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Current Limitations and Recent Advances in the Management of Asthma. Dis Mon 2022:101483. [DOI: 10.1016/j.disamonth.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tortajada-Girbés M, Bousquet R, Bosque M, Carrera Martínez JJ, Ibáñez MD, Moreira A, Nieto A, Plaza AM, Rivas C, Requena G, Sánchez-Solis M, Tabar A, Torres-Borrego J, Zapatero L. Efficacy and effectiveness of omalizumab in the treatment of childhood asthma. Expert Rev Respir Med 2018; 12:745-754. [PMID: 30141696 DOI: 10.1080/17476348.2018.1507740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E, a mediator involved in the clinical manifestations of allergic asthma. Evidence for its efficacy and safety in the treatment of moderate-to-severe allergic asthma is based primarily on studies in adolescents and adults. However, there is increasing evidence of its utility in children with allergic asthma aged 6-12 years. Areas covered: This article reviews efficacy, safety, and effectiveness of omalizumab in the treatment of moderate-to-severe allergic asthma in children aged 6-12 years in clinical trials and in studies in clinical practice. Pharmacoeconomic aspects of its use among this population and the positioning of omalizumab in pediatric asthma management guidelines are also discussed. Additionally, an algorithm for the management of poorly controlled severe pediatric asthma in children older than 6 years is proposed. Electronic databases, such as PubMed, were searched for terms Asthma and Omalizumab and for asthma management guidelines. Expert commentary: Add-on omalizumab is an effective maintenance therapy in children aged 6-12 years with poorly controlled moderate-to-severe allergic asthma treated with medium-high inhaled corticosteroids doses and inhaled long-acting β2-agonists. Omalizumab appears safe in children in both clinical trials and real-life setting and may be cost-effective.
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Affiliation(s)
- Miguel Tortajada-Girbés
- a Department of Pediatrics, Obstetrics and Gynecology , University of Valencia , Valencia , Spain.,b Pediatric Pulmonology and Allergy Unit , Dr. Peset University Hospital , Valencia , Spain
| | - Rosa Bousquet
- c Pediatric Pulmonology and Allergy Unit, Pediatric Service , Hospital del Mar , Barcelona , Spain
| | - Montserrat Bosque
- d Pediatric Allergy and Pulmonology Unit , Hospital Universitario Parc Taulí , Sabadell , Spain
| | | | | | - Ana Moreira
- g Medical Advisor Xolair-Asma, Novartis , Barcelona , Spain
| | - Antonio Nieto
- h Pediatric Pulmonology and Allergy Unit , Children's Hospital la Fe , Valencia , Spain
| | - Ana María Plaza
- i Allergy and Clinical Immunology Service , Hospital Sant Joan de Déu , Barcelona , Spain
| | - Cristina Rivas
- j Pediatric Service , Hospital de Sagunto , Valencia , Spain
| | - Gloria Requena
- k Allergy Department , Hospital Vithas-Xanit Internacional , Málaga , Spain
| | - Manuel Sánchez-Solis
- l Pediatric Pulmonology Unit, University Hospital Virgen de la Arrixaca , IMIB Bio-Health Research Institute , Murcia , Spain
| | - Ana Tabar
- m Allergology Service , Complejo Hospitalario de Navarra , Pamplona , Spain
| | - Javier Torres-Borrego
- n Pediatric Allergy and Pulmonology Unit , Children´s University Hospital Reina Sofía , Córdoba , Spain
| | - Lydia Zapatero
- o Pediatric Allergy Unit , Maternal and Child Hospital Gregorio Marañón , Madrid , Spain
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Hyland ME, Lanario JW, Pooler J, Masoli M, Jones RC. How patient participation was used to develop a questionnaire that is fit for purpose for assessing quality of life in severe asthma. Health Qual Life Outcomes 2018; 16:24. [PMID: 29374455 PMCID: PMC5787281 DOI: 10.1186/s12955-018-0851-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research shows that existing asthma quality of life questionnaires fail to measure the burden of oral corticosteroids that can be used to treat severe asthma, and are therefore not fit for purpose for severe asthma according to the USA's Federal Drug Authority's (FDA) criteria for content validity. Patient input and documentation of that input is key to achieving content validity according to FDA guidelines. This paper describes the process of constructing a new questionnaire to measure the burden of asthma symptoms and burden of treatment in severe asthma, using criteria specified by the FDA. METHODS A draft severe asthma questionnaire (SAQ) was constructed using qualitative input from severe asthma patients who took part in an earlier study. The aim of this study was to improve that draft questionnaire using a further group of patients. In four iterative focus groups, 16 people with severe asthma completed the draft questionnaire, discussed the wording and structure and suggested changes that were incorporated into the final version. RESULTS The original intention to ask patients to identify whether problems were caused by asthma symptoms or side effects of medication was abandoned as the attribution of cause was found to be difficult and inconsistent. The recall period of 2 weeks was acceptable but fails to reflect the patients' desire to express the variability of severe asthma. Patients suggested improvements to the wording of the draft questionnaire, including splitting some items in two, combining two items in one, and changes to some of the words in individual items and the response scale. CONCLUSIONS The final version of the questionnaire was substantially different from one constructed using only qualitative reports from patients about the quality of life deficits of severe asthma. Patients make a valuable contribution to the questionnaire if they are asked to comment and improve an initial draft and where patients are treated as partners in the process of questionnaire construction, rather than only as a source of information to experts who construct the questionnaire.
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Affiliation(s)
- Michael E Hyland
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
- Plymouth Hospital's NHS Trust, Plymouth, UK.
| | - Joseph W Lanario
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK
- Plymouth Hospital's NHS Trust, Plymouth, UK
| | - Jill Pooler
- Peninsula School of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | | | - Rupert C Jones
- Plymouth Hospital's NHS Trust, Plymouth, UK
- Peninsula School of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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Hew M, Gillman A, Sutherland M, Wark P, Bowden J, Guo M, Reddel HK, Jenkins C, Marks GB, Thien F, Rimmer J, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Wright C, Bint M, Yozghatlian V, Burgess S, Sivakumaran P, Yan KY, Kritikos V, Peters M, Baraket M, Aminazad A, Robinson P, Jaffe A, Powell H, Upham JW, McDonald VM, Gibson PG. Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria. Clin Exp Allergy 2016; 46:1407-1415. [PMID: 27377155 DOI: 10.1111/cea.12774] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR). OBJECTIVES To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. METHODS Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). RESULTS Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV1 ) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV1 . CONCLUSIONS AND CLINICAL RELEVANCE Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.
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Affiliation(s)
- M Hew
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia.
| | - A Gillman
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia
| | | | - P Wark
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J Bowden
- Flinders Medical Centre, Bedford Park, SA, Australia
| | - M Guo
- Woolcock Institute of Medical Research, Glebe, University of Sydney NSW, Australia
| | - H K Reddel
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C Jenkins
- Concord Hospital, Concord, NSW, Australia
| | - G B Marks
- Liverpool Hospital, Liverpool, NSW, Australia
| | - F Thien
- Box Hill Hospital, Box Hill, Vic., Australia
| | - J Rimmer
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | | | - M Cook
- Canberra Hospital, Woden, ACT, Australia
| | - I Yang
- The Prince Charles Hospital, Chermside, Qld, Australia
| | - C Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia
| | - S Bowler
- Mater Adult Hospital, South Brisbane, Qld, Australia
| | - D Langton
- Frankston Hospital, Frankston, Vic., Australia
| | - C Wright
- Nambour Hospital, Nambour, Qld, Australia
| | - M Bint
- Nambour Hospital, Nambour, Qld, Australia
| | | | - S Burgess
- QLD Children's Lung and Sleep Specialists, Woolloongabba, Qld, Australia
| | - P Sivakumaran
- Gold Coast District Hospital, Southport, Qld, Australia
| | - K Y Yan
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - V Kritikos
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - M Peters
- Concord Hospital, Concord, NSW, Australia
| | - M Baraket
- Liverpool Hospital, Liverpool, NSW, Australia
| | - A Aminazad
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - P Robinson
- Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A Jaffe
- School of Women's & Children's Health, UNSW Medicine, Randwick, NSW, Australia
| | - H Powell
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J W Upham
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - V M McDonald
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - P G Gibson
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
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Lommatzsch M, Stoll P. Novel strategies for the treatment of asthma. ALLERGO JOURNAL INTERNATIONAL 2016; 25:11-17. [PMID: 27069845 PMCID: PMC4792349 DOI: 10.1007/s40629-016-0093-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/15/2015] [Indexed: 12/16/2022]
Abstract
Novel treatment strategies are currently emerging for patients with inadequately controlled asthma despite good adherence and trigger avoidance. These strategies serve primarily to reduce or completely avoid long-term oral corticosteroid therapy. A number of these options have already been implemented in practice or will soon be authorized for the treatment of asthma, while others still need to prove their clinical practicability, safety and efficacy. The present article provides an overview of the broad spectrum of novel inhaled, oral, systemic, and invasive treatment strategies for asthma.
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Affiliation(s)
- Marek Lommatzsch
- />Department of Pneumology and Critcal Care Medicine, University of Rostock, Rostock, Germany
- />Department of Pneumology and Interdisciplinary, Internal Intensive Care Unit, Medical Clinic I, Center for Internal Medicine, Rostock University Hospital, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Paul Stoll
- />Department of Pneumology and Critcal Care Medicine, University of Rostock, Rostock, Germany
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Lommatzsch M, Stoll P. Neue Strategien in der Asthmatherapie. ALLERGO JOURNAL 2016. [DOI: 10.1007/s15007-016-1002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lommatzsch M, Virchow JC. Severe asthma: definition, diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:847-55. [PMID: 25585581 DOI: 10.3238/arztebl.2014.0847] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND A minority of patients with asthma have uncontrolled or partially controlled asthma despite intensive treatment. These patients present a special challenge because of the extensive diagnostic evaluation that they need, insufficient evidence regarding personalized treatments, and their high consumption of health-care resources. METHODS The definition, diagnosis, and treatment of severe asthma are presented on the basis of a selective literature review and the authors' clinical experience. RESULTS Severe asthma is present, by definition, when adequate control of asthma cannot be achieved by high-dose treatment with inhaled cortico - steroids and additional controllers (long-acting inhaled beta 2 agonists, montelukast, and/or theophylline) or by oral corticosteroid treatment (for at least six months per year), or is lost when the treatment is reduced. Before any further treatments are evaluated, differential diagnoses of asthma should be ruled out, comorbidities should be treated, persistent triggers should be eliminated, and patient adherence should be optimized. Moreover, pulmonary rehabilitation is recommended in order to stabilize asthma over the long term and reduce absences from school or work. The additional drugs that can be used include tiotropium, omalizumab (for IgE-mediated asthma), and azithromycin (for non-eosinophilic asthma). Antibodies against interleukin-5 or its receptor will probably be approved soon for the treatment of severe eosinophilic asthma. CONCLUSION The diagnosis and treatment of severe asthma is time consuming and requires special experience. There is a need for competent treatment centers, continuing medical education, and research on the prevalence of severe asthma.
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Affiliation(s)
- Marek Lommatzsch
- Department of Pneumology/Interdisciplinary Intensive Care Unit, University of Rostock
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Abstract
PURPOSE OF REVIEW There are a considerable number of patients with moderate-to-severe uncontrolled asthma needing additional therapy. Omalizumab, an anti-IgE monoclonal antibody, improves control while reducing IgE-mediated airway inflammation and potentially interfering in the progressive remodeling process. The clinical implications are reductions in the required doses of inhaled steroids, a decrease in exacerbation number, and a reduction in emergency room visits and hospitalizations. In addition to its use in asthma, there is an increasing interest on the use of omalizumab for other uncontrolled IgE-mediated diseases, supported by the favorable risk-benefit background. The present review explores the most recent publications on the use of omalizumab for allergic asthma and other atopic conditions in children. RECENT FINDINGS Omalizumab has also shown efficacy in allergic rhinitis, and it is being investigated in the treatment of anaphylaxis, food allergy, atopic dermatitis, and chronic spontaneous urticaria, as well as cystic fibrosis and allergic bronchopulmonary aspergillosis. Despite the benefits shown so far, more data are needed for optimal use in these conditions, particularly looking at the safety issues that have to be confirmed. SUMMARY Confirmatory evidence on the efficacy and safety of omalizumab in children is reviewed, as well as newest fields of applicability in which IgE is involved in disease mechanism.
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Berair R, Pavord ID. Rationale and clinical results of inhibiting interleukin-5 for the treatment of severe asthma. Curr Allergy Asthma Rep 2014; 13:469-76. [PMID: 23904099 DOI: 10.1007/s11882-013-0379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Severe asthma is responsible for considerable morbidity and a high proportion of the healthcare costs attributable to asthma. Management is not straightforward as the clinical, pathological and physiological features are heterogeneous and the relationships between these features are poorly understood. In recent years significant progress has been made in understanding this heterogeneity and eosinophilic asthma has emerged as a potentially clinically important phenotype because treatment with monoclonal antibodies against IL-5 is effective. This has required a change in our understanding of the role of eosinophilic airway inflammation in airways disease and the developments of reliable biomarkers of eosinophilic airway inflammation. We will review these developments and describe the clinical experience so far with treatment with monoclonal antibiotics against IL-5.
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Affiliation(s)
- Rachid Berair
- Department of Respiratory Medicine, Thoracic Surgery, and Allergy, Institute for Lung and Health, Glenfield Hospital, Leicester, LE3 9QP, UK
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Abstract
Asthma control remains a significant challenge in the pediatric age range in which ongoing loss of lung function in children with persistent asthma has been reported, despite the use of regular preventer therapy. This has important implications for observed mortality and morbidity during adulthood. Over the past decade, there has been an emergence of other treatment adjuncts, such as anti-Immunoglobulin E (IgE)-directed therapy, low dose theophylline, and the use of macrolide antibiotics, yet their exact role in asthma management remains unclear, despite omalizumab now being incorporated into several international asthma guidelines. As with many aspects of pediatric care, this is driven by a lack of appropriately designed pediatric trials. Extrapolation of data reported in adult studies may be appropriate for adolescent asthma, but is not for younger age groups, in which important pathophysiological differences exist. Novel drugs under development offer potential for benefit in the future, but to date existing data are in most cases limited to adults. Pediatric asthma also offers unique potential to prevent or modify the underlying pathophysiology. Although attempts to do so have been unsuccessful to date, advances may yet come from this approach, as our understanding about the interaction between genetics, environmental factors, and viral illness improve. This review provides an overview of the newer treatment options available for management of pediatric asthma and discusses the merits of other novel therapies in development, as we search to optimize management and improve future outcomes.
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Abstract
For many years, pathogenetic concepts and the results of clinical trials supported the view that anti-IgE treatment is specifically effective in allergic asthma. However, there is now growing clinical and mechanistic evidence suggesting that treatment with the anti-IgE antibody omalizumab can be effective in patients with intrinsic asthma. Therefore, large and well-controlled clinical trials with anti-IgE are urgently warranted in patients with intrinsic asthma. In addition, there is a need to find new biomarkers which can identify patients with asthma who respond to anti-IgE treatment.
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Affiliation(s)
- Marek Lommatzsch
- Department of Pneumology and Critical Care Medicine, University of Rostock, , Rostock, Germany
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