Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy

BACKGROUND

A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial.

METHODS

In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response.

RESULTS

The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated.

CONCLUSIONS

This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.

RESISTANCE TO GLUCOCORTICOSTEROID THERAPY IN PATIENTS WITH SARS-COV-2 INFECTION WITH ELEVATED MARKERS OF ENDOTOXEMIA

Introduction

One of the most important factors potentiating the effect of SARS-CoV-2 virus influencing the results of anti-inflammatory therapy may be lipopolysaccharides of gram negative flora, which are strong activators of innate immune system mechanisms.

Methods

104 patients with PCR-positive SARS-CoV-2 age 44-70 years who were hospitalized were examined. Patients were divided into 2 groups: Group 1 (n = 51) – patients with a positive response to glucocorticosteroid therapy; and Group 2 (n = 53) – patients with no response to glucocorticosteroid therapy. For the control 20 healthy people were selected. The patients were examined for the levels of lipopolysaccharide-binding protein (LBP), sCD14-ST, ferritin and C-reactive protein (CRP) in peripheral blood.

Results

In the Group 1 patients with new PCR-positive SARS-CoV-2 infection who responded positively to glucocorticosteroid therapy, significantly higher levels of LBP, 60.1 μg/mL [36.3; 73.5], sCD14-ST – 3181 pg/mL [2799; 3420], ferritin 276.00 µg/L [184.00;463.00], and CRP 74.3 mg/L [34.9;108.0] were noted compared with the control group (p<0.01). In the Group 2 patients with a negative response to glucocorticosteroid anti-inflammatory therapy, significantly higher levels of LBP, sCD14-ST, ferritin, and CRP were seen compared with Group 1.

Conclusion

Elevated levels of endotoxemia markers may play a role in the response to glucocorticosteroid therapy in patients with SARS-CoV-2.