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Thomas D, McDonald VM, Stevens S, Harvey ES, Baraket M, Bardin P, Bowden JJ, Bowler S, Chien J, Chung LP, Gillman A, Hew M, Hodge S, James A, Jenkins C, Katelaris CH, Katsoulotos GP, Langton D, Lee J, Marks G, Peters M, Radhakrishna N, Reynolds PN, Rimmer J, Sivakumaran P, Upham JW, Wark P, Yang IA, Gibson PG. Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients. Allergy 2024; 79:384-392. [PMID: 37632144 DOI: 10.1111/all.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission. METHODS This observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real-world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5-item Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post-bronchodilator FEV1 ≥80%) or stabilization (post-bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut-offs of ACQ-5/FEV1 scores. The predictors of clinical remission were identified. RESULTS 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission. CONCLUSION Biologic treatment with mepolizumab or omalizumab for severe asthma-induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.
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Affiliation(s)
- Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sean Stevens
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
| | - Erin S Harvey
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Melissa Baraket
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Philip Bardin
- Lung and Sleep Medicine, Monash University and Medical Centre and Hudson Institute, Clayton, Victoria, Australia
| | - Jeffrey J Bowden
- Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | - Simon Bowler
- Department of Respiratory Medicine, Mater Hospital, Brisbane, Queensland, Australia
| | - Jimmy Chien
- Department of Sleep and Respiratory Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Andrew Gillman
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Hodge
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Alan James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medcial School, The University of Western Australia, Perth, Western Australia, Australia
| | - Christine Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
- Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Constance H Katelaris
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Gregory P Katsoulotos
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- The University of Notre Dame, Sydney, Western Australia, Australia
- St George Specialist Centre, Kogarah, New South Wales, Australia
- St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia
| | - Joy Lee
- Austin Health, Melbourne, Victoria, Australia
| | - Guy Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
| | | | - Paul N Reynolds
- Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Pathmanathan Sivakumaran
- Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Wark
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Pérez de Llano L, Urrutia I, G Cosío B, Gullón-Blanco JA, Habernau Mena A, Cisneros C, Martínez-Moragón E, Marina Malanda N, Muñoz Esquerre M, Quirce S, Dacal Rivas D. Impact of comorbidities on the achievement of specific therapeutic goals in biologic-treated asthma patients. Allergy 2024. [PMID: 38180244 DOI: 10.1111/all.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/03/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Affiliation(s)
| | - Isabel Urrutia
- Pneumology Service, Galdakao-Usansolo University Hospital, Galdakao, Spain
| | - Borja G Cosío
- Pneumology Service, Son Espases University Hospital, IdISBa-Ciberes, Palma de Mallorca, Spain
| | | | - Alicia Habernau Mena
- Allergy Section, Internal Medicine Service, Complejo Hospitalario de Mérida, Badajoz, Spain
| | | | | | | | - Mariana Muñoz Esquerre
- Pneumology Service, Bellvitge University Hospital, IBIDELL, Barcelona University, Barcelona, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain
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