1
|
Uses of biologics in allergic diseases: What to choose and when. Ann Allergy Asthma Immunol 2018; 120:357-366. [PMID: 29499367 DOI: 10.1016/j.anai.2018.02.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 01/09/2023]
|
2
|
Abstract
INTRODUCTION The classification of asthma into phenotypes and endotoypes allows for the use of targeted therapies, including three biologics which target interleukin 5 (IL-5) signaling in eosinophilic asthma. Areas covered: As of December 2016, two monoclonal antibodies, mepolizumab and reslizumab, are approved by U.S. Food and Drug Administration and one, benralizumab, is in clinical development. Two phase 3 trials for benralizumab, SIROCCO and CALIMA, were published in September 2016. Although there are no direct comparisons among these three anti-IL-5 therapies, the goal of this review is to summarize the current data and discuss their potential similarities and differences, with a focus on benralizumab. Expert commentary: Compared to mepolizumab and reslizumab, the possible advantages of benralizumab are less frequent dosing and a potential to reduce exacerbations irrespective of the blood eosinophil count. Some improvements in asthma symptom scores and quality of life occur with all three biologics, but the clinical meaningfulness of these improvements is less clear. A more defined reference range for eosinophil levels is necessary to determine which subjects will best benefit from these medications. Until quality randomized controlled trials directly compare the three, choosing among them for the treatment of eosinophilic asthma remains difficult.
Collapse
Affiliation(s)
- Tara Vinyette Saco
- a Division of Allergy and Immunology, Department of Internal Medicine , University of South Florida Morsani College of Medicine and James A. Haley Veterans Affairs Medical Center , Tampa , FL , USA
| | - Amber N Pepper
- a Division of Allergy and Immunology, Department of Internal Medicine , University of South Florida Morsani College of Medicine and James A. Haley Veterans Affairs Medical Center , Tampa , FL , USA
| | - Richard F Lockey
- a Division of Allergy and Immunology, Department of Internal Medicine , University of South Florida Morsani College of Medicine and James A. Haley Veterans Affairs Medical Center , Tampa , FL , USA
| |
Collapse
|
3
|
Lam K, Kern RC, Luong A. Is there a future for biologics in the management of chronic rhinosinusitis? Int Forum Allergy Rhinol 2016; 6:935-42. [PMID: 27103607 PMCID: PMC5012929 DOI: 10.1002/alr.21780] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/22/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory condition of the sinonasal mucosa consisting of poorly defined subtypes and characterized by variable clinical manifestations, responses to therapy, and underlying pathophysiologies. In the related disorder of asthma, progress has been made in defining disease subtypes on both clinical and pathophysiologic levels, facilitating the development of targeted biologic pharmacotherapy. The potential role of these drugs for the management of CRS will be reviewed. The objective of this work is to highlight the emerging therapeutic targets in CRS in light of evolving treatment options for asthma and enhanced understandings of the clinical manifestations and pathophysiology of CRS. METHODS This article is a review of recent studies regarding current and future advances in biomarker-directed therapies in the medical treatment of CRS. RESULTS Various biologic therapies used in the management of asthma have demonstrated clinical promise for CRS, particularly within the CRS with nasal polyposis (CRSwNP) phenotype. Several randomized, double-blind, placebo-controlled studies increasingly support the targeting of immunoglobulin E (IgE) and interleukin (IL)-5 pathways to improve outcome measures in CRSwNP patients. The IL-4/IL-13 pathway and other type 2 inflammatory pathways have also shown potential as targets for CRSwNP, but all pathways require further investigation. CONCLUSION Recalcitrant CRS in the United States and Europe is most commonly associated with nasal polyposis and a type 2 cytokine skewing in the tissue, resulting in tissue infiltration of eosinophils, mast cells, and basophils. Targeting biomarkers of the associated type 2 pathways may be a practical treatment option for recalcitrant CRSwNP in the future.
Collapse
Affiliation(s)
- Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at, The University of Texas Health Science Center at Houston, Houston, TX
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amber Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at, The University of Texas Health Science Center at Houston, Houston, TX.
| |
Collapse
|
4
|
Menzella F, Lusuardi M, Galeone C, Taddei S, Facciolongo N, Zucchi L. Mepolizumab for severe refractory eosinophilic asthma: evidence to date and clinical potential. Ther Adv Chronic Dis 2016; 7:260-277. [PMID: 27803792 DOI: 10.1177/2040622316659863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe asthma is characterized by major impairment of quality of life, poor symptom control and frequent exacerbations. Inflammatory, clinical and causative factors identify different phenotypes and endotypes of asthma. In the last few years, new treatment options have allowed for targeted treatments according to the different phenotypes of the disease. To accurately select a specific treatment for each asthmatic variant, the identification of appropriate biomarkers is required. Eosinophilic asthma is a distinct phenotype characterized by thickening of the basement membrane and corticosteroid responsiveness. This review reports the latest evidence on an anti-IL-5 monoclonal antibody, mepolizumab, a new and promising biological agent recently approved by the FDA specifically for the treatment of severe eosinophilic refractory asthma.
Collapse
Affiliation(s)
- Francesco Menzella
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Mirco Lusuardi
- Unit of Respiratory Rehabilitation, AUSL Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Carla Galeone
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Sofia Taddei
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| | - Luigi Zucchi
- Department of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 56, 42123 Reggio Emilia, Italy
| |
Collapse
|
5
|
Autofluorescence multiphoton microscopy for visualization of tissue morphology and cellular dynamics in murine and human airways. J Transl Med 2016; 96:918-31. [PMID: 27400364 PMCID: PMC4972900 DOI: 10.1038/labinvest.2016.69] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/07/2023] Open
Abstract
The basic understanding of inflammatory airway diseases greatly benefits from imaging the cellular dynamics of immune cells. Current imaging approaches focus on labeling specific cells to follow their dynamics but fail to visualize the surrounding tissue. To overcome this problem, we evaluated autofluorescence multiphoton microscopy for following the motion and interaction of cells in the airways in the context of tissue morphology. Freshly isolated murine tracheae from healthy mice and mice with experimental allergic airway inflammation were examined by autofluorescence multiphoton microscopy. In addition, fluorescently labeled ovalbumin and fluorophore-labeled antibodies were applied to visualize antigen uptake and to identify specific cell populations, respectively. The trachea in living mice was imaged to verify that the ex vivo preparation reflects the in vivo situation. Autofluorescence multiphoton microscopy was also tested to examine human tissue from patients in short-term tissue culture. Using autofluorescence, the epithelium, underlying cells, and fibers of the connective tissue, as well as blood vessels, were identified in isolated tracheae. Similar structures were visualized in living mice and in the human airway tissue. In explanted murine airways, mobile cells were localized within the tissue and we could follow their migration, interactions between individual cells, and their phagocytic activity. During allergic airway inflammation, increased number of eosinophil and neutrophil granulocytes were detected that moved within the connective tissue and immediately below the epithelium without damaging the epithelial cells or connective tissues. Contacts between granulocytes were transient lasting 3 min on average. Unexpectedly, prolonged interactions between granulocytes and antigen-uptaking cells were observed lasting for an average of 13 min. Our results indicate that autofluorescence-based imaging can detect previously unknown immune cell interactions in the airways. The method also holds the potential to be used during diagnostic procedures in humans if integrated into a bronchoscope.
Collapse
|
6
|
Huang T, Hazen M, Shang Y, Zhou M, Wu X, Yan D, Lin Z, Solon M, Luis E, Ngu H, Shi Y, Katewa A, Choy DF, Ramamoorthi N, Castellanos ER, Balazs M, Xu M, Lee WP, Matsumoto ML, Payandeh J, Arron JR, Hongo JA, Wang J, Hötzel I, Austin CD, Reif K. Depletion of major pathogenic cells in asthma by targeting CRTh2. JCI Insight 2016; 1:e86689. [PMID: 27699264 DOI: 10.1172/jci.insight.86689] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Eosinophilic inflammation and Th2 cytokine production are central to the pathogenesis of asthma. Agents that target either eosinophils or single Th2 cytokines have shown benefits in subsets of biomarker-positive patients. More broadly effective treatment or disease-modifying effects may be achieved by eliminating more than one inflammatory stimulator. Here we present a strategy to concomitantly deplete Th2 T cells, eosinophils, basophils, and type-2 innate lymphoid cells (ILC2s) by generating monoclonal antibodies with enhanced effector function (19A2) that target CRTh2 present on all 4 cell types. Using human CRTh2 (hCRTh2) transgenic mice that mimic the expression pattern of hCRTh2 on innate immune cells but not Th2 cells, we demonstrate that anti-hCRTh2 antibodies specifically eliminate hCRTh2+ basophils, eosinophils, and ILC2s from lung and lymphoid organs in models of asthma and Nippostrongylus brasiliensis infection. Innate cell depletion was accompanied by a decrease of several Th2 cytokines and chemokines. hCRTh2-specific antibodies were also active on human Th2 cells in vivo in a human Th2-PBMC-SCID mouse model. We developed humanized hCRTh2-specific antibodies that potently induce antibody-dependent cell cytotoxicity (ADCC) of primary human eosinophils and basophils and replicated the in vivo depletion capacity of their murine parent. Therefore, depletion of hCRTh2+ basophils, eosinophils, ILC2, and Th2 cells with h19A2 hCRTh2-specific antibodies may be a novel and more efficacious treatment for asthma.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jian Payandeh
- Department of Protein Engineering, Genentech Inc., South San Francisco, California, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Scichilone N, Ventura MT, Bonini M, Braido F, Bucca C, Caminati M, Del Giacco S, Heffler E, Lombardi C, Matucci A, Milanese M, Paganelli R, Passalacqua G, Patella V, Ridolo E, Rolla G, Rossi O, Schiavino D, Senna G, Steinhilber G, Vultaggio A, Canonica G. Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly. Clin Mol Allergy 2015; 13:7. [PMID: 26101468 PMCID: PMC4476207 DOI: 10.1186/s12948-015-0016-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/26/2015] [Indexed: 12/22/2022] Open
Abstract
The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of "rare" disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range. The older asthmatic patients are also characterized the coexistence of comorbid conditions that, in conjunction with age-associated structural and functional changes of the lung, may contribute to complicate the management of asthma. The current review addresses the main issues related to the management of allergic asthma in the geriatric age. In particular, the paper aims at revising current pharmacological and non pharmacological treatments for allergic asthmatics of advanced ages, primarily focusing on their safety and efficacy, although most behaviors are an arbitrary extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. Experimental studies and real life observations specifically testing the efficacy and safety of therapeutic approaches in allergic asthma in the elderly are urgently needed.
Collapse
Affiliation(s)
- Nicola Scichilone
- />Department of Medicine, University of Palermo, via Trabucco 180, 90146 Palermo, Italy
| | - Maria T Ventura
- />Interdisciplinary Department of Medicine, Unit of Geriatric Immunoallergology, University of Bari, Bari, Italy
| | - Matteo Bonini
- />Lung Function Unit, Department of Public Health and Infectious Diseases “Sapienza”, University of Rome, Rome, Italy
| | - Fulvio Braido
- />Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Caterina Bucca
- />Pneumology Unit, Department of Medical Sciences, University of Turin, AOU San Giovanni Battista, Torino, Italy
| | - Marco Caminati
- />Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Stefano Del Giacco
- />Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy
| | - Enrico Heffler
- />Department of Clinical and Experimental Medicine - Respiratory Medicine & Allergy, University of Catania, Catania, Italy
| | - Carlo Lombardi
- />Departmental Unit of Allergology-Clinical Immunology & Pneumology, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Matucci
- />Centre of Excellence DENOTHE, Dept. of Experimental and Clinical Medicine, Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Manlio Milanese
- />Struttura Complessa di Pneumologia, ASL2 Savonese, Savona, Italy
| | - Roberto Paganelli
- />Laboratory of Immunology and Allergy, Department of Medicine and Sciences of Aging, University of G. d’Annunzio, Chieti Scalo, Italy
| | - Giovanni Passalacqua
- />Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Vincenzo Patella
- />Division of Allergy and Clinical Immunology, ASL SALERNO, Hospital of Battipaglia, 84100 Salerno, Italy
| | - Erminia Ridolo
- />Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Giovanni Rolla
- />Allergologia e Immunologia Clinica, AO Ordine Mauriziano & University of Torino, Torino, Italy
| | - Oliviero Rossi
- />Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico Schiavino
- />Università Cattolica del Sacro Cuore, Policlinico A.Gemelli, Rome, Italy
| | - Gianenrico Senna
- />Allergy Unit, Verona University and General Hospital, Verona, Italy
| | | | - Alessandra Vultaggio
- />Centre of Excellence DENOTHE, Dept. of Experimental and Clinical Medicine, Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giorgio Canonica
- />Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| |
Collapse
|
8
|
Polosa R, Bellinvia S, Caruso M, Emma R, Alamo A, Kowalski ML, Domingo C. Weekly low-dose methotrexate for reduction of Global Initiative for Asthma Step 5 treatment in severe refractory asthma: study protocol for a randomized controlled trial. Trials 2014; 15:492. [PMID: 25523634 PMCID: PMC4302097 DOI: 10.1186/1745-6215-15-492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic severe asthma (CSA) have a crippling disease and current available treatments are not satisfactory. Thus, management of CSA remains a major unmet need. Although the evidence from existing randomized controlled trials fails to support a definite role for immunomodulatory drugs in these patients due to major methodologic drawbacks, findings with low-dose methotrexate (MTX) are encouraging. However, larger and well-designed clinical trials are required to establish the beneficial role of MTX in CSA, and for the detection of the key characteristics of those who are going to respond to this drug. METHODS/DESIGN Patients will be recruited from the accessible asthmatic patients lists of tertiary referral centers. All patients will meet the stringent diagnostic criteria for CSA, including the requirement for the regular use of Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention Step 5 medications (oral prednisone and/or omalizumab). The experimental design of the proposed study will take the form of a double-blind parallel-randomized placebo-controlled trial consisting of a total of eight visits, including run-in and run-out periods. Patients will be randomly allocated to receive either MTX or a matched placebo once a week as an add-on therapy to their existing medication after run-in. Physiological, laboratory and clinical assessments will be measured regularly throughout the study and compared with baseline assessments. DISCUSSION We expect that MTX will reduce Step 5 medications dosage in patients with CSA without compromising the overall disease control. Improvement in several indicators of asthma severity and control will be also investigated. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02124226 (assigned 25 April 2014).
Collapse
Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Biomolecular Medicine, University of Catania, Ospedale Garibaldi Nesima, 636 Via Palermo, 95122 Catania, Italy.
| | | | | | | | | | | | | |
Collapse
|
9
|
Quirce S, Bobolea I, Domínguez-Ortega J, Barranco P. Future biologic therapies in asthma. Arch Bronconeumol 2014; 50:355-61. [PMID: 24685200 DOI: 10.1016/j.arbres.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 01/28/2023]
Abstract
Despite the administration of appropriate treatment, a high number of patients with asthma remain uncontrolled. This suggests the need for alternative treatments that are effective, safe and selective for the established asthma phenotypes, especially in patients with uncontrolled severe asthma. The most promising options among the new asthma treatments in development are biological therapies, particularly those monoclonal antibodies directed at selective targets. It should be noted that the different drugs, and especially the new biologics, act on very specific pathogenic pathways. Therefore, determination of the individual profile of predominant pathophysiological alterations of each patient will be increasingly important for prescribing the most appropriate treatment in each case. The treatment of severe allergic asthma with anti-IgE monoclonal antibody (omalizumab) has been shown to be effective in a large number of patients, and new anti-IgE antibodies with improved pharmacodynamic properties are being investigated. Among developing therapies, biologics designed to block certain pro-inflammatory cytokines, such as IL-5 (mepolizumab) and IL-13 (lebrikizumab), have a greater chance of being used in the clinic. Perhaps blocking more than one cytokine pathway (such as IL-4 and IL-13 with dulipumab) might confer increased efficacy of treatment, along with acceptable safety. Stratification of asthma based on the predominant pathogenic mechanisms of each patient (phenoendotypes) is slowly, but probably irreversibly, emerging as a tailored medical approach to asthma, and is becoming a key factor in the development of drugs for this complex respiratory syndrome.
Collapse
Affiliation(s)
- Santiago Quirce
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
| | - Irina Bobolea
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Pilar Barranco
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| |
Collapse
|