit and Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, Barcelona, Spain
| | - V Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - J Mullol
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Barcelona, Spain.,Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - J Sastre
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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11
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Pérez de Llano L, Cisneros C, Domínguez-Ortega J, Martínez-Moragón E, Olaguibel JM, Plaza V, Quirce S, Dávila I. Response to Monoclonal Antibodies in Asthma: Definitions, Potential Reasons for Failure, and Therapeutic Options for Suboptimal Response. J Investig Allergol Clin Immunol 2023; 33:1-13. [PMID: 36040046 DOI: 10.18176/jiaci.0857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Real-life data reveal that more than half of severe asthma patients treated with monoclonal antibodies (mAbs) do not achieve a complete response. Response to mAbs must be assessed holistically, considering all the clinically meaningful therapeutic goals, not only reduction of exacerbations and oral corticosteroids. There are 2 different ways of measuring the response to mAbs. One, qualitative, classifies patients according to the degree of disease control they have achieved, without explaining how much a given patient improves relative to the baseline (pre-mAb) clinical situation; the other, quantitative, scores the changes occurring after treatment. Both methods are complementary and essential to making clinical decisions on whether to continue treatment. The various potential causes of suboptimal response to mAbs include incorrect identification of the specific T2 pathways, comorbidities that reduce the room for improvement, insufficient dose, autoimmune phenomena, infections, change in the initial inflammatory endotype, and adverse events. Once a suboptimal response has been confirmed, a well-structured and multifaceted assessment of the potential causes of failure should be performed, with emphasis on the resulting inflammatory process of the airway after mAb therapy and the presence of chronic or recurrent infection. This investigation should guide the decision on the best therapeutic approach. The present review aims to help clinicians gain insights into how to measure response to mAbs and proceed in cases of suboptimal response.
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Affiliation(s)
- L Pérez de Llano
- Respiratory Medicine Department, Hospital Universitario Lucus Augusti, EOXI Lugo, Monforte, Cervo, Spain
| | - C Cisneros
- Respiratory Medicine Department, Hospital La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - J Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - E Martínez-Moragón
- Respiratory Medicine Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - J M Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Allergy Department, Hospital Universitario de Navarra, Pamplona, Spain.,Instituto de Investigaciones de Navarra (IDISNA), Pamplona, Spain
| | - V Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,Facultad de Medicina, Universitat Autònoma Barcelona, Spain
| | - S Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - I Dávila
- Allergy Department, Hospital Universitario de Salamanca, Spain.,Instituto de Investigación Biosanitaria de Salamanca (IBSAL), Salamanca, Spain.,Departamento de Ciencias Biomédicas y del Diagnóstico, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
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12
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Nam YH. Nonepisodic angioedema with eosinophilia after COVID-19 vaccination: a case successfully treated with reslizumab. Allergy Asthma Clin Immunol 2023; 19:11. [PMID: 36732834 PMCID: PMC9893190 DOI: 10.1186/s13223-023-00765-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Angioedema with eosinophilia (AE) is a rare allergic disease classified as episodic or nonepisodic. AE is characterized by angioedema, urticaria, fever, weight gain, and eosinophilia, but its etiology and pathogenesis have not yet been clarified. CASE PRESENTATIONS We present a 70-year-old woman presented with generalized edema and urticaria after Moderna COVID-19 vaccination. Peripheral blood eosinophil count was marked elevated and echocardiography and Doppler ultrasonography of both the upper and lower extremities were unremarkable. Her symptoms and peripheral blood eosinophil count were improved after systemic steroid therapy, but she failed to respond to steroid tapering. Reslizumab (anti-interluekin-5) was administered intravenously, and she remained symptom free with a normal eosinophil count during 8 months of reslizumab treatment without steroids. CONCLUSIONS We report a case of nonepisodic AE after COVID-19 vaccination that was successfully treated with reslizumab.
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Affiliation(s)
- Young-Hee Nam
- grid.255166.30000 0001 2218 7142Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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13
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Shakuntulla F, Chiarella SE. Safety of Biologics for Atopic Diseases During Pregnancy. J Allergy Clin Immunol Pract 2022; 10:3149-3155. [PMID: 35987486 PMCID: PMC10084524 DOI: 10.1016/j.jaip.2022.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/23/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
The high prevalence of atopic diseases in women of childbearing age reveals the need to determine the safety of biologics during pregnancy. This review summarizes the effects of 7 Food and Drug Administration-approved biologics (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, tezepelumab, and tralokinumab) on maternal and fetal outcomes. For this purpose, we reviewed English-language publications to investigate whether the use of biologics for atopic diseases during pregnancy increased the risk of preterm delivery, stillbirth, low birth weight, or congenital malformations. Most publications found were case reports, case series, or observational studies reporting outcomes in a total of 313 pregnancies. No randomized controlled studies were identified. We found that biologics do not seem to influence maternal or fetal outcomes. Indeed, worsening of the underlying atopic disease during pregnancy appears to be more detrimental to the viability of the pregnancy. Given the small sample size and scarcity of studies, future research should include prospective studies with comparable control groups without exposure to biologics and multicenter registries for long-term follow-up.
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14
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Gschwend A, Helbling A, Feldmeyer L, Mani-Weber U, Meincke C, Heidemeyer K, Bossart S, Jörg L. Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS). Allergo J Int 2022; 32:1-8. [PMID: 36035809 PMCID: PMC9396594 DOI: 10.1007/s40629-022-00224-7] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/15/2022] [Indexed: 12/02/2022]
Abstract
Purpose Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed drug hypersensitivity reaction with exanthema, eosinophilia, and organ manifestations. After culprit drug withdrawal, systemic corticosteroids (CS) are the most widely used treatment, often requiring high doses for months. Blocking the IL-5/IL‑5 receptor axis with mepolizumab, reslizumab, and benralizumab is a promising targeted treatment with a good safety profile and no immunosuppressive effect. The aim of this study is to summarize current experience with the anti-IL5/IL-5-receptor therapy in DRESS. Methods A retrospective analysis of all patients diagnosed with DRESS and treated with mepolizumab, reslizumab, or benralizumab in DRESS was performed. In addition, a PubMed-Medline search for publications on DRESS with anti-IL-5/IL‑5 receptor treatment was performed. Results Of the 14 cases identified, 6 patients were treated with mepolizumab, 6 with benralizumab, 1 patient with reslizumab, and 1 patient was switched from benralizumab to mepolizumab. The main indication for an IL‑5 blockade was a therapy-refractory course (7/14 [50.0%]), recurrent relapses (3/14 [21.4%]), and severe organ dysfunction (2/14 [14.3%]). In 13/14 (93%) cases, a rapid clinical improvement with suppression of eosinophilia and reduction of CS could be achieved. In all but two cases under mepolizumab (dose 100-600 mg) or reslizumab (dose according to body weight), two or more doses were necessary until resolution of DRESS. In 4/7 cases under benralizumab, a single 30 mg dose was sufficient. Conclusion Blockade of the IL-5/IL‑5 receptor axis appears to be a promising treatment in DRESS with fast clinical improvement, which may allow more rapid reduction of CS, and a good safety profile. In addition, a summary of recommendations on when to use blockade of the IL-5/IL‑5 receptor axis in DRESS treatment is provided.
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Affiliation(s)
- Anna Gschwend
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Helbling
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Cordula Meincke
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Jörg
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Hashimoto S, Kroes JA, Eger KA, Mau Asam PF, Hofstee HB, Bendien SA, Braunstahl GJ, Broeders MEAC, Imming LM, Langeveld B, Maitland-van der Zee AH, Oud KTM, Patberg KW, Smeenk FWJM, Romme EAPM, van Bezouw MJ, van de Ven MJ, van Veen A, van Velzen E, van Veen IHPAA, Weersink EJM, Ten Brinke A, Sont JK, Bel EH. Real-World Effectiveness of Reslizumab in Patients With Severe Eosinophilic Asthma - First Initiators and Switchers. J Allergy Clin Immunol Pract 2022; 10:2099-2108.e6. [PMID: 35487369 DOI: 10.1016/j.jaip.2022.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/04/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Reslizumab, a biologic targeting IL-5, has been shown to reduce asthma exacerbations and maintenance oral corticosteroid use in randomized controlled trials and pre-post studies in patients with severe eosinophilic asthma. However, real-world effectiveness data of reslizumab are scarce, and it is unknown whether reslizumab has added value after switching from another type 2 biologic. OBJECTIVE To evaluate (1) the real-world effectiveness of reslizumab on severe asthma exacerbations, maintenance oral corticosteroid use, and overall treatment response, both in biologic-naive patients who initiated reslizumab and in those who switched from another type 2 biologic; and (2) physicians' experience with reslizumab treatment. METHODS This observational real-world study evaluated data from 134 adults with severe eosinophilic asthma included in the Dutch severe asthma registry (RAPSODI), who initiated reslizumab treatment (4-weekly infusions, 0.3 mg/kg) before April 2020 and had follow-up data for 6 months and greater. Clinical asthma experts completed surveys on their experience with reslizumab treatment. RESULTS Overall, reslizumab reduced the exacerbation rate (odds ratio [95% CI] = 0.10 [0.05-0.21]; P < .001), oral corticosteroid use (OR [95% CI], 0.2 [0.0-0.5]; P < .001), and maintenance dose (median [CI], 5.0 [0.0-10.0] to 0.0 [0.0-5.0]; P < .001), with comparable results in biologic-naive reslizumab initiators and switchers. The overall response to reslizumab was graded good or excellent in 59.2% of patients. The additive effectiveness of reslizumab after switching from another biologic was reflected in physicians' surveys. CONCLUSIONS Real-world data show that reslizumab reduces severe asthma exacerbations and oral corticosteroid use in patients with severe eosinophilic asthma, both in biologic-naive reslizumab initiators and in those who switched from another type 2 biologic. This additional value of reslizumab was recognized by clinical asthma experts.
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Affiliation(s)
- Simone Hashimoto
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Johannes A Kroes
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Katrien A Eger
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pearl F Mau Asam
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hendrik B Hofstee
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarah A Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | - Leonie M Imming
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Bas Langeveld
- Department of Pulmonology, Deventer Ziekenhuis, Schalkhaar, The Netherlands
| | | | | | | | - Frank W J M Smeenk
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands; Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | | | - Maarten J van Bezouw
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Anneke van Veen
- Canisius Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - Edwin van Velzen
- Department of Respiratory Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Ten Brinke
- Department of Pulmonology, Leeuwarden Medical Center, Leeuwarden, the Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth H Bel
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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16
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Pérez de Llano LA, Cosío BG, Lobato Astiárraga I, Soto Campos G, Tejedor Alonso MA, Malanda NM, Padilla Galo A, Urrutia Landa I, Michel de la Rosa FJ, García-Moguel I. First line versus second line use of reslizumab in severe uncontrolled asthma. J Investig Allergol Clin Immunol 2022:0. [PMID: 35797112 DOI: 10.18176/jiaci.0839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - B G Cosío
- Pneumology Service, Hospital Universitario Son Espases-IdISBa-Ciberes, Palma de Mallorca, Spain
| | | | - G Soto Campos
- Pneumology and Allergy Unit, University Hospital of Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - N M Malanda
- Pneumology Service, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - A Padilla Galo
- Pneumology Service, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - I Urrutia Landa
- Respiratory Department, Galdakao Hospital, Galdakao, Bizkaia, Spain
| | | | - I García-Moguel
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
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17
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Collins PD, Meadows CIS, Lams BE, Agarwal S, Wyncoll DLA. Diffuse "tree-in-bud" Pattern on High Resolution CT in Severe Vaping-Induced Lung Injury. Am J Respir Crit Care Med 2022; 206:501-502. [PMID: 35704280 DOI: 10.1164/rccm.202112-2666im] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Patrick D Collins
- Guy's and Saint Thomas' NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland;
| | - Christopher I S Meadows
- Guy's and Saint Thomas' NHS Foundation Trust, 8945, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Boris Ea Lams
- Guy's and Saint Thomas' NHS Foundation Trust, 8945, Department of Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland.,Guy's and Saint Thomas NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Sangita Agarwal
- Guy's and Saint Thomas' Hospitals NHS Trust, 8945, Department of Rheumatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Duncan L A Wyncoll
- Guy's and St Thomas' NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
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18
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Jue JH, Shim YJ, Park S, Kim DH, Jung HR. Korean Adolescent Patient with Manifestations of Lymphocyte Variant Hypereosinophilic Syndrome and Episodic Angioedema with Eosinophilia, Treated with Reslizumab. Iran J Allergy Asthma Immunol 2022; 21:215-218. [PMID: 35490275 DOI: 10.18502/ijaai.v21i2.9229] [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: 04/29/2021] [Accepted: 09/23/2021] [Indexed: 06/14/2023]
Abstract
A four-year-old female patient visited the pediatric hematologic clinic due to periodic generalized edema and eosinophilia. Laboratory assessment showed an eosinophil count of 40.02×109/L (73.6% of white blood cells). A bone marrow aspirate smear film showed no signs of malignant cells but had hypercellular marrow particles with eosinophilia (45% of all nucleated cells) and 52% of eosinophils were immature. Other laboratory tests showed an increased IgM level of 827 mg/dL, and lymphocyte phenotyping by flow cytometry revealed an aberrant CD3-CD4+ T-cell population of 27-53×109/L (1.9-3.6% of lymphocytes). Polymerase chain reaction analysis for the T-cell receptor gamma gene rearrangement showed a T-cell clonality peak. At the age of 13, allogeneic stem cell transplantation was performed, but with primary rejection. From the age of 17, she has continued receiving 3 mg/kg of reslizumab intravenously every 4 weeks for 21 months. Since reslizumab treatment was initiated, her eosinophil count remained consistently within the normal range. This is the first report describing the effective use of reslizumab in a Korean adolescent patient for the management of lymphocytic-variant hypereosinophilic syndrome (L-HES). Since the patient showed clinical manifestations of L-HES as well as episodic angioedema with eosinophilia (EAE), a continuous periodic examination is required given the higher risk of developing lymphoma or leukemia.
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Affiliation(s)
- Jie Hee Jue
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Ye Jee Shim
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Sunggyun Park
- Department of Laboratory Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Do-Hoon Kim
- Department of Laboratory Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Hye Ra Jung
- Department of Pathology, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
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19
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Guilleminault L, Conde E, Reber LL. Pharmacological approaches to target type 2 cytokines in asthma. Pharmacol Ther 2022; 237:108167. [PMID: 35283171 DOI: 10.1016/j.pharmthera.2022.108167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Abstract
Asthma is the most common chronic lung disease, affecting more than 250 million people worldwide. The heterogeneity of asthma phenotypes represents a challenge for adequate assessment and treatment of the disease. However, approximately 50% of asthma patients present with chronic type 2 inflammation initiated by alarmins, such as IL-33 and thymic stromal lymphopoietin (TSLP), and driven by the TH2 interleukins IL-4, IL-5 and IL-13. These cytokines have therefore become important therapeutic targets in asthma. Here, we discuss current knowledge on the structure and functions of these cytokines in asthma. We review preclinical and clinical data obtained with monoclonal antibodies (mAbs) targeting these cytokines or their receptors, as well as novel strategies under development, including bispecific mAbs, designed ankyrin repeat proteins (DARPins), small molecule inhibitors and vaccines targeting type 2 cytokines.
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Affiliation(s)
- Laurent Guilleminault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, 31024 Toulouse, France; Department of Respiratory Medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Eva Conde
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR 1222 INSERM, F-75015 Paris, France; Sorbonne University, ED394, F-75005 Paris, France
| | - Laurent L Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, 31024 Toulouse, France.
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20
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Charles D, Shanley J, Temple SN, Rattu A, Khaleva E, Roberts G. Real-World Efficacy of Treatment with Benralizumab, Dupilumab, Mepolizumab and Reslizumab for Severe Asthma: A Systematic Review and Meta-analysis. Clin Exp Allergy 2022; 52:616-627. [PMID: 35174566 PMCID: PMC9311192 DOI: 10.1111/cea.14112] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Severe asthma is a major cause of morbidity. Some patients may benefit from biological therapies. Most evaluations of these treatments are derived from randomised controlled trials (RCTs), but few patients are eligible for these trials. Studies involving more diverse groups of participants exist but there is a lack of precise pooled estimates. OBJECTIVE This systematic review aims to evaluate the real-world efficacy of recently and nearly licensed biological therapies for severe asthma to assess the generalisability of the RCT data. METHODS Clinical outcomes including exacerbation rate, oral corticosteroid (OCS) usage, forced expiratory volume in 1 second (FEV1 ) and fractional exhaled nitric oxide (FeNO) were examined. Studies were assessed for risk of bias using the Critical Appraisal Skills Programme (CASP) checklist tool. The certainty of evidence was assessed using GRADE. RESULTS A total of 21 studies examining biologicals in real-world settings were identified, they mostly focused on benralizumab and mepolizumab. The introduction of biologicals reduced the annualised exacerbation rate significantly by -3.79 (95% CI -4.53, -3.04), -3.17 (95% CI -3.74, -2.59) and -6.72 (95% CI -8.47, -4.97) with benralizumab, mepolizumab and reslizumab respectively. Likewise, improvements were observed in FEV1 (0.17 L 95% CI 0.11, 0.24) and FeNO (-14.23 ppb 95% CI -19.71, -8.75) following treatment with mepolizumab. After treatment with benralizumab there was an increase in FEV1 (0.21 L 95% CI 0.08, 0.34). CONCLUSIONS These data demonstrate that anti-IL5 biologicals may improve the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs. The data were mainly retrospective and unadjusted, so estimated effect sizes may not be reliable. More data is needed to acquire accurate effect estimates in different subpopulations of patients.
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Affiliation(s)
- David Charles
- Academic Clinical Medicine, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Jemma Shanley
- Child Health, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Sasha-Nicole Temple
- Clinical Medicine, Royal London Hospital, Whitechapel Road, Whitechapel, London, UK
| | - Anna Rattu
- Clinical and Experimental Sciences and Human Development, Faculty of Medicine, University of Southampton, University Road, Highfield, Southampton, UK
| | - Ekaterina Khaleva
- Clinical and Experimental Sciences and Human Development, Faculty of Medicine, University of Southampton, University Road, Highfield, Southampton, UK
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development, University of Southampton, University Road, Highfield, Southampton, UK
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Wang Q, Sun Q, Chen Q, Li H, Liu D, Wu Q. Efficacy and Safety of Anti-Interleukin-5 Therapies in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int Arch Allergy Immunol 2022; 183:732-743. [PMID: 35108711 DOI: 10.1159/000521859] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The efficacy and safety of benralizumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved, and relevant meta-analyses are lacking. Additionally, mepolizumab has been evaluated in far fewer patients, and the evidence is unclear. We conducted a meta-analysis to identify evidence gaps that will guide future investigation of therapies targeting interleukin (IL)-5 signaling (anti-IL-5Rα or anti-IL-5) for CRSwNP. METHODS We performed a systematic review and meta-analysis that were registered with PROSPERO (No. CRD42021276867). A comprehensive search was performed in PubMed, Embase, Web of Science, and the Cochrane Library on September 2, 2021. Only randomized controlled trials (RCTs) assessing anti-IL-5 treatments (anti-IL-5Rα or anti-IL-5) in adult patients for CRSwNP were included. RESULTS Seven RCTs with 799 patients evaluating the efficacy and safety of treatments targeting IL-5 pathway (benralizumab [anti-IL-5Rα], mepolizumab, and reslizumab [anti-IL-5]) were included. The overall pooled meta-analysis showed that anti-IL-5 treatments were associated with a significantly better nasal polyp score (weighted mean difference [WMD]: -0.71; 95% confidence interval [CI]: [-0.87, -0.55]; p < 0.00001). Anti-IL-5 treatments were associated with a significantly better nasal congestion score (WMD: -1.73; 95% CI: [-2.29, -1.16]; p < 0.00001). Anti-IL-5 treatments were associated with a significantly better Sino-Nasal Outcome Test (SNOT-22) score (WMD: -11.30; 95% CI: [-14.77, -7.83]; p < 0.00001). The overall pooled meta-analysis showed that anti-IL-5 treatments were associated with a significantly better University of Pennsylvania Smell Identification Test (UPSIT) score (WMD: 2.09; 95% CI: [0.42, 3.77]; p = 0.01). Anti-IL-5 treatments significantly reduced the loss of smell score in the overall pooled meta-analysis (WMD: -1.38; 95% CI: [-1.97, -0.79]; p < 0.00001). In the overall pooled meta-analysis, anti-IL-5 treatments showed no difference with the placebo in the risk of adverse events (AEs; risk ratio [RR]: 1.01; 95% CI: [-0.93, 1.09]; p = 0.83) and serious AEs (SAEs; RR: 0.73; 95% CI: [0.40, 1.34]; p = 0.32). CONCLUSION This systematic review and meta-analysis identified that anti-IL-5 treatments significantly improved the size of nasal polyps, health-related quality of life, and sense of smell in moderate to severe CRSwNP, and they were safe and well tolerated.
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Affiliation(s)
- Qiong Wang
- Department of Otolaryngology, Shiyan People's Hospital of Baoan District in Shenzhen City, Shenzhen, China
| | - Qun Sun
- Department of Otolaryngology, Shiyan People's Hospital of Baoan District in Shenzhen City, Shenzhen, China
| | - Qiguo Chen
- Department of Otolaryngology, Shiyan People's Hospital of Baoan District in Shenzhen City, Shenzhen, China
| | - Hao Li
- Department of Otolaryngology, Shiyan People's Hospital of Baoan District in Shenzhen City, Shenzhen, China
| | - Ding Liu
- Department of Otolaryngology, Shiyan People's Hospital of Baoan District in Shenzhen City, Shenzhen, China
| | - Qingwu Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Wangberg H, Spierling Bagsic SR, Osuna L, White AA. Appraisal of the Real-World Effectiveness of Biologic Therapies in Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract 2022; 10:478-484.e3. [PMID: 34597850 PMCID: PMC8837666 DOI: 10.1016/j.jaip.2021.09.030] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are no head-to-head studies for patients with aspirin-exacerbated respiratory disease (AERD) comparing any of the 5 Food and Drug Administration-approved respiratory biologic therapies. OBJECTIVE Explore outcomes in subjects with AERD using biologic therapies in a real-world clinic setting. METHODS A retrospective pilot study was conducted for subjects with AERD who had been prescribed omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor alpha [anti-IL-5Rα]), or dupilumab (anti-IL-4 receptor alpha [anti-IL-4Rα]). Clinical outcomes pre- versus postinitiation of biologic therapy were explored including symptoms, 22-item sino-nasal outcome test scores, systemic corticosteroid and antibiotic prescriptions, and emergency room visits related to AERD. RESULTS Of the 74 subjects, 58.1% (n = 43) had used 1 biologic, though many (41.9%, n = 31) trialed more than 1 biologic. Of the 50 subjects who had used anti-IL-4Rα therapy, 98% (49 of 50) still had this therapy prescribed at study completion compared with 48.6% (17 of 35) and 26.9% (7 of 26) of those who used anti-IgE and anti-IL-5 and anti-IL-5 receptor alpha (anti-IL-5/IL-5Rα) therapy, respectively. Among those on anti-IL-4Rα therapy, there was a significant reduction in median total 22-item sino-nasal outcome test scores (51 to 19, P = .0002), corticosteroid bursts (2 to 0, P < .0001), and median number of antibiotic courses for respiratory disease (1 to 0, P = .0469) prebiologic versus postbiologic initiation. No statistically significant difference in those outcomes was observed for individuals on anti-IgE or anti-IL-5/IL-5Rα therapy. CONCLUSIONS Anti-IL-4Rα therapy led to significantly higher rates of clinical improvement in AERD when compared with anti-IL-5/IL-5Rα and anti-IgE biologic therapies. Prospective studies would help clarify best practices for the use of biologic therapies in AERD.
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Affiliation(s)
- Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | | | - Lilliana Osuna
- Scripps Health, Scripps Whittier Diabetes Institute, San Diego, Calif
| | - Andrew A. White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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Abstract
The small airways dysfunction (SAD) asthma phenotype is characterised by narrowing of airways < 2 mm in diameter between generations 8 and 23 of the bronchial tree. Recently, this has become particularly relevant as measurements of small airways using airway oscillometry for example, are strong determinants of asthma control and exacerbations in moderate-to-severe asthma. The small airways can be assessed using spirometry as forced expiratory flow rate between 25 and 75% of forced vital capacity (FEF25-75) and has been deemed more accurate in detecting small airways dysfunction than forced expiratory volume in 1 s (FEV1). Oscillometry as the heterogeneity in resistance between 5 and 20 Hz (R5-R20), low frequency reactance at 5 Hz (X5) or area under the reactance curve between 5 Hz and the resonant frequency can also be used to assess the small airways. The small airways can also be assessed using the multiple breath nitrogen washout (MBNW) test giving rise to values including functional residual capacity, lung clearance index and ventilation distribution heterogeneity in the conducting (Scond) and the acinar (Sacin) airways. The ATLANTIS group showed that the prevalence of small airways disease in asthma defined on FEF25-75, oscillometry and MBNW all increased with progressive GINA asthma disease stages. As opposed to topical inhaler therapy that might not adequately penetrate the small airways, it is perhaps more intuitive that systemic anti-inflammatory therapy with biologics targeting downstream cytokines and upstream epithelial anti-alarmins may offer a promising solution to SAD. Here we therefore aim to appraise the available evidence for the effect of anti-IgE, anti-IL5 (Rα), anti-IL4Rα, anti-TSLP and anti-IL33 biologics on small airways disease in patients with severe asthma.
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Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, DD1 9SY, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, DD1 9SY, UK.
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Park H, Choi GS, Lee EM. Successful Treatment of Imatinib-Induced DRESS Syndrome Using Reslizumab without Cessation of Imatinib: A Case Report. Case Rep Oncol 2021; 14:1548-1554. [PMID: 34899250 PMCID: PMC8613629 DOI: 10.1159/000519471] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/04/2021] [Indexed: 12/17/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction; reported cases are sometimes imatinib mesylate induced. The main treatment is the withdrawal of the causative drug, and most cases with imatinib-induced DRESS syndrome required withdrawal of imatinib. However, in such cases involving anticancer drugs, this may compromise cancer treatment. Herein, we report a patient with imatinib-induced DRESS syndrome that was successfully treated with reslizumab while continuing imatinib treatment. A 65-year-old female presented with facial edema and generalized skin rash after being given 400 mg imatinib 2 weeks ago for metastatic gastrointestinal stromal tumor. After stopping imatinib, the clinical symptoms improved. Imatinib desensitization was performed, and it was administered again. However, the clinical symptoms reappeared more severely 2 months after restart of imatinib, and the peripheral absolute eosinophil count increased to 1,690/μL. A diagnosis of imatinib-induced DRESS syndrome was made, based on the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria. Imatinib desensitization was repeated, but the clinical symptoms reappeared, and the peripheral eosinophilia persisted. We administered reslizumab, an interleukin-5 monoclonal antibody, without cessation of imatinib. The absolute eosinophil count decreased immediately, and the clinical symptoms improved gradually. After 2 weeks, the clinical symptoms reappeared mildly, but after administering reslizumab again, these disappeared completely. Reslizumab can be considered in the management of DRESS syndrome in cases wherein the causative medication needs to be continued.
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Affiliation(s)
- Hyerin Park
- Kosin University College of Medicine, Busan, Republic of Korea
| | - Gil-Soon Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea
| | - Eun Mi Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea
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Casas-Maldonado F, Álvarez-Gutiérrez FJ, Blanco-Aparicio M, Domingo-Ribas C, Cisneros-Serrano C, Soto-Campos G, Román-Bernal B, González-Barcala FJ. Monoclonal antibody treatment for severe uncontrolled asthma in Spain: analytical map. J Asthma 2021; 59:1997-2007. [PMID: 34503370 DOI: 10.1080/02770903.2021.1978483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Monoclonal antibodies (mABs) have become available to treat more efficiently patients with severe uncontrolled asthma (SUA). However, the use of mABs is lower than expected given the prevalence of SUA, with significant disparities in the use of these treatments. OBJECTIVE To evaluate the proportion of patients with SUA treated with mABs in Spain, and to analyze some of the factors that could determine these prescription patterns. METHODS An analysis was performed on the data provided from the Hospitals National Health System (NHS) 2018 catalogue where Chest Diseases Department and a Hospital Pharmacy were available. Random sampling was performed to determine the sample size, stratifying proportionally by geographic area and hospital level. Characteristics of the participating sites, as well as the prescribing of mABs were collected, which included geographic area, hospital levels, prescribing medical specialities, types of clinics, and mABs prescribed. RESULTS Data from 90 hospitals were analyzed (Response rate 64.3%). Level 4 hospitals, the Canary Islands geographical area, and the presence of a high complexity Asthma Healthcare Unit (ACU) were associated with a higher probability that the SUA was treated with mABs. CONCLUSION The map of the prescribing of mABs for SUA in Spain shows a significant variation by geographic area, hospital level, type of clinic, and the accreditation level of the ACUs. At the current time, there appears to be significant under-prescribing of these treatments.
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Affiliation(s)
| | | | | | - Christian Domingo-Ribas
- Servei de Pneumologia, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.,Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - Carolina Cisneros-Serrano
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España.,Fundación de Investigación Biomédica La Princesa, Madrid, España
| | - Gregorio Soto-Campos
- Servicio de Neumología y Alergia, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - Berta Román-Bernal
- Neumología, Hospital Dr. José Molina Orosa, Arrecife, Las Palmas, España
| | - Francisco-Javier González-Barcala
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.,Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias - CIBERES, Madrid, España.,Grupo Translational Research in Airway Diseases-FIDIS, Santiago de Compostela, A Coruña, España
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26
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Harish A, Schwartz SA. Targeted Anti-IL-5 Therapies and Future Therapeutics for Hypereosinophilic Syndrome and Rare Eosinophilic Conditions. Clin Rev Allergy Immunol 2021; 59:231-247. [PMID: 31919743 DOI: 10.1007/s12016-019-08775-4] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Eosinophilic inflammation is a component of many atopic diseases such as asthma, and biologics targeting eosinophils have been shown to be effective in subsets of these patients. However, there also are conditions in which eosinophils are the key inflammatory cells responsible for driving tissue damage. In these eosinophilic diseases such as hyper-eosinophilic syndrome, eosinophilic esophagitis, and eosinophilic granulomatosis with polyangiitis (EGPA), the development of biologics inhibiting eosinophilic inflammation have offered targeted therapeutic strategies for patients that have not responded well to typical first line drugs, which often have significant adverse side effects with poor disease modification or recurrent relapse with significant morbidity. IL-5 has long been recognized as the key inflammatory cytokine involved in the priming and survival of eosinophils and their proliferation and maturation in eosinophilic disease. There are a number of trials and case series demonstrating the immunomodulatory benefits of anti-IL-5 therapies in these diseases with good clinical responses. Yet, due to the heterogeneity and rarity of these conditions, anti-IL-5 therapies have not resulted in disease remission for all patients. Clearly, further research into the use of anti-IL-5 therapies in various eosinophilic diseases is needed and ongoing investigation into other immune mechanisms underlying chronic eosinophilic diseases may provide alternative therapies for these challenging conditions.
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Affiliation(s)
- Aasha Harish
- Division of Allergy and Immunology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1020 Youngs Road, Williamsville, NY, 14221, USA.
| | - Stanley A Schwartz
- Division of Allergy and Immunology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1020 Youngs Road, Williamsville, NY, 14221, USA
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Abstract
Asthma is a heterogeneous disease, with the immune processes behind the chronic inflammation underlying this disorder differing between the various identified asthma endotypes. In addition to heterogeneity in underlying disease pathophysiology, asthmatics fall across a broad spectrum of disease severity and can vary greatly in their response to convention asthma therapies. A small percentage of patients with severe persistent asthma will remain uncontrolled despite treatment with high-dose inhaled corticosteroids and a long-acting beta-agonist. Less than two decades ago, there were few options for these treatment-refractory asthmatics beyond chronic systemic steroids, with their myriad of treatment-limiting side effects. However, in recent years, there have been a growing number of Food and Drug Administration (FDA)-approved biologic medications with targets that include immunoglobulin E (IgE), interleukin-5 (IL-5), the IL-5 receptor and the IL-4/IL-13 receptor-alpha subunit. The current FDA-approved biologics for severe persistent asthma are omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab. These monoclonal antibodies have been shown to improve asthma control, decrease asthma exacerbations and decrease glucocorticoid dependence in certain subsets of patients with asthma. The optimal biologic for treatment of severe asthma varies from patient to patient, depending on the underlying pathophysiology of the patient's disease. For each of these medications, there are certain biomarkers that can help predict whether a patient is likely to respond favorably to the medication. This review will discuss the currently approved biologics for severe persistent asthma, including their indications, efficacy and side effects.
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28
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Pepper AN, Hanania NA, Humbert M, Casale TB. How to Assess Effectiveness of Biologics for Asthma and What Steps to Take When There Is Not Benefit. J Allergy Clin Immunol Pract 2021; 9:1081-1088. [PMID: 33685606 DOI: 10.1016/j.jaip.2020.10.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
Five biologic medications are approved in the United States for the treatment of asthma that is not well controlled with other therapies. All target asthma with elevated type 2 inflammatory markers, such as elevated eosinophils, fractional exhaled nitric oxide, or total and specific IgE. Asthma severity, phenotype, age, biomarkers, treatment goals/outcomes, comorbid conditions, safety, and cost should all help guide the initial biologic choice. In addition, a shared decision-making process with the patient is needed to optimize adherence, with special attention to patient preference regarding outcomes, safety concerns, and medication administration options. After a biologic agent is initiated, sufficient time is needed to monitor efficacy and response. For patients who do not respond favorably, patient-, disease-, and medication-related factors should be considered and remedied, if possible. Persistent suboptimal responders necessitate a reexamination of asthma phenotype, biomarkers, and the suspected immune response pathways. For some patients, a change in biologic therapy or other therapeutic options may be warranted. In this review, we examine the clinical approach for choosing an initial biologic for the treatment of asthma, the assessment of response to biologics, and the process of troubleshooting and adjusting biologic treatment for those patients with suboptimal responses.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Thomas B Casale
- Food Allergy Research & Education (FARE), University of South Florida, Tampa, Fla.
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Akenroye AT, Heyward J, Keet C, Alexander GC. Lower Use of Biologics for the Treatment of Asthma in Publicly Insured Individuals. J Allergy Clin Immunol Pract 2021:S2213-2198(21)00169-0. [PMID: 33556592 DOI: 10.1016/j.jaip.2021.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite bearing a disproportionate burden of poorly controlled asthma, publicly insured individuals are less likely to receive biologics. OBJECTIVE To assess biologic use by payer among individuals with asthma. METHODS We used IQVIA's National Disease and Therapeutic Index, a nationally representative, all-payer audit of ambulatory care in the United States, to describe the patterns of use by payer. RESULTS Asthma treatment visits in which a biologic product was reported increased from approximately 0.1% of asthma-related visits in 2003 to 1% in 2015 and doubled to 2% by 2019. Omalizumab use initially increased from 2003 to 2006 and plateaued till 2015 when its use declined modestly, coinciding with the release of additional biologic products. In 2019, omalizumab accounted for 37% of biologic treatment visits, mepolizumab 21%, benralizumab 27%, dupilumab 15%, and reslizumab <1%. Biologic treatment visits were higher for privately insured individuals (28.3 per 1000 visits) compared with publicly insured individuals (16.3 per 1000 visits). This difference persisted after accounting for age, sex, and race using nationally representative estimates. Whites accounted for a disproportionate amount of biologic treatment visits among the publicly insured (80%) despite accounting for only 60% of publicly insured asthma treatment visits. No biologic treatment visits were observed for individuals who were uninsured. Half of dupilumab visits were for publicly insured patients, compared with 22% of mepolizumab/benralizumab and 27% of omalizumab visits. CONCLUSION Biologics were uncommonly used among patients with asthma, and the basis for disproportionately lower use of biologics among the publicly insured, where the burden of uncontrolled asthma is greatest, merits further investigation.
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Abstract
The management of atopic diseases such as severe asthma, severe atopic dermatitis, and severe food allergy in childhood is challenging. In particular, there are safety concerns regarding the use of high-dose corticosteroids. The recent development of biologicals and their approval for the treatment of children offer a new, very promising, and more personalized therapy option. Omalizumab, mepolizumab, and dupilumab are currently approved as add-on treatments of severe asthma in children and have been shown to be effective in improvement of asthma control and reduction of exacerbations. Dupilumab is the only biological approved for the treatment of atopic dermatitis in adolescents so far. It has been demonstrated to significantly improve symptoms of atopic dermatitis.However, safety data for biologicals used in atopic diseases in children and adolescents are still very limited. Biologicals are generally considered to be safe in adults. These data are often extrapolated to children. Additionally, data for long-term use are lacking. Thus, the safety profiles of those biologicals cannot yet be conclusively assessed.
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Affiliation(s)
- Maike Vom Hove
- Hospital for Children and Adolescents, Leipzig University Medical Center, Leipzig, Germany
| | - Martina P Neininger
- Drug Safety Center, Institute of Pharmacy, Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center, Institute of Pharmacy, Leipzig University, Leipzig, Germany
| | - Freerk Prenzel
- Hospital for Children and Adolescents, Leipzig University Medical Center, Leipzig, Germany.
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31
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Corren J, Du E, Gubbi A, Vanlandingham R. Variability in Blood Eosinophil Counts in Patients with Eosinophilic Asthma. J Allergy Clin Immunol Pract 2020; 9:1224-1231.e9. [PMID: 33130147 DOI: 10.1016/j.jaip.2020.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Blood eosinophil (EOS) counts are critical to the accurate identification of asthma phenotypes. However, there are few long-term data on intraindividual EOS count variability among patients with eosinophilic asthma. OBJECTIVE This post hoc analysis of 2 phase III clinical trials from the reslizumab BREATH program explored the variability of blood EOS counts in patients with eosinophilic asthma receiving placebo. METHODS Pooled data from study participants receiving placebo (previously randomized 1:1 to receive reslizumab or placebo) were analyzed for blood EOS count variability over 52 weeks. EOS counts were measured up to twice during screening, every 4 weeks from randomization to the end of treatment and at the 90-day follow-up visit. RESULTS Of 476 included patients, 31 (6.5%), 38 (8.0%), 55 (11.6%), and 352 (73.9%) patients had baseline blood EOS counts of <150, ≥150 to <300, ≥300 to <400, and ≥400 cells/μL, respectively. Patients frequently shifted between EOS count categories during the 52-week treatment period, most often moving to the highest EOS category. Among patients in each of the lower 3 EOS categories, 27% to 56% of patients shifted to the ≥400 cells/μL category at some point during the treatment period. CONCLUSION Intraindividual variability in blood EOS count was high among patients with eosinophilic asthma receiving placebo, with shifts to ≥400 cells/μL from lower categories frequently observed. Repeat determinations of blood EOS count may be important to ensure appropriate selection of therapy in patients with severe asthma.
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Affiliation(s)
- Jonathan Corren
- Division of Clinical Immunology and Allergy, David Geffen School of Medicine at University of California, Los Angeles, Calif.
| | - Evelyn Du
- Teva Branded Pharmaceutical Products R&D Inc., West Chester, Pa
| | - Ananda Gubbi
- Teva Branded Pharmaceutical Products R&D Inc., West Chester, Pa
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Eger K, Kroes JA, Ten Brinke A, Bel EH. Long-Term Therapy Response to Anti-IL-5 Biologics in Severe Asthma-A Real-Life Evaluation. J Allergy Clin Immunol Pract 2020; 9:1194-1200. [PMID: 33069885 DOI: 10.1016/j.jaip.2020.10.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with severe eosinophilic asthma show different responses to various anti-IL-5 biologics, ranging from super response to nonresponse. Residual disease manifestations observed in partial responders may prompt physicians to switch between biologics. More data on response, switches, and residual disease manifestations are needed to improve personalized treatment. OBJECTIVE To assess (1) prevalences and predictors of super, partial, and nonresponders to long-term anti-IL-5 treatment, (2) frequency and reasons for switches between anti-IL-5 biologics, and (3) nature of residual disease manifestations. METHODS In this 2-year follow-up study, patients with severe asthma were included who initiated an anti-IL-5 biologic (mepolizumab, reslizumab, benralizumab) (n = 114). Patient characteristics (clinical, functional, inflammatory) and comorbidities were collected at baseline and 2-year follow-up. "Super responders" showed no residual disease manifestations at 2-year follow-up, "partial responders" experienced residual disease manifestations, and "nonresponders" discontinued anti-IL-5 treatment after less than 2 years because of clinical worsening. RESULTS After 2-year anti-IL-5 treatment, 14% of patients were super responders, 69% partial responders, and 11% nonresponders. Super response was predicted by shorter asthma duration and higher FEV1, and tended to be associated with adult-onset asthma, absence of nasal polyps, and lower body mass index. Switches between anti-IL-5 biologics occurred frequently (41%). After 2-year treatment, most common residual disease manifestations included impaired lung function (59%), uncontrolled sinonasal disease (58%), and uncontrolled asthma symptoms (48%). CONCLUSIONS After 2 years of anti-IL-5 treatment, a favorable response was found in 83% of patients with severe asthma, including a super response in 14%. Most partial responders show impaired lung function or uncontrolled sinonasal disease, causing physicians to switch between biologics.
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Affiliation(s)
- Katrien Eger
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Johannes A Kroes
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Anneke Ten Brinke
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Caminati M, Bagnasco D, Rosenwasser LJ, Vianello A, Senna G. Biologics for the Treatments of Allergic Conditions: Severe Asthma. Immunol Allergy Clin North Am 2020; 40:549-564. [PMID: 33012319 DOI: 10.1016/j.iac.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
By selectively targeting specific steps of the immune inflammation cascade, biologic drugs for severe asthma have substantially contributed to increase the standard of care, to reduce drug-related morbidity. and most importantly to ameliorate patients' quality of life. Upcoming molecules are going to provide a chance for severe phenotypes besides Th2 high through the interaction with epithelial and innate immunity. Some practical aspects including optimal treatment duration, the possibility of a dose treatment modulation, the place and relevance of ICS in best responders are still under debate. Long-term safety, especially when interacting with innate immunity needs to be further investigated.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Largo Rosanna Benzi, 10, Genoa 16132, Italy
| | | | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padua, Padua, Italy; Dipartimento di Scienze CardioToraco Vascolari e Sanità Pubblica, Via Nicolo` Giustiniani, 2, Padua 35128, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy and Clinical Immunology School, University of Verona & Asthma Center and Allergy Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy
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Wechsler ME, Hickey L, Garin M, Chauhan A. Efficacy of Reslizumab Treatment in Exacerbation-Prone Patients with Severe Eosinophilic Asthma. J Allergy Clin Immunol Pract 2020; 8:3434-3442.e4. [PMID: 32562877 DOI: 10.1016/j.jaip.2020.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/07/2020] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with severe eosinophilic asthma have increased risk of clinical asthma exacerbations (CAEs), impaired lung function, and lower quality of life (QoL) compared with patients with noneosinophilic asthma. The efficacy and safety of intravenous reslizumab have been demonstrated in 2 duplicate, randomized, double-blind, placebo-controlled, phase 3 studies. OBJECTIVE We present findings from post hoc analyses of the subgroup of patients from the phase 3 studies with severe (Global Initiative for Asthma [GINA] Step 4 or 5) eosinophilic asthma who had ≥2 or ≥3 CAEs in the 12 months before screening. METHODS Patients aged ≥12 years with severe eosinophilic asthma were randomized (1:1) to reslizumab 3.0 mg/kg or placebo every 4 weeks for 1 year. Outcomes assessed included CAEs, forced expiratory volume in 1 second (FEV1), and Asthma Control Questionnaire 6 (ACQ-6) and Asthma QoL Questionnaire (AQLQ) scores. RESULTS Of 953 patients randomized, 318 (reslizumab: n = 156; placebo: n = 162) and 164 (reslizumab: n = 72; placebo: n = 92) were GINA 4/5 with ≥2 CAEs in the prior year and ≥3 CAEs in the prior year, respectively. Reslizumab significantly improved CAE rate, time to first CAE, and the proportion of patients who experienced ≥1 CAE versus placebo in both CAE subgroups. Improvements in FEV1, ACQ-6 and AQLQ scores, and systemic corticosteroid burden were also observed with reslizumab versus placebo after 52 weeks of treatment in both CAE subgroups. CONCLUSION Reslizumab reduced CAE frequency and improved lung function, asthma control, and QoL versus placebo in patients with severe eosinophilic asthma with a high CAE rate before treatment.
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Affiliation(s)
- Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo.
| | - Lisa Hickey
- Teva Branded Pharmaceuticals R&D Inc., West Chester, Pa
| | | | - Anoop Chauhan
- Respiratory Department, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, United Kingdom
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Coffey K, Fajt ML, Acho M, Gladwin M, Petrov AA. Successful Treatment of Corticosteroid-Refractory Hypereosinophilia With Reslizumab. J Investig Allergol Clin Immunol 2020; 29:241-242. [PMID: 31219038 DOI: 10.18176/jiaci.0366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K Coffey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - M L Fajt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - M Acho
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - M Gladwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - A A Petrov
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
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Abstract
This review highlights recent data concerning efficacy and safety of biological agents that are currently approved by Food and Drug Administration (FDA), as well as several agents that will likely soon be FDA approved, for management of properly selected patients with severe persistent asthma that is poorly or not well controlled despite "stepped care" management according to best evidence.
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Affiliation(s)
- Mauli Desai
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1089, New York, NY 10029, USA
| | - John Oppenheimer
- Department of Medicine UMDNJ - Rutgers, Pulmonary and Allergy Assoc, 1 Springfield Avenue, Summit, NJ 07901, USA
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Respiratory Institute, 9500 Euclid Avenue - A90, Cleveland, OH 44195, USA.
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Ramonell RP, Iftikhar IH. Effect of Anti-IL5, Anti-IL5R, Anti-IL13 Therapy on Asthma Exacerbations: A Network Meta-analysis. Lung 2020; 198:95-103. [PMID: 31894410 DOI: 10.1007/s00408-019-00310-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several new treatments for severe asthma have become available in the last decade; yet, little data exist to guide their use in specific patient populations. OBJECTIVE A network meta-analysis was conducted comparing the efficacy of FDA-approved monoclonal antibody therapies in preventing exacerbations in patients with severe eosinophilic asthma. METHODS PubMed and Ovid were searched from inception until July 2019 for randomized controlled trials that studied the efficacy of benralizumab, dupilumab, mepolizumab, and reslizumab, in preventing acute exacerbations of asthma. Studies were included if they reported data for patients with severe eosinophilic asthma (defined in this meta-analysis as absolute eosinophil count ≥ 250 cells/μL). Annualized rate ratios for asthma exacerbations (during treatment) were calculated and converted to log rate ratios. Direct and indirect treatment estimates (for inter-drug differences) were analyzed using frequentist network meta-analysis methodology in R and treatments were ranked based on P-scores. RESULTS In total, nine studies were included in the final analysis. Network meta-analysis revealed that all drugs were superior to placebo in preventing rates of asthma exacerbation in the study population and no inter-drug differences existed. Dupilumab was found to have the greatest magnitudes of effect on decreasing log rate ratio of asthma exacerbation based on P-score (0.83). CONCLUSION Benralizumab, dupilumab, mepolizumab, and reslizumab are all associated with decreased asthma exacerbations in patients with eosinophilic asthma, with no significant inter-drug differences.
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Affiliation(s)
- Richard P Ramonell
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
| | - Imran H Iftikhar
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA.
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Nair P, Bardin P, Humbert M, Murphy KR, Hickey L, Garin M, Vanlandingham R, Chanez P. Efficacy of Intravenous Reslizumab in Oral Corticosteroid-Dependent Asthma. J Allergy Clin Immunol Pract 2019; 8:555-564. [PMID: 31626990 DOI: 10.1016/j.jaip.2019.09.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reslizumab displays efficacy in patients with inadequately controlled eosinophilic asthma; previous reports in oral corticosteroid-dependent asthma are limited. OBJECTIVE To assess efficacy of reslizumab in oral corticosteroid-dependent patients and benefits on oral corticosteroid burden. METHODS We report post hoc analyses of pooled data from duplicate, placebo-controlled phase 3 trials. Patients aged 12 to 75 years with inadequately controlled, moderate-to-severe asthma were randomized 1:1 to receive intravenous reslizumab 3.0 mg/kg or placebo every 4 weeks for 52 weeks, stratified by oral corticosteroid use at enrollment and by region. Assessments included efficacy and predictors of clinical asthma exacerbation response in oral corticosteroid-dependent patients, and systemic corticosteroids burden in the overall population. RESULTS Patients were randomized to reslizumab (n = 477) or placebo (n = 476); 73 (15%) patients in each group were taking oral corticosteroids at baseline. Reslizumab was favored over placebo for all efficacy end points in oral corticosteroid-dependent patients, with numerically greater improvements in oral corticosteroid-dependent patients than the overall population. Having 2 or more versus 1 clinical asthma exacerbation in the previous 12 months was the strongest positive predictor of reduced exacerbation risk with reslizumab (risk reduction, 77.5% vs 15.2%; P ≤ .02). Significantly fewer new systemic corticosteroid prescriptions were issued per patient receiving reslizumab versus placebo (mean ± SD, 0.5 ± 1.07 vs 1.0 ± 1.52; P < .0001). Total and per-patient systemic corticosteroid burdens were lower: 121,135 versus 290,977 mg and 254 versus 611 mg/patient, respectively (both P < .0001). CONCLUSIONS Oral corticosteroid-dependent patients benefited from reslizumab across asthma efficacy outcome measures. Reslizumab-treated patients required fewer new systemic corticosteroid prescriptions and had a lower systemic corticosteroid burden compared with placebo.
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Affiliation(s)
- Parameswaran Nair
- Department of Medicine, McMaster University & St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Philip Bardin
- Monash Lung and Sleep, Monash Medical Centre and University, Melbourne, VIC, Australia
| | - Marc Humbert
- Université Paris-Sud, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Lisa Hickey
- Teva Branded Pharmaceutical Products R&D, Inc, Malvern, Pa
| | - Margaret Garin
- Teva Branded Pharmaceutical Products R&D, Inc, Malvern, Pa
| | | | - Pascal Chanez
- Department of Respiratory Diseases, Aix-Marseille University, Marseille, France
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39
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Virchow JC, Katial R, Brusselle GG, Shalit Y, Garin M, McDonald M, Castro M. Safety of Reslizumab in Uncontrolled Asthma with Eosinophilia: A Pooled Analysis from 6 Trials. J Allergy Clin Immunol Pract 2019; 8:540-548.e1. [PMID: 31404668 DOI: 10.1016/j.jaip.2019.07.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intravenous reslizumab, a monoclonal IL-5 antibody, is approved for treating severe asthma with eosinophilia. Limited structured information is available on the safety of reslizumab in larger populations. OBJECTIVE To investigate the safety profile of intravenous reslizumab 3.0 mg/kg by analyzing data from 6 asthma clinical trials: 5 placebo-controlled (duration ≤52 weeks) and 1 open-label extension (up to 2 years of treatment). METHODS Patients were aged 12 to 75 years with inadequately controlled asthma with eosinophilia. In the placebo-controlled trials, 730 patients received placebo and 1028 received reslizumab 3.0 mg/kg. RESULTS Adverse events (AEs) and serious AEs occurred in higher percentages of patients in the placebo group (81% and 9%) than in the reslizumab group (67% and 6%). Asthma, nasopharyngitis, and upper respiratory tract infection were the most common AEs with placebo and reslizumab. Three cases of anaphylaxis, related to reslizumab, were successfully managed with standard therapies. No significant difference in the incidence of malignancies was seen when compared with placebo or the general population. Among 756 patients with more than 12 months of reslizumab exposure, the AE rate was lower than in the placebo-controlled trials (367.3 vs 433.9 events/100 patient-years). The incidence of AEs in patients on treatment for more than 12 months was no higher than in patients with shorter treatment durations. CONCLUSIONS This analysis confirms that treatment with intravenous reslizumab for more than 12 months is well tolerated in patients with asthma, with no evidence of rare safety events that were not detected in individual trials.
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Affiliation(s)
- J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, University of Rostock, Rostock, Germany.
| | - Rohit Katial
- Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Margaret Garin
- Teva Branded Pharmaceutical Products R&D Inc, Malvern, Pa
| | - Mirna McDonald
- Teva Branded Pharmaceutical Products R&D Inc, Malvern, Pa
| | - Mario Castro
- Department of Medicine, Pediatrics, and Radiology, Washington University School of Medicine, St Louis, Mo
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Matera MG, Calzetta L, Rogliani P, Cazzola M. Monoclonal antibodies for severe asthma: Pharmacokinetic profiles. Respir Med 2019; 153:3-13. [PMID: 31136930 DOI: 10.1016/j.rmed.2019.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
Several monoclonal antibodies (mAbs) (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) are currently approved for the treatment of severe asthma. They have complex pharmacokinetic profiles. These profiles are unique in that they are dependent on their structure as well as can be markedly influenced by the biology of their target antigen, but their general behaviour can still be considered a class property, similar to their endogenous IgG counterpart. They cannot be administered by oral route, have a slow distribution into tissue, are metabolized to peptides and amino acids in several tissues but are protected from degradation by binding to protective receptors (the FcRn), which explains their long elimination half-lives. Their clearance is nonlinear because of the saturation of the target-mediated elimination. Also anti-drug antibody (ADA) response and off-target binding, as well as their glycosylation pattern, can influence the pharmacokinetics of mAbs.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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Pérez de Llano LA, Cosío BG, Domingo C, Urrutia I, Bobolea I, Valero A, Entrenas Costa LM, Quirce S, Barranco P, Marina Malanda N, Andrés LP, Alvarez-Gutiérrez FJ. Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study. J Allergy Clin Immunol Pract 2019; 7:2277-2283.e2. [PMID: 30677539 DOI: 10.1016/j.jaip.2019.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies. OBJECTIVE To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab. METHODS We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period. RESULTS Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab. CONCLUSION Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.
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Affiliation(s)
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Domingo
- Department of Pulmonary Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Isabel Urrutia
- Asthma Unit, Department of Pulmonary Medicine, Hospital Galdakao, Bizkaia, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Allergy Section, Department of Pulmonology and Allergy, Hospital Clinic Barcelona-Institute for Health Research (IdiBAPS), Madrid, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Allergy Section, Department of Pulmonology and Allergy, Hospital Clinic Barcelona-Institute for Health Research (IdiBAPS), Madrid, Spain
| | - Luis M Entrenas Costa
- Pneumology Service, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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Liddament M, Husten J, Estephan T, Laine D, Mabon D, Pukac L, Lyons J, Clarke AW, Doyle A. Higher Binding Affinity and in vitro Potency of Reslizumab for Interleukin-5 Compared With Mepolizumab. Allergy Asthma Immunol Res 2019; 11:291-298. [PMID: 30661320 PMCID: PMC6340799 DOI: 10.4168/aair.2019.11.2.291] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/21/2022]
Abstract
Reslizumab and mepolizumab are recently approved monoclonal antibodies for the treatment of severe (uncontrolled) eosinophilic asthma. Both are effective in neutralizing the function of interleukin-5 (IL-5). This study is the first to compare the binding affinity and in vitro potency of both antibodies in head-to-head assays. Two assays assessed binding affinity (using the equilibrium dissociation constant [KD]) of each drug for human IL-5. In the Biacore surface plasmon resonance assay, the association constant (kon) values for human IL-5 for reslizumab and mepolizumab were 3.93 × 106 and 1.83 × 105, respectively. The dissociation constant (koff) values were 4.29 × 10−4 and 2.14 × 10−4, respectively. Calculated KD values for human IL-5 for reslizumab and mepolizumab were 109 and 1,170 pM, respectively, representing an approximately 11-fold stronger binding affinity with reslizumab. In the Kinetic Exclusion Assay, the kon values for human IL-5 for reslizumab and mepolizumab were 3.17 × 106 and 1.32 × 105, respectively. The koff values were 1.36 × 10−5 and 1.48 × 10−5, respectively. Measured KD values for human IL-5 for reslizumab and mepolizumab were 4.3 and 112 pM, respectively, representing an approximately 26-fold stronger binding affinity for reslizumab. A human-IL-5-dependent cell proliferation assay was developed to assess in vitro potency, based on a human cell line selected for enhanced surface expression of IL-5 receptor-alpha and consistent proliferation response to IL-5. The concentration at which 50% inhibition occurred (IC50) was determined for both antibodies. Reslizumab and mepolizumab inhibited IL-5-dependent cell proliferation, with IC50 values of approximately 91.1 and 286.5 pM, respectively, representing on average 3.1-fold higher potency with reslizumab. In conclusion, comparative assays show that reslizumab has higher affinity binding for and in vitro potency against human IL-5 compared with mepolizumab. However, these results do not take into consideration the different methods of administration of reslizumab and mepolizumab.
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Affiliation(s)
- Mark Liddament
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia.
| | - Jean Husten
- R&D, Biologics, Teva Pharmaceuticals USA, West Chester, PA, USA
| | - Tanya Estephan
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia.
| | - David Laine
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia
| | - David Mabon
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia
| | - Laurie Pukac
- R&D, Biologics, Teva Pharmaceuticals USA, West Chester, PA, USA
| | - Jacquelyn Lyons
- R&D, Biologics, Teva Pharmaceuticals USA, West Chester, PA, USA
| | - Adam W Clarke
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia
| | - Anthony Doyle
- R&D, Biologics Lead Antibody Discovery, Teva Pharmaceuticals Australia, Sydney, NSW, Australia
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Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus affecting both children and adults, with debilitating and progressive symptoms. EoE has shown an explosive epidemiological rise in the past few decades. Many patients experience a poor level of disease control despite maximal use of available guideline-based therapies, which seriously hampers their quality of life. Diet restrictions and systemic and topical corticosteroids are the current mainstays of EoE therapy, but are associated with significant efficacy, treatment compliance, and safety issues such as oral or esophageal candidiasis, growth retardation, osteopenia, osteoporosis, glucose intolerance, and cataract formation. As EoE is a chronic inflammatory disease, immune cells and cytokines are responsible for the inflammatory response and symptoms. Monoclonal antibodies specifically targeting these pathophysiologic effectors offer more potent relief of histologic and clinical disease features while keeping off-target adverse effects to a minimum. Herein, we have reviewed the current evidence regarding efficacy and safety of monoclonal antibodies including mepolizumab (anti-IL-5), reslizumab (anti-IL-5), QAX576 (anti-IL-13), omalizumab (anti-immunoglobulin-E), and infliximab (anti-TNF-α) in treatment of EoE. Our review indicates that although the use of monoclonal antibodies for EoE treatment is safe with limited and reversible adverse events, however, it is not yet possible to reach a final verdict on the efficacy of mAbs in EoE. Future well-designed studies are needed to clarify the exact role of mAbs in EoE.
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Affiliation(s)
- Mahsa Eskian
- Molecular Immunology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - MirHojjat Khorasanizadeh
- Molecular Immunology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. .,Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Boston, MA, USA.
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Weinstein SF, Katial RK, Bardin P, Korn S, McDonald M, Garin M, Bateman ED, Hoyte FCL, Germinaro M. Effects of Reslizumab on Asthma Outcomes in a Subgroup of Eosinophilic Asthma Patients with Self-Reported Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract 2018; 7:589-596.e3. [PMID: 30193936 DOI: 10.1016/j.jaip.2018.08.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 07/23/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An estimated 7% of patients with asthma have chronic rhinosinusitis with nasal polyps (CRSwNP), and more than 80% have at least some radiographic evidence of sinonasal inflammation. Aspirin sensitivity is strongly associated with elevated blood eosinophil levels and increased asthma severity. Intravenous (IV) reslizumab has been shown to improve asthma control in patients with nasal polyps. OBJECTIVE These post hoc analyses of pooled data from 2 BREATH phase 3 clinical trials, studies 1 and 2 (NCT01287039 and NCT01285323), examined asthma-related outcomes in patients with comorbid, self-reported CRSwNP with and without aspirin sensitivity. METHODS Patients aged 12-75 years with elevated blood eosinophils (≥400 cells/μL) and inadequately controlled asthma were randomized to receive placebo or reslizumab (3 mg/kg IV) every 4 weeks for 52 weeks. Patients continued their background asthma maintenance therapy during the study. Information regarding the presence of CRSwNP was obtained through patient-reported medical history. RESULTS Add-on reslizumab treatment reduced the frequency of clinical asthma exacerbations by 83% versus placebo among patients with CRSwNP. Among patients with and without aspirin sensitivity, reductions of 79% and 84%, respectively, were observed. Patients with CRSwNP (with and without aspirin sensitivity) treated with reslizumab add-on therapy also had significant improvements in lung function, as measured by forced expiratory volume in 1 second, compared with placebo. Among patients with CRSwNP, reslizumab was also associated with improvements in patient-reported asthma control and asthma quality of life. CONCLUSIONS Patients with eosinophilic asthma and self-reported CRSwNP, with and without aspirin sensitivity, are highly responsive to treatment with reslizumab for asthma-related outcomes. These findings suggest that prospective investigation of reslizumab in this patient population is warranted.
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Affiliation(s)
- Steven F Weinstein
- Allergy and Asthma Specialists Medical Group and Research Center, Huntington Beach, Calif.
| | - Rohit K Katial
- Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Philip Bardin
- Monash Lung and Sleep, Monash Medical Centre and University, Melbourne, VIC, Australia
| | - Stephanie Korn
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Mirna McDonald
- Global Respiratory R&D, Teva Branded Pharmaceutical Products R&D Inc., Malvern, Pa
| | - Margaret Garin
- Global Respiratory R&D, Teva Branded Pharmaceutical Products R&D Inc., Malvern, Pa
| | - Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Flavia C L Hoyte
- Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Matthew Germinaro
- Global Respiratory R&D, Teva Branded Pharmaceutical Products R&D Inc., Malvern, Pa
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Iftikhar IH, Schimmel M, Bender W, Swenson C, Amrol D. Comparative Efficacy of Anti IL-4, IL-5 and IL-13 Drugs for Treatment of Eosinophilic Asthma: A Network Meta-analysis. Lung 2018; 196:517-530. [PMID: 30167841 DOI: 10.1007/s00408-018-0151-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several new biologics have been studied in patients with eosinophilic asthma with varying degrees of response on clinical outcomes. No head-to-head trial has directly compared the efficacy of these drugs. OBJECTIVE To synthesize data on the relative efficacy of benralizumab, dupilumab, lebrikizumab, mepolizumab, reslizumab, and tralokinumab using network meta-analysis. DATA SOURCES We searched PubMed from inception to December 15th, 2017. DATA EXTRACTION AND SYNTHESIS We used the 'frequentist' methodology with random effect models using primarily 'netmeta' function in R to generate network meta-analysis results. Outcomes assessed included changes in forced expiratory volume-in 1 s (FEV1), asthma control questionnaire (ACQ), and asthma quality of life questionnaire (AQLQ). We also separately analyzed the annualized rate ratios for asthma exacerbations for each drug and compared to placebo. For all outcomes assessed, all drugs were superior to placebo except tralokinumab. In terms of magnitude of effect, dupilumab, followed by reslizumab and benralizumab showed the greatest increase in FEV1, 0.16L (95% CIs: 0.08-0.24), 0.13L (0.10-0.17), and 0.12L (0.08-0.17), compared to placebo. While mepolizumab, followed by dupliumab, benralizumab, and reslizumab showed reductions in ACQ scores, in order of magnitude of effect, dupilumab, followed by mepolizumab, benralizumab, and reslizumab showed the greatest increase in AQLQ scores. All drugs decreased asthma exacerbations but the results were only significant for reslizumab and dupilumab. CONCLUSIONS All drugs except for tralokinumab showed improvements in FEV1, ACQ, and AQLQ. Only reslizumab and dupilumab were associated with statistically significant reductions in asthma exacerbation rates.
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Affiliation(s)
- Imran H Iftikhar
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA.
| | - Mathew Schimmel
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
| | - William Bender
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
| | - Colin Swenson
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
| | - David Amrol
- Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
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Matucci A, Vultaggio A, Danesi R. The use of intravenous versus subcutaneous monoclonal antibodies in the treatment of severe asthma: a review. Respir Res 2018; 19:154. [PMID: 30115042 PMCID: PMC6097430 DOI: 10.1186/s12931-018-0859-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/08/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Monoclonal antibodies (mAbs) approved for use as add-on therapy in patients with severe asthma target the underlying pathogenesis of asthma. MAIN BODY Omalizumab binds immunoglobulin E (IgE), thereby inhibiting its interaction with the high-affinity IgE receptor and reducing the quantity of free IgE available to trigger the allergic cascade. Anti-interleukin (IL)-5 mAbs mepolizumab, benralizumab and reslizumab block the interaction between IL-5 and its receptor on eosinophils, thus targeting the eosinophilic pathway in asthma. Most mAbs are available as intravenous (IV) or subcutaneous (SC) formulations, as their high molecular weight and gastric degradation preclude oral administration. This review compares the pharmacology, efficacy, immunogenicity, injection- and infusion-related adverse drug reactions of subcutaneously administered omalizumab and mepolizumab with the intravenously administered reslizumab. In terms of pharmacokinetics, IV route of administration appears to be superior to the SC route due to quicker absorption, greater bioavailability, shorter time to maximum serum concentration and similar elimination half-life. Route of administration does not appear to translate into striking differences in efficacy and safety of mAbs used for the treatment of severe asthma, as all are generally considered to be effective and well tolerated. Hypersensitivity and administration-related reactions have been described with both IV and SC mAbs. CONCLUSION mABs are effective and have low immunogenicity due to their nature as humanised antibodies. Evidence on the use of mAbs in indications other than severe asthma suggest that both the SC and the IV routes of administrations have their respective advantages and disadvantages; but their full utility remains to be elucidated.
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Affiliation(s)
- Andrea Matucci
- Immunoallergology Unit, AOU Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandra Vultaggio
- Immunoallergology Unit, AOU Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Murphy K, Jacobs J, Bjermer L, Fahrenholz JM, Shalit Y, Garin M, Zangrilli J, Castro M. Long-term Safety and Efficacy of Reslizumab in Patients with Eosinophilic Asthma. J Allergy Clin Immunol Pract 2018; 5:1572-1581.e3. [PMID: 29122156 DOI: 10.1016/j.jaip.2017.08.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/14/2017] [Accepted: 08/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND In placebo-controlled trials, reslizumab, an anti-IL-5 monoclonal antibody, significantly reduced asthma exacerbations and improved lung function and asthma control in patients with eosinophilic asthma. OBJECTIVE This open-label extension study evaluated safety and efficacy of reslizumab for up to 24 months. METHODS After participation in 1 of 3 placebo-controlled, phase III trials in moderate-to-severe eosinophilic asthma, patients received reslizumab 3.0 mg/kg intravenously every 4 weeks for up to 24 months. Adverse events (AEs), lung function, and patient-reported asthma control were evaluated. RESULTS In the open-label extension, 1,051 patients received ≥1 reslizumab dose (480 reslizumab-naïve, 571 reslizumab-experienced); median (range) exposure was 319 (36-840) and 343 (36-863) days in reslizumab-naïve and reslizumab-experienced patients, respectively. Continuous exposure, including during the placebo-controlled studies, was ≥12 months for 740 patients and ≥24 months for 249 patients. The most common AEs were worsening of asthma and nasopharyngitis. Serious AEs affected 78 of 1,051 (7%) patients; 18 of 1,051 (2%) discontinued treatment because of AEs; and there were 3 deaths (all non-treatment-related). Fifteen adult patients (15 of 1,023; 1%) had malignancies of diverse tissue types. Reslizumab-experienced patients maintained improved lung function and asthma control; reslizumab-naïve patients had improvements in these measures throughout open-label treatment. Blood eosinophil counts appeared to be returning to baseline after reslizumab discontinuation. CONCLUSIONS In patients with moderate-to-severe eosinophilic asthma, intravenous reslizumab 3.0 mg/kg displays favorable long-term safety and sustained long-term efficacy. Initial improvements in lung function and asthma control were maintained for up to 2 years. These findings substantially add to our understanding of the long-term safety and efficacy of anti-IL-5 strategies.
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Affiliation(s)
- Kevin Murphy
- Allergy, Asthma, and Pulmonary Research, Boys Town National Research Hospital, Boys Town, Neb.
| | - Joshua Jacobs
- Allergy and Asthma Clinical Research, Allergy and Asthma Medical Group of the Bay Area, Inc., Walnut Creek, Calif
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - John M Fahrenholz
- Section of Allergy and Immunology, Department of Veterans Affairs Medical Center, Nashville, Tenn
| | - Yael Shalit
- Global Patient Safety and Pharmacovigilance, Teva Pharmaceuticals, Petah Tikva, Israel
| | - Margaret Garin
- Global Respiratory R&D, Teva Pharmaceuticals, Philadelphia, Pa
| | - James Zangrilli
- Global Respiratory R&D, Teva Pharmaceuticals, Philadelphia, Pa
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Mo
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Ilmarinen P, Tuomisto LE, Niemelä O, Kankaanranta H. Prevalence of Patients Eligible for Anti-IL-5 Treatment in a Cohort of Adult-Onset Asthma. J Allergy Clin Immunol Pract 2018; 7:165-174.e4. [PMID: 29894793 DOI: 10.1016/j.jaip.2018.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antibodies against the IL-5 pathway have been developed for the treatment of late-onset eosinophilic corticosteroid-resistant asthma. However, the prevalence of severe asthma and the proportion of patients who could benefit from such treatment among the general population of asthmatics remain unknown. OBJECTIVE To evaluate the prevalence and characteristics of patients eligible to anti-IL-5 treatment and severe asthma in an unselected cohort of adult-onset asthma. METHODS Seinäjoki Adult Asthma Study is a 12-year follow-up study of patients with new-onset adult asthma (n = 203). Prevalence was estimated based on information collected at 12-year follow-up visit. Health care use was collected from the whole 12-year follow-up period. RESULTS The prevalence of anti-IL-5-treatable patients was 2%, when the following criteria were used: daily use of medium-to-high inhaled corticosteroid (ICS) dose and long-acting β2-agonist, ≥2 exacerbations/previous year and blood eosinophil count ≥300 cells/μL or fraction of exhaled nitric oxide ≥ 50 ppb. The prevalence of severe asthma, as defined according to European Respiratory Society/American Thoracic Society, was 5.9%, and only 1 patient met criteria for both groups. When compared with anti-IL-5 eligible patients, severe asthmatics were more often current smokers at diagnosis, obese, used higher ICS dose, and had higher blood neutrophils 12 years after diagnosis. Both groups differed from nonsevere asthma by a higher number of all and unplanned respiratory-related visits to health care. Severe asthmatics showed the highest number of hospitalizations. CONCLUSIONS In a cohort of unselected consecutive patients with adult-onset asthma, 5.9% fulfilled criteria for severe asthma and 2% qualified for anti-IL-5 treatment. Both groups represent a high burden to health care and specifically targeted treatment could lead to lower use of health care at long term.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Abstract
Asthma is the most common chronic respiratory disease in the USA. A subset of patients with asthma have refractory symptoms, persistent eosinophilic inflammation, and recurrent exacerbations despite maximal medical therapy. The monoclonal antibodies targeting the IL-5 pathway are a new class of medications designed to target severe eosinophilic asthma. There are two medications clinically available: mepolizumab and reslizumab, both of which target IL-5. A third medication, benralizumab, is currently under development and targets the IL-5 receptor. Clinical data suggest these medications can reduce asthma exacerbations and improve lung function in patients with peripheral eosinophilia and poorly controlled asthma despite maximal medical therapy. The anti-IL-5 medications are among the first targeted molecular therapies for asthma and will usher in an exciting new era in the treatment of severe asthma.
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Affiliation(s)
- Matthew P Giannetti
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis St. Smith Building, 628, Boston, MA, 02115, USA
| | - Juan C Cardet
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis St. Smith Building, 628, Boston, MA, 02115, USA.
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
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50
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Brusselle G, Germinaro M, Weiss S, Zangrilli J. Reslizumab in patients with inadequately controlled late-onset asthma and elevated blood eosinophils. Pulm Pharmacol Ther 2017; 43:39-45. [PMID: 28159511 DOI: 10.1016/j.pupt.2017.01.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Asthma with adult onset and elevated blood eosinophils is a difficult-to-treat subgroup. This post hoc analysis evaluated reslizumab, an anti-interleukin-5 monoclonal antibody, in patients with late-onset eosinophilic asthma. METHODS Data from two 52-week placebo-controlled trials of reslizumab IV 3 mg/kg every 4 weeks in patients aged 12-75 years with inadequately controlled asthma, ≥1 asthma exacerbation within 12 months, and screening blood eosinophils ≥400/μL (NCT01287039/NCT01285323) were stratified by age of asthma onset (<40 or ≥40 years). Annual clinical asthma exacerbation rates, change in lung function, and patient-reported outcomes were analyzed. RESULTS 273 patients with late-onset asthma (placebo, n = 130; reslizumab, n = 143) and 658 with early-onset asthma (placebo, n = 336; reslizumab, n = 322) were included. Baseline demographics were similar between groups. The interaction between age at onset of asthma and effect of reslizumab on asthma exacerbations was statistically significant (p = 0.0083). Compared with placebo, reslizumab produced a 75% relative reduction in asthma exacerbations in patients with late-onset asthma (rate ratio [RR] 0.25; 95% confidence interval [CI], 0.16, 0.40), substantially larger than the reduction in earlier onset patients (RR 0.58; 95% CI, 0.44, 0.76). Similar findings were observed for other measures of asthma, including forced expiratory volume in 1 s (FEV1). The adverse event profile of reslizumab was similar in patients with early- or late-onset asthma. CONCLUSIONS Compared with placebo, reslizumab produced larger reductions in asthma exacerbations and larger improvements in lung function in patients with late versus early-onset asthma.
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Affiliation(s)
- Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
| | | | - Sivan Weiss
- Teva Pharmaceutical Industries Ltd., Netanya, Israel
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