101
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Yılmaz İ. Careful Selection of Patients Is Required to Obtain Higher Potential Benefit From Mepolizumab Therapy. Chest 2021; 158:2229-2230. [PMID: 33160530 DOI: 10.1016/j.chest.2020.05.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- İnsu Yılmaz
- Erciyes University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Kayseri, Turkey.
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102
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Fong WCG, Azim A, Knight D, Mistry H, Freeman A, Felongco M, Kyyaly A, Harvey M, Dennison P, Zhang H, Howarth P, Arshad SH, Kurukulaaratchy RJ. Real-world Omalizumab and Mepolizumab treated difficult asthma phenotypes and their clinical outcomes. Clin Exp Allergy 2021; 51:1019-1032. [PMID: 33866615 DOI: 10.1111/cea.13882] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Omalizumab and Mepolizumab are biologic drugs with proven efficacy in clinical trials. However, a better understanding of their real-world effectiveness in severe asthma management is needed. OBJECTIVES To better understand the real-world effectiveness of Omalizumab and Mepolizumab, elucidate the clinical phenotypes of patients treated with these drugs, identify baseline characteristics associated with biologic response and assess the spectrum of responses to these medications. METHODS Using real-world clinical data, we retrospectively phenotyped biologic naïve patients from the Wessex AsThma CoHort of difficult asthma (N = 478) commenced on Omalizumab (N = 105) or Mepolizumab (N = 62) compared to severe asthma patients not receiving biologics (SNB, N = 178). We also assessed multiple clinical endpoints and identified features associated with response. RESULTS Compared to SNB, Omalizumab patients were younger, diagnosed with asthma earlier, and more likely to have rhinitis. Conversely, compared to SNB, Mepolizumab patients were predominantly older males, diagnosed with asthma later, and more likely to have nasal polyposis but less dysfunctional breathing. Both treatments reduced exacerbations, Acute Healthcare Encounters [AHE] (emergency department or hospital admissions), maintenance oral corticosteroid dose, and improved Asthma Control Questionnaire 6 (ACQ6) scores. Omalizumab response was independently associated with more baseline exacerbations (p = .024) but fewer AHE (p = .050) and absence of anxiety (p = .008). Lower baseline ACQ6 was independently associated with Mepolizumab response (p = .007). A composite group of non-responders demonstrated significantly more psychopathologies and worse baseline subjective disease compared to responder groups. CONCLUSIONS AND CLINICAL RELEVANCE In a difficult asthma cohort, Omalizumab and Mepolizumab were used in distinct clinical phenotypes but were both multidimensionally efficacious. Certain baseline clinical characteristics were associated with poorer biologic responses, such as psychological co-morbidity, which may assist clinicians in biologic selection. These characteristics also emphasize the need for comprehensive approaches to support these patients.
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Affiliation(s)
- Wei Chern Gavin Fong
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adnan Azim
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Deborah Knight
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Heena Mistry
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Anna Freeman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Mae Felongco
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Aref Kyyaly
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Matthew Harvey
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Patrick Dennison
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Peter Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
| | - Ramesh J Kurukulaaratchy
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton
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103
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Real-World Effectiveness of Mepolizumab in Severe Eosinophilic Asthma: A Systematic Review and Meta-analysis. Clin Ther 2021; 43:e192-e208. [PMID: 33962763 DOI: 10.1016/j.clinthera.2021.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Mepolizumab is a human monoclonal antibody against interleukin 5 (IL-5) used to treat severe eosinophilic asthma. Several studies have evaluated the effectiveness of mepolizumab in the real world. We conducted a systematic review and meta-analysis in the context of heterogeneity among patients, clinicians, and treatment regimens to study the effectiveness of mepolizumab in the real world. METHODS We searched the PubMed and Embase databases for real-world studies on severe asthma treatment with mepolizumab as of June 30, 2020. Exacerbations, asthma-related hospitalizations, forced expiratory volume in 1 second (FEV1), Asthma Control Questionnaire (ACQ) or Asthma Control Test (ACT), corticosteroid use, peripheral blood eosinophil counts, and the fraction of exhaled nitric oxide were selected as indicators to evaluate the effectiveness. Standardized mean differences by the Cohen method and mean differences were chosen as indicators of effect size. Cohen d values of 0.2, 0.5, and 0.8 are considered as small, medium, and large effects, respectively. We used the Dersimonian-Laird random-effect model to quantify pooled effectiveness estimates. FINDINGS A total of 1457 patients from 13 studies were included in this review. At all time points, mepolizumab was associated with reductions in exacerbations (2.92 and 2.73 events per patient per year fewer at 6 and 12 months, respectively) and hospitalizations (0.36 events per patient per year fewer at 12 months); improvements in asthma control (ACQ scores reductions of 1.32 and 1.03 at 6 and 12 months, respectively; ACT scores increase of 6.52 at 6-12 months); slight improvements in pulmonary function (FEV1 increase of 0.23 L at 1-3 months and 6-12 months, respectively); reductions in oral corticosteroid use (9.02- and 7.68-mg decrease at 6 and 12 months, respectively); and reductions in peripheral blood eosinophil counts (decreases of 559.11 cells/μL and 599.17 cells/μL at 1-3 months and 6-12 months, respectively) and fraction of exhaled nitric oxide (13-ppb reduction at 6-12 months). IMPLICATIONS Our study suggests that mepolizumab is associated with improvements in several clinically meaningful real-world outcomes. This study is a supplement to and extension of the efficacy of randomized controlled trials of mepolizumab. (Clin Ther. 2021;XX:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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104
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Jacobsen EA, Jackson DJ, Heffler E, Mathur SK, Bredenoord AJ, Pavord ID, Akuthota P, Roufosse F, Rothenberg ME. Eosinophil Knockout Humans: Uncovering the Role of Eosinophils Through Eosinophil-Directed Biological Therapies. Annu Rev Immunol 2021; 39:719-757. [PMID: 33646859 PMCID: PMC8317994 DOI: 10.1146/annurev-immunol-093019-125918] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The enigmatic eosinophil has emerged as an exciting component of the immune system, involved in a plethora of homeostatic and inflammatory responses. Substantial progress has been achieved through experimental systems manipulating eosinophils in vivo, initially in mice and more recently in humans. Researchers using eosinophil knockout mice have identified a contributory role for eosinophils in basal and inflammatory processes and protective immunity. Primarily fueled by the purported proinflammatory role of eosinophils in eosinophil-associated diseases, a series of anti-eosinophil therapeutics have emerged as a new class of drugs. These agents, which dramatically deplete eosinophils, provide a valuable opportunity to characterize the consequences of eosinophil knockout humans. Herein, we comparatively describe mouse and human eosinophil knockouts. We put forth the view that human eosinophils negatively contribute to a variety of diseases and, unlike mouse eosinophils, do not yet have an identified role in physiological health; thus, clarifying all roles of eosinophils remains an ongoing pursuit.
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Affiliation(s)
- Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona 85259, USA;
| | - David J Jackson
- Guy's and St Thomas' Hospitals, London WC2R 2LS, United Kingdom;
- Department of Immunobiology, King's College London, London WC2R 2LS, United Kingdom
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy;
| | - Sameer K Mathur
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53792, USA;
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Ian D Pavord
- Respiratory Medicine Unit, Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, Oxford OX3 9DU, United Kingdom;
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California 92093, USA;
| | - Florence Roufosse
- Médecine Interne, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA;
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105
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Treatment Challenges in Severe Eosinophilic Asthma: Differential Response to Anti-IL-5 and Anti-IL-5R Therapy. Int J Mol Sci 2021; 22:ijms22083969. [PMID: 33921360 PMCID: PMC8069413 DOI: 10.3390/ijms22083969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
Severe asthma greatly affects patients' quality of life. Major advances have occurred in the management of severe eosinophilic asthma the past few years due to the new targeted biological therapies. There are three anti-IL-5 mAbs, mepolizumab, reslizumab and benralizumab. Despite the different mechanism of blocking IL-5 the clinical effects are quite similar as randomized controlled trials and real-life studies have shown. Moreover, there are reports of responding to one after failing to respond to another anti-IL-5 therapy. Accordingly, it is challenging to explore the possible differences in the response to anti-IL-5 treatments. This might help us not only understand possible mechanisms that contribute to the resistance to treatment in this particular asthma endotype, but also to phenotype within severe eosinophilic asthma in order to treat our patients more efficiently.
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106
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Matucci A, Bormioli S, Nencini F, Chiccoli F, Vivarelli E, Maggi E, Vultaggio A. Asthma and Chronic Rhinosinusitis: How Similar Are They in Pathogenesis and Treatment Responses? Int J Mol Sci 2021; 22:3340. [PMID: 33805199 PMCID: PMC8037977 DOI: 10.3390/ijms22073340] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Severe asthma and rhinosinusitis represent frequent comorbidities, complicating the overall management of the disease. Both asthma and chronic rhinosinusitis (CRS) can be differentiated into endotypes: those with type 2 eosinophilic inflammation and those with a non-type 2 inflammation. A correct definition of phenotype/endotype for these diseases is crucial, taking into account the availability of novel biological therapies. Even though patients suffering from type 2 severe asthma-with or without CRS with nasal polyps-significantly benefit from treatment with biologics, the existence of different levels of patient response has been clearly demonstrated. In fact, in clinical practice, it is a common experience that patients reach a good clinical response for asthma symptoms, but not for CRS. At first glance, a reason for this could be that although asthma and CRS can coexist in the same patient, they can manifest with different degrees of severity; therefore, efficacy may not be equally achieved. Many questions regarding responders and nonresponders, predictors of response, and residual disease after blocking type 2 pathways are still unanswered. In this review, we discuss whether treatment with biological agents is equally effective in controlling both asthma and sinonasal symptoms in patients in which asthma and chronic rhinosinusitis with nasal polyps coexist.
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Affiliation(s)
- Andrea Matucci
- Immunoallergology Unit, University Hospital Careggi, 50134 Florence, Italy; (S.B.); (F.N.); (E.V.); (A.V.)
| | - Susanna Bormioli
- Immunoallergology Unit, University Hospital Careggi, 50134 Florence, Italy; (S.B.); (F.N.); (E.V.); (A.V.)
| | - Francesca Nencini
- Immunoallergology Unit, University Hospital Careggi, 50134 Florence, Italy; (S.B.); (F.N.); (E.V.); (A.V.)
| | - Fabio Chiccoli
- Immunology and Cellular Therapy Unit, University Hospital Careggi, 50134 Florence, Italy;
| | - Emanuele Vivarelli
- Immunoallergology Unit, University Hospital Careggi, 50134 Florence, Italy; (S.B.); (F.N.); (E.V.); (A.V.)
| | - Enrico Maggi
- Immunology Department, Children Hospital Bambino Gesù, IRCCS, 00165 Rome, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, University Hospital Careggi, 50134 Florence, Italy; (S.B.); (F.N.); (E.V.); (A.V.)
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107
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Kankaanranta H, Ilmarinen P. Patient Selection for Mepolizumab in Severe Asthma: Time for Reappraisal? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3009-3010. [PMID: 33039015 DOI: 10.1016/j.jaip.2020.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
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108
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Dhariwal J, Hearn AP, Kavanagh JE, d'Ancona G, Green L, Fernandes M, Thomson L, Roxas C, Kent BD, Nanzer AM, Jackson DJ. Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2315-2320.e1. [PMID: 33689868 DOI: 10.1016/j.jaip.2021.02.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe asthma with fungal sensitization (SAFS) is a complex clinical phenotype associated with poorly controlled type 2 inflammation and significant morbidity from both the disease itself and a high steroid burden. OBJECTIVE To assess the effectiveness of biologic therapies targeting eosinophilic inflammation in SAFS. METHODS We assessed the effectiveness of treatment with mepolizumab or benralizumab in patients with SAFS, and compared outcomes with patients with severe atopic asthma without fungal sensitization and patients with severe nonatopic asthma. Baseline clinical characteristics and clinical outcomes at 48 weeks were evaluated. A subgroup analysis was performed of patients who met the criteria for allergic bronchopulmonary aspergillosis (ABPA) rather than SAFS. RESULTS A total of 193 patients treated with mepolizumab (n = 63) or benralizumab (n = 130) were included. Patients with SAFS had higher baseline IgE level compared with patients with severe atopic asthma without fungal sensitization and severe nonatopic asthma (733 ± 837 IU/mL vs 338 ± 494 and 142 ± 171, respectively; both P < .001). There were no other significant baseline differences in clinical characteristics between groups. At 48 weeks, there were significant improvements in 6-item asthma control questionnaire score and exacerbation frequency, and reduction in maintenance oral corticosteroid dose across all groups (all P < .05). No significant between-group differences in outcomes were observed at 48 weeks. Patients with ABPA (n = 9) had a significant reduction in exacerbation frequency (P = .013) with treatment. CONCLUSIONS Treatment with eosinophil-targeting biologics led to improvements in exacerbation frequency, oral corticosteroid requirements, and patient-reported outcomes in patients with SAFS, with a reduction in exacerbations in the subgroup of patients with ABPA. These data highlight the potential clinical utility of targeting eosinophilic inflammation in SAFS and ABPA.
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Affiliation(s)
- Jaideep Dhariwal
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew P Hearn
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanne E Kavanagh
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gráinne d'Ancona
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alexandra M Nanzer
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Asthma UK Centre, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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109
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Pelaia C, Crimi C, Benfante A, Caiaffa MF, Calabrese C, Carpagnano GE, Ciotta D, D'Amato M, Macchia L, Nolasco S, Pelaia G, Pellegrino S, Scichilone N, Scioscia G, Spadaro G, Valenti G, Vatrella A, Crimi N. Therapeutic Effects of Benralizumab Assessed in Patients with Severe Eosinophilic Asthma: Real-Life Evaluation Correlated with Allergic and Non-Allergic Phenotype Expression. J Asthma Allergy 2021; 14:163-173. [PMID: 33654413 PMCID: PMC7910091 DOI: 10.2147/jaa.s297273] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Benralizumab can be utilized as add-on biological treatment of severe eosinophilic asthma. However, so far only a few real-life studies have been published with regard to the use of this anti-IL-5 receptor humanized monoclonal antibody. Objective The primary aim of this multicenter observational investigation has been to assess the therapeutic effects of benralizumab in patients with severe uncontrolled, corticosteroid refractory eosinophilic asthma. The secondary objective was to evaluate the efficacy of benralizumab with regard to positive or negative skin prick test (SPT). Methods Clinical, functional, and laboratory parameters were evaluated in order to verify the therapeutic actions of benralizumab in atopic and non atopic subjects with difficult-to-treat eosinophilic asthma. Moreover, a comparative evaluation was carried out in relation to the presence or absence of SPT positivity. Results After 6 months of add-on biological therapy with benralizumab, our 111 patients experienced a marked improvement of their severe eosinophilic asthma, expressed by significant changes in asthma exacerbation rate, prednisone intake, daily use of short-acting β2-adrenergic agonists (SABA), asthma control test (ACT) score, asthma quality of life questionnaire (AQLQ) score (56 patients), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), blood eosinophil count, blood basophil count (59 patients), and fractional exhaled nitric oxide (FeNO) levels (39 patients). In addition, significantly more effective outcomes were detected in patients with positive SPT, when compared to subjects with negative SPT, only in regard to asthma exacerbation number, ACT score, and daily SABA utilization. No significant correlation was found between serum IgE concentrations and each of all measured parameters. Conclusion and Clinical Relevance Taken together, the results of this real-world study indicate that in both allergic and non-allergic subjects benralizumab can be used as a valuable pharmacotherapeutic option for add-on biological therapy of severe eosinophilic asthma, regardless of SPT positivity or negativity.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alida Benfante
- Department of Biomedicine and Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | | | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Foggia, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Domenico Ciotta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Maria D'Amato
- Division of Pneumology, "V. Monaldi" University Hospital, Naples, Italy
| | - Luigi Macchia
- Allergology and Clinical Immunology Unit, University "Aldo Moro" of Bari, Bari, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Pellegrino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nicola Scichilone
- Department of Biomedicine and Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Giuseppe Spadaro
- Allergology and Immunology Unit, University "Federico II" of Naples, Naples, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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110
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Menzella F, Bonavia M, Bonini M, D’Amato M, Lombardo S, Murgia N, Patella V, Triggiani M, Pelaia G. Real-World Experience with Benralizumab in Patients with Severe Eosinophilic Asthma: A Case Series. J Asthma Allergy 2021; 14:149-161. [PMID: 33654412 PMCID: PMC7910093 DOI: 10.2147/jaa.s295676] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/11/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Severe eosinophilic asthma (SEA) is characterized by high eosinophilia, severe symptoms, important comorbidities, frequent exacerbations, and poor asthma control. Benralizumab, targeting the interleukin-5 receptor alpha, proved effective in inducing rapid eosinophil depletion and amelioration of symptoms and lung function; it also allowed to reduce exacerbations and the use of oral corticosteroids (OCS). The present case series, spanning different subtypes of SEA, aimed at expanding the real-world experience with benralizumab in Italy. PATIENTS AND METHODS We collected data from SEA patients treated with benralizumab, at baseline and during treatment. We focused on the effects of benralizumab in the following conditions and endpoints: i) overlap between high-IgE and high-eosinophilic asthma; ii) presence of nasal polyposis as comorbidity; iii) corticosteroid-sparing effect; iv) patient perception. RESULTS Ten SEA patients (females: N=7; age range: 19-70 years) referred to 8 Italian Centers and treated with benralizumab were included, presenting with several comorbidities such as non-allergic disease (8/10), atopy (3/10), high IgE (5/10) and nasal polyposis (6/10). Overall, benralizumab yielded optimal disease control in all patients, particularly in terms of rapid clinical and functional improvement, decreased systemic steroid need (OCS therapy was completely discontinued in 7 cases) and amelioration of patient quality of life, except for 1 case, in whom other conditions not related to benralizumab therapy interfered with the patient perception. CONCLUSION Our findings further support the efficacy and safety of benralizumab observed in randomized clinical trials, providing even better results for lung function improvement.
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Affiliation(s)
- Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Marco Bonavia
- Pneumologia Riabilitativa - Ospedale Ge-Arenzano, ASL3-, Genoa, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria D’Amato
- Respiratory Department- Monaldi Hospital AO Dei Colli, Naples, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, Santa Maria Della Speranza Hospital, Salerno, Italy
- Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Fisciano, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, Respiratory Unit, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
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111
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Taillé C, Devillier P, Dusser D, Humbert M, Maurer C, Roche N. Evaluating response to biologics in severe asthma: Precision or guesstimation? Respir Med Res 2021; 80:100813. [PMID: 34171552 DOI: 10.1016/j.resmer.2021.100813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/07/2021] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C Taillé
- Service de pneumologie et centre de référence constitutif des maladies pulmonaires rares, groupe hospitalier universitaire AP-HP Nord-université de Paris, hôpital Bichat; Inserm UMR 1152, Paris, France.
| | - P Devillier
- Department of airway diseases, hôpital Foch; Laboratory of research in respiratory pharmacology, VIM-UMR-0092, Université Paris-Saclay, Suresnes, France
| | - D Dusser
- Service de pneumologie, groupe hospitalier universitaire AP-HP centre-université de Paris, Hôpital Cochin, INSERM UMR 1016 (institut Cochin), Paris, France
| | - M Humbert
- Faculty of medicine, Université Paris-Saclay; INSERM UMR_S 999; AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - C Maurer
- Service de pneumologie, groupe hospitalier intercommunal de Montfermeil, 10, rue du général Leclerc, Montfermeil, France
| | - N Roche
- Service de pneumologie, groupe hospitalier universitaire AP-HP centre-université de Paris, Hôpital Cochin, INSERM UMR 1016 (institut Cochin), Paris, France
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Mepolizumab and Oral Corticosteroid Stewardship: Data from the Australian Mepolizumab Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2715-2724.e5. [PMID: 33545399 DOI: 10.1016/j.jaip.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship. OBJECTIVES This study evaluated the trajectories of OCS exposure (prednisolone-equivalent) in patients with severe eosinophilic asthma before and after starting mepolizumab and the predictors of becoming OCS free after 6 months of mepolizumab therapy. METHODS This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed up for 1 year (n = 225). RESULTS Patients had a median age of 60 (interquartile range: 50, 68) years, and 58% were female. At baseline, 48% used maintenance OCS, 96% had ≥1 OCS burst, and 68% had received ≥1 g of OCS in the previous year. After commencing mepolizumab, only 55% of those initially on maintenance OCS remained on this treatment by 12 months. Maintenance OCS dose reduced from median 10 (5.0, 12.5) mg/day at baseline to 2 (0, 7.0) mg/day at 12 months (P < .001). Likewise, proportions of patients receiving OCS bursts in the previous year reduced from 96% at baseline to 50% at 12 months (P < .001). Overall, 137 (48%) patients required OCS (maintenance/burst) after 6 months' mepolizumab therapy. Becoming OCS free was predicted by a lower body mass index (odds ratio: 0.925; 95% confidence interval: 0.872-0.981), late-onset asthma (1.027; 1.006-1.048), a lower Asthma Control Test score (1.111; 0.011-1.220), and not receiving maintenance OCS therapy at baseline (0.095; 0.040-0.227). CONCLUSION Mepolizumab led to a significant and sustained reduction in OCS dependence in patients with severe eosinophilic asthma. This study supports the OCS-sparing effect of mepolizumab and highlights the pivotal role of mepolizumab in OCS stewardship initiatives.
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113
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Time for a Paradigm Shift. Chest 2021; 159:459-461. [PMID: 33563426 DOI: 10.1016/j.chest.2020.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022] Open
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114
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Hearn AP, Kavanagh J, d'Ancona G, Roxas C, Green L, Thomson L, Fernandes M, Kent BD, Dhariwal J, Nanzer AM, Jackson DJ. The relationship between Feno and effectiveness of mepolizumab and benralizumab in severe eosinophilic asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2093-2096.e1. [PMID: 33486140 DOI: 10.1016/j.jaip.2021.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom
| | - Joanne Kavanagh
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Marianna Fernandes
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Alexanda M Nanzer
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, United Kingdom.
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115
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Calzetta L, Matera MG, Coppola A, Rogliani P. Prospects for severe asthma treatment. Curr Opin Pharmacol 2020; 56:52-60. [PMID: 33310456 DOI: 10.1016/j.coph.2020.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
Biological drugs are approved to treat patients with severe uncontrolled asthma and are directed against mediators of type 2 immunity. These agents are effective in reducing the risk of exacerbation, maintaining asthma symptom control and reducing the need of systemic corticosteroids. Although biological drugs have revolutionized the management of the disease, to date there are no head-to-head studies across the current available molecules and there remains the need of specific biomarkers for the diagnosis, prognosis and response to treatment. Moreover, there is still an urgent need to identify further molecular targets to offer effective treatments for those patients who are not responsive to the currently available biological drugs, by moving upstream in the inflammatory cascade to inhibit multiple inflammatory pathways and/or identify effective nontype 2 immunity mechanisms.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angelo Coppola
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy; Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Oral corticosteroid sparing effects of anti-IL5/ anti-IL5 receptor treatment after 2 years of treatment. Respir Med 2020; 176:106260. [PMID: 33264712 DOI: 10.1016/j.rmed.2020.106260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Clinical trials have shown oral corticosteroid (OCS) sparing effects of anti-IL5/anti-IL5-receptor treatments. The generalisability of these clinical trials may be limited, due to the rigid inclusion and exclusion criteria, and the short tapering duration. Real-world evidence is needed to bridge the gap between the clinical trials and the clinical practice. With this study we present real-life data on the OCS sparing effects of anti-IL5/anti-IL5-receptor treatments after 12 and 24 months of treatment. METHODS Severe, eosinophilic asthma patients treated with mepolizumab, reslizumab or benralizumab for 24 months were included in this observational study. Data on OCS-dose, FEV1, ACT/ACQ score and blood eosinophils were obtained from the patients records before anti-IL5/anti-IL5-receptor treatment, and after 12 and 24 months of treatment. RESULTS At baseline 75% of patients were on daily OCS. This number was reduced to 50% after one year of treatment, p < 0.001, and 28% after two years of treatment, p < 0.001. Within the group on daily OCS the median daily dose was reduced from 10 mg of Prednisolone at baseline (IQR 5-20) to 3.75 mg Prednisolone (IQR 0-10) after 12 months, and 0 mg Prednisolone (IQR 0-7.5) after 24 months, p < 0.001. CONCLUSIONS The findings in this study add to the generalisability of the clinical studies, showing significant OCS sparing effects of anti-IL5/anti-IL5-receptor treatment in a real-life setting. Furthermore, these findings add to the understanding of the long-term effects of anti-IL5/anti-IL5-receptor treatment, showing an even further and persistent OCS reduction after two years of treatment.
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Hearn AP, Kent BD, Jackson DJ. Biologic treatment options for severe asthma. Curr Opin Immunol 2020; 66:151-160. [PMID: 33212388 DOI: 10.1016/j.coi.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
Asthma is a common condition that causes episodic expiratory airflow limitation due to bronchial smooth muscle constriction and airways inflammation resulting in increased respiratory symptoms and acute asthma exacerbations. Patients with severe asthma have relied on either recurrent courses or daily use of oral corticosteroids (OCS) to control their disease. However a high level of OCS exposure is associated with significant morbidity and mortality. In recent years the elucidation of the role of T2 inflammation underpinning asthma pathogenesis has led to the development of monoclonal antibody (mAb) therapies targeting this pathway. Established therapies now include omalizumab targeting IgE, mepolizumab and reslizumab targeting IL-5, benralizumab targeting the IL-5R and dupilumab targeting IL-4R. For many patients these therapies have been transformative and their use has additionally advanced our understanding of the immunology that underpins the disease. This article reviews the biologic therapies currently available for the treatment of severe asthma.
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Affiliation(s)
- Andrew P Hearn
- Guy's Severe Asthma - Guy's Hospital - Guy's & St. Thomas', NHS Foundation Trust, United Kingdom
| | - Brian D Kent
- St. James's Hospital, Dublin, Republic of Ireland
| | - David J Jackson
- Guy's Severe Asthma - Guy's Hospital - Guy's & St. Thomas', NHS Foundation Trust, United Kingdom; Asthma UK Centre, Faculty of Life Sciences & Medicine, King's College London, United Kingdom.
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Di Bona D, Minenna E, Albanesi M, Nettis E, Caiaffa MF, Macchia L. Benralizumab improves patient reported outcomes and functional parameters in difficult-to-treat patients with severe asthma: Data from a real-life cohort. Pulm Pharmacol Ther 2020; 64:101974. [PMID: 33137516 DOI: 10.1016/j.pupt.2020.101974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 01/10/2023]
Abstract
In the last decade, an increasing number of randomized controlled trials (RCTs) on biologic therapy in patients with severe asthma have included patient-reported outcomes (PROs) as secondary efficacy measures. The majority of these RCTs showed a benefit in symptoms and quality of life. However, the magnitude of this benefit remains uncertain, because it rarely exceeded the minimal important difference (MID), owing to a significant improvement in the control group (placebo effect). Real-life studies on biologic therapies assessing PRO are scarce. They may support and integrate RCT results through their different experimental design. This real-life retrospective study provides data on 15 patients with difficult-to-treat severe eosinophilic asthma treated with benralizumab up to 6 months. Asthma quality of life questionnaire (AQLQ) and asthma control test (ACT) were assessed and administered at each visit to minimize the Hawthorne effect. Changes in general accepted efficacy measures, such as forced expiratory volume in 1 s (FEV1), peak expiratory flux (PEF), exacerbation rate and blood eosinophils, from baseline were also assessed. AQLQ and ACT improved from 3.9 ± 0.4 to 5.2 ± 0.4 and from 15.6 ± 5.7 to 18.1 ± 5.6, respectively. FEV1 increased of about 250 ml (+14%). PEF increased from 288 ± 107 to 333 ± 133 l/min. The number of exacerbations requiring OCS courses decreased from 2.8 ± 2.2 to 0.5 ± 0.8. Eosinophil counts dropped to 25.6 ± 15 cells/microliter. In conclusion, most patients reported improvements in AQLQ and ACT greater than MID, suggesting that these outcome represent a sensitive tool in real-life effectiveness studies. Our approach reduced the limitations of transition questions and the Hawthorne effect, increasing findings reliability.
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Affiliation(s)
- Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari - Aldo Moro, Italy.
| | - Elena Minenna
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Marcello Albanesi
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari - Aldo Moro, Italy; Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Eustachio Nettis
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari - Aldo Moro, Italy
| | | | - Luigi Macchia
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari - Aldo Moro, Italy
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119
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Paggiaro P, Rogliani P. Mepolizumab Effectiveness and Allergic Status in Real Life. Int Arch Allergy Immunol 2020; 182:311-318. [PMID: 33113532 DOI: 10.1159/000511147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. OBJECTIVE We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. METHOD We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97-72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37-27.6%). They had taken mepolizumab for at least 6 months. RESULTS After 10.9 ± 3.7 months, improvements in FEV1%, FEF25-75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5-9]) than in SAEA (5 [2.5-8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25-75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = -0.110; p = 0.266), FEF25-75% (β = -0.228; p = 0.06), BE counts (β = -0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = -0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43-2.55], p = 0.923; FEF25-75 >65%: OR = 0.41 [95% CI: 0.08-2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32-1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55-3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40-3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40-29.27], p = 0.258), were differently associated with 1 or the other phenotype. CONCLUSION Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy, .,Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy,
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Corrado Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Telese Terme, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Girolamo Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.,Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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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. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 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] [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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121
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Rogliani P, Paggiaro P. Real-life Mepolizumab effectiveness in severe eosinophilic asthmatics with nasal polyposis. Respir Med Res 2020; 78:100791. [PMID: 33039948 DOI: 10.1016/j.resmer.2020.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - M Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Telese, 82037 Telese Terme (BN), Italy
| | - A Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Baglioni
- Pneumology Department, Perugia Hospital, Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - S Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - A Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - M Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy; Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Rome, Italy
| | - P Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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122
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Kavanagh JE, Hearn AP, Dhariwal J, d'Ancona G, Douiri A, Roxas C, Fernandes M, Green L, Thomson L, Nanzer AM, Kent BD, Jackson DJ. Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma. Chest 2020; 159:496-506. [PMID: 32882249 DOI: 10.1016/j.chest.2020.08.2083] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/08/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Benralizumab is an IL5-receptor monoclonal antibody licensed for the treatment of severe eosinophilic asthma (SEA). It has demonstrated efficacy in clinical trials in reducing asthma exacerbation rates and maintenance oral corticosteroids (mOCSs). RESEARCH QUESTION What is the real-world effectiveness of benralizumab and what baseline characteristics are associated with response to therapy? STUDY DESIGN AND METHODS We assessed outcomes in all SEA patients who began benralizumab treatment at our specialist center. At each dosing visit, exacerbation history, mOCS dose, spirometry, and Asthma Control Questionnaire (ACQ6) and Mini-Asthma Quality of Life Questionnaire (mAQLQ) scores were recorded. Response to treatment was defined as a reduction of ≥ 50% in annualized exacerbation rate (AER) or in mOCS dose after 48 weeks of treatment. Super response was defined as zero exacerbations and no mOCSs for asthma. RESULTS One hundred thirty patients were included in the analysis. At 48 weeks, a 72.8% reduction in AER was noted, from 4.92 ± 3.35 per year in the year preceding biologic treatment to 1.34 ± 1.71 per year (P < .001), including 57 patients (43.8%) who were exacerbation-free with benralizumab. In those receiving mOCSs (n = 74 [56.9%]), the median daily prednisolone dose fell from 10 mg (interquartile range, 5-20 mg) to 0 mg (interquartile range, 0-5 mg; P < .001), and 38 of 74 patients (51.4%) were able to discontinue mOCS therapy. Clinically and statistically significant improvements were found in ACQ6 scores, mAQLQ scores, and FEV1. Overall, 51 patients (39%) met the super responder definition and 112 patients (86%) met the responder definition. The optimal regression model of super responders vs other responders included baseline characteristics associated with a strongly eosinophilic phenotype and less severe disease. Eighteen patients (13.8%) were nonresponders to benralizumab. Evidence of chronic airway infection was observed in 6 of 18 patients, and an increase in the blood eosinophil count consistent with the development of anti-drug antibodies was observed in 5 of 18 patients. INTERPRETATION In a large real-world SEA cohort, benralizumab led to significant improvements in all clinical outcome measures. A lack of response was seen in a minority of patients and should be a focus for future investigation.
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Affiliation(s)
- Joanne E Kavanagh
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England
| | - Andrew P Hearn
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Gráinne d'Ancona
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Abdel Douiri
- Department of Medical Statistics, King's College London, London, England
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England
| | - Brian D Kent
- Department of Respiratory Medicine, St. James' Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, England; Asthma UK Centre, King's College London, London, England.
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Bergantini L, d'Alessandro M, Cameli P, Bianchi F, Sestini P, Bargagli E, Refini RM. Personalized Approach of Severe Eosinophilic Asthma Patients Treated with Mepolizumab and Benralizumab. Int Arch Allergy Immunol 2020; 181:746-753. [PMID: 32731216 DOI: 10.1159/000508936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND New anti-IL-5 antibodies, mepolizumab and benralizumab, have recently been approved for severe asthma, sharing the same inclusion criteria. OBJECTIVE To contribute on biomarkers research leading to the personalized choice, we investigated L-selectin, Krebs von den Lungen (KL-6), and lymphocyte subsets as bioindicators of airway hyper-responsiveness and remodeling. MATERIALS AND METHODS A cohort of 28 patients affected by severe eosinophilic asthma were treated with anti-IL-5 drugs. According to clinical parameters, patients were subdivided into early and partial responders. Lymphocytes subsets were analyzed through flow cytometry, while KL-6 and sL-selectin were analyzed on serum samples. Clinical, functional, and immunological data at baseline (T0), after 1 month (T1), and 6 months of therapy were collected in a database. RESULTS All treated patients showed an increase in the percentage of forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity ratio and a decrease of peripheral eosinophils for both drugs after 1 month of treatment. Mepolizumab-treated patients also showed decreased CD8+ and NKT-like cell percentages and a significant increase in sL-selectin concentrations between T0 and T1. Stratifying the cohort of our patients in early and partial responders at T0, they showed a reduction of peripheral eosinophils, sL-selectin and KL-6, while no differences were found at T0 between early and partial responders patients treated with benralizumab. CONCLUSIONS This real-life study provides new insights for the personalized approach to severe asthma therapy. Although preliminary, the results indicate that besides eosinophils, KL-6 and sL-selectin are useful as biomarkers of early response that can also involve in the pathogenesis of severe asthma.
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Affiliation(s)
- Laura Bergantini
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy,
| | - Miriana d'Alessandro
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Paolo Cameli
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Francesco Bianchi
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Piersante Sestini
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Elena Bargagli
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Rosa Metella Refini
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
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