1
|
Soong W, Chipps BE, O'Quinn S, Trevor J, Carr WW, Belton L, Trudo F, Ambrose CS. Health-Related Quality of Life and Productivity Among US Patients with Severe Asthma. J Asthma Allergy 2021; 14:713-725. [PMID: 34211280 PMCID: PMC8240863 DOI: 10.2147/jaa.s305513] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/09/2021] [Indexed: 01/01/2023] Open
Abstract
Background Health-related quality of life (HRQoL) and productivity of patients with confirmed severe asthma (SA) have not been well characterized in large, real-world populations. Purpose To characterize SA impact on HRQoL, work productivity, and activity impairment in a large, real-world cohort in the United States (US). Methods CHRONICLE is an observational study of specialist-treated adults (≥18 years) in the US with SA receiving biologics or maintenance systemic corticosteroids (mSCS), or those persistently uncontrolled by high-dosage inhaled corticosteroids with additional controllers (HD ICS+). At enrollment, patients completed the St. George’s Respiratory Questionnaire (SGRQ) and Work Productivity and Activity Impairment (WPAI) questionnaire. Results were analyzed for those enrolled between February 2018 and February 2020. Results Among patients who completed enrollment questionnaires (n = 1109), mean age was 54 years and most were women (70%). Among SGRQ respondents (n = 960), mean (SD) total score was 43 (23); 51% reported good/very good health. Among WPAI respondents (n = 1057; 566 employed), mean (SD) overall work impairment was 21% (25). Patients receiving biologics (vs mSCS, HD ICS+ only) had better SGRQ total scores (38 vs 59, 48) and lower work impairment (17% vs 34%, 27%). Patients with better SGRQ activity scores relative to symptom scores had better SGRQ impacts scores, total scores, and reported better overall health. Conclusion SA significantly affects HRQoL, work productivity, and activity. The SGRQ is a valuable research instrument for evaluating HRQoL in SA. Due to its association with HRQoL and overall health, activity impairment should be a focus when monitoring patients’ disease control. Study Registration ClinicalTrials.gov Identifier: NCT03373045.
Collapse
Affiliation(s)
- Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, AL, USA
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
| | - Sean O'Quinn
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | | | - Warner W Carr
- Allergy & Asthma Associates of Southern California, Mission Viejo, CA, USA
| | | | - Frank Trudo
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | | |
Collapse
|
2
|
Pavord ID, Menzies-Gow A, Buhl R, Chanez P, Dransfield M, Lugogo N, Keene ON, Bradford ES, Yancey SW. Clinical Development of Mepolizumab for the Treatment of Severe Eosinophilic Asthma: On the Path to Personalized Medicine. J Allergy Clin Immunol Pract 2020; 9:1121-1132.e7. [PMID: 32889223 DOI: 10.1016/j.jaip.2020.08.039] [Citation(s) in RCA: 8] [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: 04/15/2020] [Revised: 07/15/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022]
Abstract
The development of mepolizumab, an anti-IL-5 monoclonal antibody for the treatment of severe eosinophilic asthma, is an example of a clinical development program that evolved over time based on sound, basic scientific principles. Initial clinical data on the effects of mepolizumab on lung function in a general asthmatic population were disappointing. However, it became clear that mepolizumab may be more effective against other clinical endpoints, particularly asthma exacerbations, in patients with more severe disease. Furthermore, a developing understanding of asthma disease pathobiology led to the identification of an appropriate target population and predictive biomarker for mepolizumab treatment: patients with severe eosinophilic asthma and blood eosinophil count. Mepolizumab use provides clinically meaningful benefits in this target population, fulfilling an unmet need. This Clinical Commentary Review describes the clinical development of mepolizumab and details of how this program informed the development of other biologic therapies in patients with severe asthma. This account highlights how a personalized approach toward treatment of patients with severe eosinophilic asthma, supported by a large body of scientific evidence, ultimately led to new and effective treatments and improved patient outcomes.
Collapse
Affiliation(s)
- Ian D Pavord
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, United Kingdom
| | | | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Pascal Chanez
- Aix-Marseille Université, INSERM CV2N, APHM CIC NORD, Marseille, France
| | - Mark Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - Njira Lugogo
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Oliver N Keene
- Biostatistics, GSK, Stockley Park, Uxbridge, Middlesex, United Kingdom
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Steve W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC.
| |
Collapse
|
3
|
Kotanen P, Kainu A, Brander P, Bergman P, Lehtomäki A, Kreivi HR. Validation of the Finnish severe respiratory insufficiency questionnaire. Clin Respir J 2020; 14:659-666. [PMID: 32155684 DOI: 10.1111/crj.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic respiratory insufficiency impacts patients' lives and reduces quality of life. The Severe Respiratory Insufficiency (SRI) questionnaire examines health-related quality of life and is designed specifically for patients receiving home mechanical ventilation (HMV) for chronic respiratory failure (CRF). OBJECTIVES The aim of this study was to validate the Finnish version of the SRI and study its reproducibility in patients with CRF. METHODS Our 74 patients receiving HMV or long-term oxygen treatment for CRF or both completed the SRI and St George's Respiratory questionnaires (SGRQ) three times (at baseline, and then one week and one month later). Reliability and validity of the questionnaires was analysed with Cronbach's alpha and intraclass correlation coefficient. Patients were prospectively followed up for 5 years, with data collected on their use of hospital services and mortality. RESULTS Cronbach's alpha in the SRI ranged from 0.67 to 0.88 and was >0.7 on all subscales except the "attendant symptoms and sleep". On four subscales, Cronbach's alpha was >0.8, and on the summary scale, 0.95. The SRI showed high correlation with SGRQ. Both tests showed good reproducibility. During the 5-year follow-up, 27 (36%) patients died. CONCLUSIONS The Finnish SRI proved valid, reliable and reproducible. Its psychometric properties were good and similar to those of the original questionnaire and of other validation studies.
Collapse
Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Annette Kainu
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.,Terveystalo Healthcare, Digital Health, Helsinki, Finland
| | - Pirkko Brander
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Bergman
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Lehtomäki
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
4
|
Crossman-Barnes CJ, Sach T, Wilson A, Barton G. The construct validity and responsiveness of the EQ-5D-5L, AQL-5D and a bespoke TTO in acute asthmatics. Qual Life Res 2020; 29:619-627. [PMID: 31676971 PMCID: PMC7028833 DOI: 10.1007/s11136-019-02345-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Measuring quality of life in acute asthmatics is challenging, especially when asthma attacks can occur sporadically. Several questionnaires can be used to measure quality of life in this patient group; however, psychometric testing is limited on questionnaires that can be used to estimate Quality Adjusted Life years. The objective of this study is to assess the construct validity (convergent and discriminative validity) and responsiveness of the EuroQol-5-Dimensions 5-Level (EQ-5D-5L), Asthma Quality of Life Utility Index-5 Dimensions (AQL-5D) and Time Trade-Off (TTO) in acute asthma patients. METHODS Data from a prospective cohort study were used to test the validity and responsiveness of the EQ-5D-5L, AQL-5D and TTO in asthma patients who were recruited from UK accident & emergency departments or hospital wards. The spearman's rank correlation coefficient, the Kruskal-Wallis test statistic and the standardized response mean were used to test for convergent validity, discriminative validity and responsiveness, respectively. RESULTS One hundred and twenty-one participants were included in the available case analysis. The EQ-5D-5L and AQL-5D showed moderate to strong correlations for convergent validity at baseline, week 4 and week 8. The AQL-5D and TTO showed moderate correlations at week 4 and week 8. No statistical significance was observed for discriminative validity at baseline. Both the EQ-5D-5L and the AQL-5D also showed that they were sensitive to change for the recovery responses. CONCLUSIONS The EQ-5D-5L and AQL-5D showed stronger construct validity and responsiveness compared to the TTO. Therefore, both the EQ-5D-5L and AQL-5D should be considered for use in future economic evaluations.
Collapse
Affiliation(s)
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
5
|
Nelsen LM, Cockle SM, Gunsoy NB, Jones P, Albers FC, Bradford ES, Mullerova H. Impact of exacerbations on St George's Respiratory Questionnaire score in patients with severe asthma: post hoc analyses of two clinical trials and an observational study. J Asthma 2019; 57:1006-1016. [PMID: 31251094 DOI: 10.1080/02770903.2019.1630640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the effect of asthma exacerbations and mepolizumab treatment on health status of patients with severe asthma using the St George's Respiratory Questionnaire (SGRQ).Methods: Post hoc analyses were conducted using data from two randomized controlled trials in patients ≥12 years old with severe eosinophilic asthma randomized to receive placebo or mepolizumab 75 mg intravenously (32-week MENSA study) or 100 mg subcutaneously (MENSA/24-week MUSCA studies), and an observational single-visit study in patients with severe asthma (IDEAL). Linear regression models assessed the impact of historical exacerbations on baseline SGRQ total and domain scores (using data from each of the three studies), and within-study severe exacerbations and mepolizumab treatment on end-of-study SGRQ scores (using data from MENSA/MUSCA).Results: Overall, 1755 patients were included (MENSA, N = 540; MUSCA, N = 551; IDEAL, N = 664). In all studies, higher numbers of historical exacerbations were associated with worse baseline SGRQ total scores. Each additional historical exacerbation (beyond the second [MENSA/MUSCA]) or first [IDEAL] was associated with worsening mean total SGRQ scores of +1.5, +1.1 at baseline and +2.3 within the year prior to study enrollment. During MENSA and MUSCA, each within-study severe exacerbation was associated with a worsening in total SGRQ score of +2.4 and +3.4 points at study end. Independent of exacerbation reduction, mepolizumab accounted for an improvement in total SGRQ score of -5.3 points (MENSA) and -6.2 points (MUSCA).Conclusions: These findings support an association between a higher number of exacerbations and worse health status in patients with severe (eosinophilic) asthma.
Collapse
Affiliation(s)
- Linda M Nelsen
- Patient Centered Outcomes, Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | | | - Paul Jones
- Respiratory Medical, GSK House, Brentford, UK
| | - Frank C Albers
- Respiratory Medical Franchise, GSK SK, Research Triangle Park, NC, USA
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Hana Mullerova
- Real World Evidence and Epidemiology, GSK, Stockley Park, Uxbridge, UK
| |
Collapse
|
6
|
Bellocq A, Gaspard W, Couffignal C, Vigan M, Guerder A, Ambard J, Caruana S, Similowski T, Garcia G, Taillé C. Outpatient pulmonary rehabilitation for severe asthma with fixed airway obstruction: Comparison with COPD. J Asthma 2019; 56:1325-1333. [PMID: 30693816 DOI: 10.1080/02770903.2018.1541351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: The benefit of exercise has been demonstrated in asthma, but the role of pulmonary rehabilitation (PR) in people with severe asthma, especially with airway obstruction, has been less investigated. The activity limitation mechanisms differ in asthma and COPD, so the effect of a PR program not specific to asthma is unclear. Methods: We retrospectively compared the effect of an ambulatory PR program in nonsmoking patients with severe asthma and airway obstruction (FEV1/FVC ratio <70% and FEV1 < 80% measured twice, not under an exacerbation) and sex-, age-, FEV1-, and BMI-matched COPD controls. Results: We included 29 patients, each with asthma and COPD. Airway obstruction was moderate (median FEV1 57% [44-64]). VO2 at peak was higher for asthma than COPD patients (19.0 [15.7-22.2] vs 16.1 [15.3-19.6] ml.min-1.kg-1, p = 0.05). After PR, asthma and COPD groups showed a significant and similar increase in constant work cycling test of 378 [114-831] s and 377 [246-702] s. Changes in Hospital Anxiety and Depression Scale (HAD) total score were similar (-2.5 [-7.0 to 0.0] vs -2.0 [-5.0 to 2.0], p > 0.05). Quality of life on the St. George's Respiratory Questionnaire (SGRQ) was significantly improved in both groups (-14.0 [-17.7 to -2.0], p < 0.005 and -8.3 [-13.0 to -3.6], p < 0.0001). Conclusion: Outpatient PR is feasible and well tolerated in patients with severe asthma with fixed airway obstruction. A nondedicated program strongly improves HAD and SGRQ scores and constant work-rate sub-maximal cycling, with similar amplitude as with COPD.
Collapse
Affiliation(s)
- Agnès Bellocq
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département R3S, Paris, France.,Sorbonne Université, INSERM, UMRS1158, Paris, France
| | - Wanda Gaspard
- Service des Maladies Respiratoires, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Couffignal
- Assistance Publique-Hôpitaux de Paris, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, Paris, France
| | - Marie Vigan
- Assistance Publique-Hôpitaux de Paris, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, Paris, France
| | - Antoine Guerder
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et de Réanimation Médicale du Département R3S, Paris, France
| | - Julien Ambard
- Réseau Recup'Air, Agence Régionale de Santé Ile de France, Paris, France
| | - Sylvie Caruana
- Réseau Recup'Air, Agence Régionale de Santé Ile de France, Paris, France
| | - Thomas Similowski
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et de Réanimation Médicale du Département R3S, Paris, France
| | - Gilles Garcia
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service de Pneumologie, Le Kremlin-Bicetre, France
| | - Camille Taillé
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Service de Pneumologie, INSERM UMR1152, Université Paris Diderot, Labex Inflamex, Paris, France
| |
Collapse
|