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Sun B, Shen K, Zhao R, Li Y, Xiang M, Lin J. Precision medicine for severe asthma - Biological targeted therapy. Int Immunopharmacol 2024; 134:112189. [PMID: 38759375 DOI: 10.1016/j.intimp.2024.112189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024]
Abstract
Severe asthma is a complex and heterogeneous chronic airway inflammatory disease. Current treatment strategies are increasingly focused on disease classification, facilitating the transition towards personalized medicine by integrating biomarkers and monoclonal antibodies for tailored therapeutic approaches. Several approved biological agents, including anti-immunoglobulin E (IgE), anti-interleukin (IL)-4, anti-IL-5, and anti-thymic stromal lymphopoietin (TSLP) monoclonal antibodies, have demonstrated significant efficacy in reducing asthma exacerbations, eosinophil counts, improving lung function, minimizing oral corticosteroid usage, and enhancing patients' quality of life. The utilization of these biological agents has brought about profound transformations in the management of severe asthma. This article provides a comprehensive review on biomarkers and biological agents for severe asthma while emphasizing the increasing importance of further research into its pathogenesis and novel treatment modalities.
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Affiliation(s)
- Bingqing Sun
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kunlu Shen
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruiheng Zhao
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Yun Li
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Min Xiang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jiangtao Lin
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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2
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Kallieri M, Papaioannou AI, Zervas E, Fouka E, Porpodis K, Hadji Mitrova M, Tzortzaki E, Makris M, Ntakoula M, Lyberopoulos P, Dimakou K, Koukidou S, Ampelioti S, Papaporfyriou A, Katsoulis K, Kipourou M, Rovina N, Antoniou K, Vittorakis S, Bakakos P, Steiropoulos P, Markopoulou K, Avarlis P, Papanikolaou ΙC, Markatos M, Gaki E, Samitas K, Glynos K, Papiris SA, Papakosta D, Tzanakis N, Gaga M, Kostikas K, Loukides S. Switching from omalizumab to mepolizumab in severe asthmatics: A post hoc analysis of the RELight study. Clin Exp Allergy 2024; 54:286-290. [PMID: 38084474 DOI: 10.1111/cea.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 03/12/2024]
Affiliation(s)
- Maria Kallieri
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Andriana I Papaioannou
- 1st Respiratory Department, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Marija Hadji Mitrova
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Maria Ntakoula
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Panagiotis Lyberopoulos
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | - Sofia Koukidou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | | | - Anastasia Papaporfyriou
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | | | - Maria Kipourou
- Pulmonary Department, 424 Army General Hospital, Thessaloniki, Greece
| | - Nikoletta Rovina
- 1st Respiratory Department, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Katerina Antoniou
- Respiratory Medicine School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Petros Bakakos
- 1st Respiratory Department, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, Alexandroupolis, Greece
| | - Katerina Markopoulou
- 1st Pulmonary Department, Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | - Spyros A Papiris
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Nikolaos Tzanakis
- Respiratory Medicine School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Mina Gaga
- 7th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
| | - Stelios Loukides
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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3
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Dragonieri S, Portacci A, Quaranta VN, Carpagnano GE. Advancing Care in Severe Asthma: The Art of Switching Biologics. Adv Respir Med 2024; 92:110-122. [PMID: 38525773 PMCID: PMC10961683 DOI: 10.3390/arm92020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024]
Abstract
Biologics targeting IgE, IL-5, IL-4/IL-13, and TSLP are crucial in severe asthma treatment. Research, including randomized controlled trials and real-world studies, has been conducted to assess their efficacy and identify patient characteristics that may predict positive responses. The effectiveness of switching biologics, especially given overlaps in treatment eligibility, and the clinical outcomes post-cessation are critical areas of investigation. This work reviews the effects of switching between these biologics and the indicators of treatment success or failure. Insights are primarily derived from real-world experiences, focusing on patients transitioning from one monoclonal antibody to another. Moreover, this review aims to provide insights into the effectiveness, safety, and broader implications of switching biologics, enhancing understanding for clinicians to optimize severe asthma management. The article underlines the importance of a patient-centered approach, biomarker assessment, and the evolving nature of asthma treatment in making informed decisions about biologic therapy.
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Affiliation(s)
- Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, 70124 Bari, Italy; (A.P.); (V.N.Q.); (G.E.C.)
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4
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Riccardi E, Guida G, Pizzimenti S, Ricciardolo FLM. The "serial switcher" in severe asthma. Pulmonology 2024; 30:90-92. [PMID: 36717295 DOI: 10.1016/j.pulmoe.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/30/2023] Open
Affiliation(s)
- E Riccardi
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - G Guida
- Department of Clinical and Biological Sciences, University of Turin, Italy; Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - S Pizzimenti
- Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - F L M Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, Italy; Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy; Institute of Translational Pharmacology, National Research Council (IFT-CNR), section of Palermo, Italy.
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Chen CY, Wu KH, Guo BC, Lin WY, Chang YJ, Wei CW, Lin MJ, Wu HP. Personalized Medicine in Severe Asthma: From Biomarkers to Biologics. Int J Mol Sci 2023; 25:182. [PMID: 38203353 PMCID: PMC10778979 DOI: 10.3390/ijms25010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Severe asthma is a complex and heterogeneous clinical condition presented as chronic inflammation of the airways. Conventional treatments are mainly focused on symptom control; however, there has been a shift towards personalized medicine. Identification of different phenotypes driven by complex pathobiological mechanisms (endotypes), especially those driven by type-2 (T2) inflammation, has led to improved treatment outcomes. Combining biomarkers with T2-targeting monoclonal antibodies is crucial for developing personalized treatment strategies. Several biological agents, including anti-immunoglobulin E, anti-interleukin-5, and anti-thymic stromal lymphopoietin/interleukin-4, have been approved for the treatment of severe asthma. These biological therapies have demonstrated efficacy in reducing asthma exacerbations, lowering eosinophil count, improving lung function, diminishing oral corticosteroid use, and improving the quality of life in selected patients. Severe asthma management is undergoing a profound transformation with the introduction of ongoing and future biological therapies. The availability of novel treatment options has facilitated the adoption of phenotype/endotype-specific approaches and disappearance of generic interventions. The transition towards precision medicine plays a crucial role in meticulously addressing the individual traits of asthma pathobiology. An era of tailored strategies has emerged, allowing for the successful targeting of immune-inflammatory responses that underlie uncontrolled T2-high asthma. These personalized approaches hold great promise for improving the overall efficacy and outcomes in the management of severe asthma. This article comprehensively reviews currently available biological agents and biomarkers for treating severe asthma. With the expanding repertoire of therapeutic options, it is becoming increasingly crucial to comprehend the influencing factors, understand the pathogenesis, and track treatment progress in severe asthma.
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Affiliation(s)
- Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung Metro Harbor Hospital, Taichung 435403, Taiwan; (C.-Y.C.); (C.-W.W.)
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Wen-Ya Lin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Taichung Veteran General Hospital, Taichung 43503, Taiwan;
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Chih-Wei Wei
- Department of Emergency Medicine, Tungs’ Taichung Metro Harbor Hospital, Taichung 435403, Taiwan; (C.-Y.C.); (C.-W.W.)
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Davis J, McMahon PM, Simon A, Haffenreffer K, Jamal-Allial A, McMahill-Walraven CN, Kline AM, Brown JS, Van Dyke MK, Jakes RW, Wu AC. The association of varying treatment thresholds of mepolizumab on asthma exacerbations in adults. J Asthma 2023; 60:2198-2206. [PMID: 37347586 DOI: 10.1080/02770903.2023.2228900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
Background: Asthma has a high healthcare burden globally, with up to 10% of the asthma population suffering from severe disease. Biologic agents are a newer class of asthma treatments for severe asthma, with good evidence for efficacy in clinical trials. Nevertheless, real-world studies of its impact on clinical outcomes are limited.Methods: This is an observational cohort study using administrative claims data. The study population consisted of patients aged ≥18 years who had a diagnosis of asthma and initiated mepolizumab after November 4, 2015 and had continuous medical and drug coverage in both the 365 days prior to and following mepolizumab initiation. In patients treated with mepolizumab, we described clinically significant asthma exacerbations by minimum continuous treatment thresholds following initiation of mepolizumab, medication switching patterns and chronic oral corticosteroid (≥28 days) use.Results: We identified 2,536 adults with asthma who initiated mepolizumab. There was an association toward reduction in severe asthma-related events over the first one year of exposure. We observed associations with reduced dispensings of oral corticosteroids over the first year after mepolizumab initiation. Very few patients switched to other biologics during the study period.Conclusions: Treatment with mepolizumab may be associated with fewer asthma-related events in the first year. Over the first one year after initiating mepolizumab, we found associations with decreased concomitant dispensings of oral corticosteroids and medium to high dose ICS/LABA. Additionally, most patients who initiated mepolizumab did not switch to other biologics.
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Affiliation(s)
| | - Pamela M McMahon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Andrew Simon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Katherine Haffenreffer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | | | - Jeffrey S Brown
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Melissa K Van Dyke
- Respiratory Epidemiology Therapy Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Rupert W Jakes
- Respiratory Epidemiology Therapy Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Ann Chen Wu
- Boston Children's Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Mümmler C, Milger K. Biologics for severe asthma and beyond. Pharmacol Ther 2023; 252:108551. [PMID: 37907197 DOI: 10.1016/j.pharmthera.2023.108551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
Advances in pathophysiological understanding and the elucidation of a type 2 inflammatory signature with interleukins 4, 5 and 13 at its center have led to the development of targeted antibody therapies that are now approved for the treatment of severe asthma. In suitable patients, these medications reduce asthma exacerbations and the necessity for oral corticosteroids, improve asthma control, quality of life and lung function. A proportion of patients with severe asthma may even achieve remission under ongoing biologic therapy. Type-2 inflammatory comorbidities are frequent in patients with severe asthma, sharing overlapping pathophysiology and may similarly respond to biologic treatment. Here, we give an overview of the six biologic therapies currently approved for severe asthma and review randomized clinical trials and real-life studies in asthma and other type-2 inflammatory diseases. We also discuss selection of biologics according to licensing criteria, asthma phenotype and biomarkers, monitoring of treatment response and proceedings in case of insufficient outcome under therapy.
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Affiliation(s)
- Carlo Mümmler
- Department of Medicine V, LMU University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
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Rogers L, Jesenak M, Bjermer L, Hanania NA, Seys SF, Diamant Z. Biologics in severe asthma: A pragmatic approach for choosing the right treatment for the right patient. Respir Med 2023; 218:107414. [PMID: 37776915 DOI: 10.1016/j.rmed.2023.107414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
The development of monoclonal antibody therapies targeting specific components of the pathways relevant to asthma pathophysiology has revolutionized treatment of severe asthma both in adults and children and helped to further unravel the heterogeneity of this disease. However, the availability of multiple agents, often with overlapping eligibility criteria, creates a need for pragmatic guidance for specialists undertaking care of patients with severe asthma. In this review, we provide an overview of the data supporting the clinical efficacy of biologics in distinct asthma phenotypes/endotypes. We also focus on the role of biomarkers and treatable traits, including comorbidities, in the choice of asthma biologics, highlight which treatments have been demonstrated to be steroid sparing in corticosteroid dependent asthma, and provide practical guidance that can drive shared decision making on treatment choice with patients. In addition, we summarize what is known to date regarding long-term safety of these drugs, and lastly, discuss future directions in biologics research.
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Affiliation(s)
- Linda Rogers
- Mount Sinai National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Milos Jesenak
- Department of Pediatrics, Department of Pulmonology and Phthisiology, Department of Allergology and Clinical Immunology, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Nicola A Hanania
- Section of Pulmonary /Critical Care/Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Zuzana Diamant
- Department Clin Pharm & Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands; Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Belgium; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
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Nieto A, El-Sayed ZA, Gómez RM, Hossny E, Jiu-Yao W, Kalayci Ö, Morais-Almeida M, Phipatanakul W, Pitrez PM, Pozo Beltrán CF, Xepapadaki P, Papadopoulos NG. Unanswered questions on the use of biologics in pediatric asthma. World Allergy Organ J 2023; 16:100837. [PMID: 38020283 PMCID: PMC10656246 DOI: 10.1016/j.waojou.2023.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
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Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit. Health Research Institute. Children's Hospital La Fe, Valencia, Spain
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Wang Jiu-Yao
- Research Center of Allergy, Immunology, and Microbiome (A.I.M.). China Medical University Children's Hospital, Taichung, Taiwan
| | - Ömer Kalayci
- Pediatric Allergy and Asthma, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo Marcio Pitrez
- School of Medicine, Pediatric Pulmonary Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK
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10
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Delgado J, Navarro A, Álvarez-Gutiérrez FJ, Cisneros C, Domínguez-Ortega J. [Unmet Needs in Severe Allergic Asthma]. OPEN RESPIRATORY ARCHIVES 2023; 5:100282. [PMID: 38053757 PMCID: PMC10694599 DOI: 10.1016/j.opresp.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Severe asthma affects 3%-10% of the world's population, according to estimates by the Global Initiative for ASTHMA (GINA). Allergic asthma is one of the most common phenotypes of severe asthma and it is characterized by allergen-induced type 2 inflammation in which immunoglobulin E (IgE) is a key mediator, making it an important therapeutic target. The introduction of targeted biological therapies or treatments has entered the management for severe asthma in the era of precision medicine, and the goal of treatment is clinical remission of the disease. There is a significant percentage of patients with severe allergic asthma who do not respond to treatments and whose symptoms are not controlled. In this paper, a group of experts in the management of severe allergic asthma reviewed and evaluated the most relevant evidence regarding the pathophysiology and phenotypes of severe allergic asthma, the role of IgE in allergic inflammation, allergen identification, techniques, biomarkers and diagnostic challenges, available treatments and strategies for disease management, with a special focus on biological treatments. From this review, recommendations were developed and validated through a Delphi consensus process with the aim of offering improvements in the management of severe allergic asthma to the professionals involved and identifying the unmet needs in the management of this pathology.
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Affiliation(s)
- Julio Delgado
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Ana Navarro
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | | | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, Instituto de Investigación IDiPAZ, Madrid, España
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11
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Al-Ahmad M, Ali A, Maher A. Omalizumab Transitions in Severe Asthma: Factors Influencing Switching Decisions and Timing for Optimal Response. Med Princ Pract 2023; 32:323-331. [PMID: 37757780 PMCID: PMC10727686 DOI: 10.1159/000534319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the effectiveness of switching from omalizumab to another biologic therapy for patients with severe asthma and evaluate factors that influenced the decision to switch and determined the optimal time for a good biologic response. SUBJECTS AND METHODS A retrospective study of severe asthma patients was conducted at Al-Rashed Allergy Center, a tertiary center in Kuwait. After meeting the eligibility criteria, patients were divided into two comparative groups: those continuing with omalizumab and those who started with omalizumab but switched to another biologic. RESULTS One hundred sixteen patients with severe asthma were recruited, and only 33 had access to multiple biological treatments. Approximately 22.4% switched from omalizumab. Male patients with a history of ischemic heart disease, chronic rhinosinusitis, and nasal polyps were more likely to switch if they had higher levels of eosinophils in the sputum. This study showed that every 1% increase in sputum eosinophils doubled the likelihood of a switch. Patients with access to alternative biological options had a much shorter mean duration of omalizumab therapy before switching compared to those with only affordable omalizumab: 4.9 ± 1.5 years versus 8.9 ± 1.3 years (p < 0.001). The optimal time to predict the likelihood of a good response was less than 5.5 years, with an area under the curve of 0.91 and p = 0.003. This cutoff point provided a sensitivity and specificity of approximately 89% and 100%, respectively. CONCLUSION An early transition from omalizumab, specifically within the first 5 years of treatment, in patients with severe asthma and higher sputum eosinophils may enhance the likelihood of a good response if other biological therapies were available.
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Affiliation(s)
- Mona Al-Ahmad
- Department of Microbiology, College of Medicine, Kuwait University, Kuwait City, Kuwait
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Asmaa Ali
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, PR China
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt
| | - Ahmed Maher
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
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Scioscia G, Tondo P, Nolasco S, Pelaia C, Carpagnano GE, Caiaffa MF, Valenti G, Maglio A, Papia F, Triggiani M, Crimi N, Pelaia G, Vatrella A, Foschino Barbaro MP, Crimi C. Benralizumab in Patients with Severe Eosinophilic Asthma: A Multicentre Real-Life Experience. J Clin Med 2023; 12:4362. [PMID: 37445397 DOI: 10.3390/jcm12134362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Mepolizumab and benralizumab are monoclonal antibodies directed against anti-IL-5 and anti-IL5R, respectively, and their use reduces the exacerbation rate and maintains oral corticosteroid requirements in severe eosinophilic asthma. Previous studies have tested the therapeutic switch between two biologics with excellent results, further demonstrating the heterogeneity of asthmatic disease and the complexity of the therapeutic choice. It remains unclear if such patients may improve following a switch from mepolizumab to benralizumab. AIMS Within a multicentre real-life setting, we decided to evaluate the potential effectiveness of a therapeutic switch to benralizumab in patients with severe eosinophilic asthma initially treated with mepolizumab, who experienced sub-optimal responses. The secondary aim was to identify the clinical factors associated with a better response to benralizumab. METHODS We retrospectively assessed patients with severe eosinophilic asthma treated at six Italian specialist centres, who were switched from mepolizumab to benralizumab following a sub-optimal response, defined as a partial or total lack of clinical remission (i.e., frequent severe exacerbations and/or poorly controlled symptoms and/or higher OCS daily use in patients with a poor or moderate response in the global evaluation of treatment effectiveness scale), after at least 12 months of treatment. RESULTS Twenty-five patients were included in the analysis (mean age 56.76 ± 11.97 years, 65% female). At 6 months of treatment with benralizumab, the ACT score was significantly higher than the ACT score with mepolizumab (20.24 ± 3.38 vs. 16.77 ± 3.48, p < 0.0001); the mean number of daily SABA inhalations was significantly lower after 6 months and 12 months of treatment with benralizumab than that after treatment with mepolizumab; OCS intake and the prednisone median dosage at 6 months of treatment with benralizumab were significantly lower than those with mepolizumab. Benralizumab treatment resulted in a marked improvement in asthma control, suppressed blood eosinophil levels and reduction in the number of exacerbations in the subgroup of patients with severe eosinophilic asthma and nasal polyposis. CONCLUSIONS Patients diagnosed with severe eosinophilic asthma who experience a partial response to mepolizumab could benefit from switching to benralizumab, and even more those who have nasal polyposis.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "Aldo Moro" of Bari, 70121 Bari, Italy
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | | | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
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Scioscia G, Nolasco S, Campisi R, Quarato CMI, Caruso C, Pelaia C, Portacci A, Crimi C. Switching Biological Therapies in Severe Asthma. Int J Mol Sci 2023; 24:ijms24119563. [PMID: 37298514 DOI: 10.3390/ijms24119563] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Currently, three classes of monoclonal antibodies targeting type 2 inflammation pathways are available in Italy for the treatment of severe asthma: anti-IgE (Omalizumab), anti-IL-5/anti-IL-5Rα (Mepolizumab and Benralizumab), and anti-IL-4Rα (Dupilumab). Numerous randomized controlled trials (RCTs) and real-life studies have been conducted to define their efficacy and identify baseline patients' characteristics potentially predictive of favorable outcomes. Switching to another monoclonal antibody is recommended in case of a lack of benefits. The aim of this work is to review the current knowledge on the impact of switching biological therapies in severe asthma as well as on predictors of treatment response or failure. Almost all of the information about switching from a previous monoclonal antibody to another comes from a real-life setting. In the available studies, the most frequent initial biologic was Omalizumab and patients who were switched because of suboptimal control with a previous biologic therapy were more likely to have a higher baseline blood eosinophil count and exacerbation rate despite OCS dependence. The choice of the most suitable treatment may be guided by the patient's clinical history, biomarkers of endotype (mainly blood eosinophils and FeNO), and comorbidities (especially nasal polyposis). Due to overlapping eligibility, larger investigations characterizing the clinical profile of patients benefiting from switching to different monoclonal antibodies are needed.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71121 Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy
| | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | | | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Portacci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, 70121 Bari, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy
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Venkitakrishnan R, Augustine J, Ramachandran D, Cleetus M. Biological therapy for severe asthma - Indian perspectives and challenges. Lung India 2023; 40:253-259. [PMID: 37148024 PMCID: PMC10298827 DOI: 10.4103/lungindia.lungindia_432_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 05/07/2023] Open
Abstract
Asthma is a complex and heterogeneous disease. Severe asthma makes up only a minority of asthma patients encountered in clinical settings but accounts for substantial healthcare utilisation in terms of manpower as well as economic allocation. The availability of monoclonal antibodies has a major impact on severe asthmatics and has provided excellent clinical results in properly selected patients. The discovery of new molecules might present uncertainties to clinicians as to the best agent to institute in an individual patient. The practice scenario in India is unique when it comes to the commercial availability of monoclonal antibodies, patient attitudes, and allocation of the healthcare budget. The present review dissects and summarises the available monoclonal antibodies for asthma treatment in India, the perspectives of Indian patients on biological therapy, and the challenges encountered by patients and physicians in this regard. We provide practical suggestions for utilising monoclonal antibodies and deciding on the optimal agent for a given patient.
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Affiliation(s)
| | - Jolsana Augustine
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
| | - Divya Ramachandran
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
| | - Melcy Cleetus
- Consultant Pulmonologists, Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India
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15
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Tuncay G, Damadoglu E, Cihanbeylerden M, Can Bostan O, Kayıkcı H, Özer S, Karakaya G, Kalyoncu AF. Comparison of the clinical outcomes of patients with NSAID-exacerbated respiratory disease receiving aspirin or biologicals. J Asthma 2023:1-10. [PMID: 36971076 DOI: 10.1080/02770903.2023.2196567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE NSAID-exacerbated respiratory disease (NERD) is characterized by exacerbation of respiratory symptoms after NSAID intake. While research for specific treatment options continues in patients who cannot tolerate or are unresponsive to aspirin treatment after aspirin desensitization (ATAD), biologicals have emerged as a new therapeutic option in NERD patients. The aim of this study was to compare the quality of life, and the sinonasal and respiratory outcomes of NERD patients treated with ATAD or biologicals. METHODS Patients who have been followed up at a tertiary care allergy center and who have been receiving at least one of ATAD, mepolizumab or omalizumab for at least six months were included. Evaluations were made using sinonasal outcome test (SNOT-22), asthma control test (ACT), short form-36 (SF-36), blood eosinophil counts, need for recurrent functional endoscopic sinus surgeries (FESS), and asthma or rhinitis exacerbations requiring oral corticosteroids (OCS). RESULTS A total of 59 patients comprised of 35 (59%) females and 24 (41%) males with a mean age of 46.1 (min-max, 20-70) years were included. The baseline blood eosinophil count was higher, and a significant decrease in blood eosinophil counts was observed in the mepolizumab group compared to ATAD group (p = 0.001, p < 0.001, respectively). At follow-up, the rate of recurrent FESS was lower in the group that received mepolizumab (p = 0.02). CONCLUSIONS In NERD patients, mepolizumab significantly decreased blood eosinophil counts and recurrent FESS. There was no significant difference between the patients receiving ATAD or mepolizumab regarding other clinical parameters.
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Walsh LJ, Casey D, Vairamani P, Arnott F, Plant BJ, Murphy DM. Real-World clinical outcomes of asthma patients switched from reslizumab to mepolizumab or benralizumab. FRONTIERS IN ALLERGY 2023; 3:1052339. [PMID: 36686966 PMCID: PMC9845591 DOI: 10.3389/falgy.2022.1052339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Approximately 3%-10% of asthma patients will remain uncontrolled despite maximum, optimal conventional therapy. Treatment of severe refractory asthma often involves the use of targeted biological therapy. Randomised controlled trials have shown improvements in clinical parameters with these treatments but real-world data is lacking. Methods The clinical parameters, frequency of exacerbations, number of hospital admissions, asthma control questionnaire score (ACQ), forced expiratory volume in one second (FEV1) and maintenance oral corticosteroid (OCS) dose of twenty asthma patients switched from reslizumab to benralizumab or mepolizumab at 1 year prior and 6 months after switching were compared, with adjustments for time. Results The mean frequency of exacerbations (0.35 v 0.3) and the mean ACQ were essentially unchanged (1.6 v 1.5) following the switch. The number of hospital admissions was one in the 6 months post switch compared to one in 1-year pre switch. 25% of patients were on maintenance OCS before and after switching but one patient required an increased dose post switch resulting in an increase in the mean maintenance OCS dose (1.6 mg to 2.4 mg). The mean FEV1 was unchanged (80% v 77.9%) six months post switching. Regarding asthma control (n = 19), 47.4% were controlled pre and post switch (ACQ < 1.5), 36.8% remained uncontrolled despite switching, 10.5% improved control while 5.3% disimproved. Conclusion We present real-world clinical outcomes of asthma patients switched from reslizumab to either benralizumab or mepolizumab without a loss of clinical effectiveness in the majority.
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Affiliation(s)
- Laura J. Walsh
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Deborah Casey
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Punitha Vairamani
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Fiona Arnott
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Barry J. Plant
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland,Clinical Research Facility, University College Cork, Cork, Ireland
| | - Desmond M. Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland,Clinical Research Facility, University College Cork, Cork, Ireland,Correspondence: Desmond Murphy
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Switching Biological Therapies in Adults with Severe Asthma: What Are the Dilemmas and Is It Worthwhile? Ann Am Thorac Soc 2022; 19:1965-1970. [PMID: 35984426 DOI: 10.1513/annalsats.202203-251ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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18
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Caruso C, Cameli P, Altieri E, Aliani M, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Centanni S, D’Amato M, Del Giacco S, De Michele F, Pastorello EA, Pelaia G, Rogliani P, Romagnoli M, Schino P, Caminati M, Vultaggio A, Zullo A, Rizzoli S, Boarino S, Vitiello G, Menzella F, Di Marco F. Switching from one biologic to benralizumab in patients with severe eosinophilic asthma: An ANANKE study post hoc analysis. Front Med (Lausanne) 2022; 9:950883. [PMID: 36117962 PMCID: PMC9478391 DOI: 10.3389/fmed.2022.950883] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSevere asthma is a heterogeneous inflammatory disease driven by eosinophilic inflammation in the majority of cases. Despite biologic therapy patients may still be sub-optimally controlled, and the choice of the best biologic is a matter of debate. Indeed, switching between biologics is common, but no official guidelines are available and real-world data are limited.Materials and methodsIn this post hoc analysis of the Italian, multi-center, observational, retrospective study, ANANKE. Patients with severe eosinophilic asthma treated with benralizumab were divided in two groups based on history of previous biologic therapy (biologic-experienced [suboptimal response] vs naïve). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment. Change over time in blood eosinophils, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use following benralizumab initiation were collected in the two groups.ResultsA total of 147 biologic-naïve and 58 biologic-experienced (34 omalizumab, 19 mepolizumab, and 5 omalizumab-mepolizumab) patients were enrolled. Biologic-experienced patients were more likely to be atopic and have a higher AER despite more frequent OCS use. Similar reductions in AER (>90% in both groups), OCS use (≥49% reduction in dosage and ≥41% able to eliminate OCS), ACT improvement (≥7 points gained in 48 weeks) and lung function (≥300 mL of FEV1 improvement in 48 weeks) were observed after benralizumab introduction within the two groups. There were no registered discontinuations of benralizumab for safety reasons.ConclusionIn this post hoc analysis, patients who were switched to benralizumab because of suboptimal control with a previous biologic therapy were more likely to be atopic and more often treated with omalizumab. Benralizumab is effective in both naïve patients and those previously treated with a biologic.
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Affiliation(s)
- Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Cristiano Caruso,
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese, MI, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I - Torino, Turin, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Asthma and Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II,” Ospedale Monaldi, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, Italy
| | | | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, 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
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli,” Acquaviva delle Fonti, BA, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | | | - Alessandro Zullo
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Sara Rizzoli
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | | | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino,” Montebelluna (TV) - AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Fabiano Di Marco
- Department of Health Sciences and Pneumology, University of Milan, ASST Papa Giovanni XXIII, Bergamo, Italy
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O'Reilly E, Casey D, Ibrahim H, McGrath A, McHugh T, Vairamani P, Murphy J, Plant B, Murphy DM. Real-World Clinical Outcomes in Asthmatic Patients Switched from Omalizumab to Anti-Interleukin-5 Therapy. J Asthma Allergy 2022; 15:935-937. [PMID: 35844776 PMCID: PMC9285523 DOI: 10.2147/jaa.s358321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emily O'Reilly
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Deborah Casey
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Hisham Ibrahim
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Alice McGrath
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Tomás McHugh
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Punitha Vairamani
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Jill Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Barry Plant
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Desmond M Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
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Porpodis K, Tsiouprou I, Apostolopoulos A, Ntontsi P, Fouka E, Papakosta D, Vliagoftis H, Domvri K. Eosinophilic Asthma, Phenotypes-Endotypes and Current Biomarkers of Choice. J Pers Med 2022; 12:jpm12071093. [PMID: 35887589 PMCID: PMC9316404 DOI: 10.3390/jpm12071093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 12/16/2022] Open
Abstract
Asthma phenotyping and endotyping are constantly evolving. Currently, several biologic agents have been developed towards a personalized approach to asthma management. This review will focus on different eosinophilic phenotypes and Th2-associated endotypes with eosinophilic inflammation. Additionally, airway remodeling is analyzed as a key feature of asthmatic eosinophilic endotypes. In addition, evidence of biomarkers is examined with a predictive value to identify patients with severe, uncontrolled asthma who may benefit from new treatment options. Finally, there will be a discussion on the results from clinical trials regarding severe eosinophilic asthma and how the inhibition of the eosinophilic pathway by targeted treatments has led to the reduction of recurrent exacerbations.
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Affiliation(s)
- Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Ioanna Tsiouprou
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Apostolos Apostolopoulos
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 12462 Athens, Greece;
| | - Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
| | - Harissios Vliagoftis
- Department of Medicine, University of Alberta, 567 HMRC, Edmonton, AB T6G 2S2, Canada;
| | - Kalliopi Domvri
- Pulmonary Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (K.P.); (I.T.); (A.A.); (E.F.); (D.P.)
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2313307258
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Gómez-Bastero Fernández A, Medina Gallardo JF, Delgado Romero J, Romero Falcón A, Benito Bernáldez C, Gallego Borrego J, Álvarez-Gutiérrez FJ. Effectiveness of Switching to Benralizumab in Severe Refractory Eosinophilic Asthma. J Asthma Allergy 2022; 15:727-735. [PMID: 35642210 PMCID: PMC9148608 DOI: 10.2147/jaa.s358705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Benralizumab is a monoclonal antibody that targets the α subunit of the IL-5 receptor. Clinical trials have demonstrated the efficacy of this agent with respect to lung function and symptom control in patients with refractory eosinophilic asthma. However, few studies have evaluated the efficacy of benralizumab after switching previous treatment with other monoclonal antibodies. Patients and Methods We performed a multicenter retrospective study under conditions of daily clinical practice. The study population comprised consecutively included patients with severe refractory eosinophilic asthma whose initial treatment with omalizumab or mepolizumab was switched to benralizumab. Patients were evaluated at 4 and 12 months after starting treatment with benralizumab. We analyzed asthma control, number of severe exacerbations, corticosteroid cycles, visits to the emergency department, and hospital admissions, as well as lung function. Similarly, we evaluated the response to treatment according to previously established criteria. Results We evaluated 40 patients who switched from omalizumab (n=16) or mepolizumab (n=24) to benralizumab. The reasons for switching were lack of response in 30 cases, adverse effects in 9, and patient request in 1. Switching was followed by a significant decrease in the number of exacerbations, visits to the emergency department, and corticosteroid cycles, as well as improved ACT both at 4 and 12 months. However, no significant improvement in lung function was observed. Asthma control (including complete response and control) was achieved in 55% of patients (n=22) at 12 months. Specifically, a complete response was achieved in 30% of patients at 12 months (66.7% switching from omalizumab and 33.3% from mepolizumab). Conclusion Patients diagnosed with severe refractory eosinophilic asthma who experience a partial response with omalizumab or mepolizumab could benefit from switching to benralizumab. This approach can reduce the number of exacerbations, visits to the emergency department, and corticosteroid cycles and improve control of asthma.
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Affiliation(s)
| | | | | | | | - Cristina Benito Bernáldez
- Asthma Unit of Pneumology, Virgen Macarena University Hospital, Seville, Spain
- Correspondence: Cristina Benito Bernáldez, Asthma Unit of Pneumology, Virgen Macarena University Hospital Avenue Doctor Fedriani, Seville, s/n. CP 41009, Spain, Tel +34 646 081 573, Fax +34 955 926 572, Email
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Mahboub B, Mohy A, El-Amir I, Lukić T, Gouhar R, Noibi S. Budget Impact Analysis of Mepolizumab for Eligible Patients in the Setting of a Severe Asthma Clinic Within Dubai Health Authority (DHA). Clinicoecon Outcomes Res 2022; 14:265-279. [PMID: 35502155 PMCID: PMC9056102 DOI: 10.2147/ceor.s343249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Abstract
Purpose To estimate 5-years budgetary impact of introducing mepolizumab to eligible patients with uncontrolled severe eosinophilic asthma treated at a tertiary care hospital within Dubai Health Authority (DHA). Patients and Methods A budget impact analysis (BIA) model was adapted to the setting of Rashid Hospital, DHA to estimate the budgetary implications of introducing first-in-class anti-IL5 (mepolizumab) as add-on therapy for eligible patients with severe eosinophilic asthma. The eligible patient population (n=60) was estimated from aggregate data provided by the clinic. Patients were eligible to treatment with mepolizumab if they had ≥2 exacerbation in the previous year and eosinophil count ≥150 cell/µL. The analysis compared the cost of treating patients in two alternative scenarios; a scenario where patients are treated with optimized usual care or with available biologic as add-on therapy, and a second scenario where mepolizumab is fully accessible to eligible patients. Results Administration of mepolizumab to eligible patients at Rashid Hospital is predicted to result in overall savings estimated at £270,545 over a 5-year time horizon. Exacerbation rates could not be indirectly compared for mepolizumab and omalizumab, since treatment continuation rules were defined differently. Therefore, these parameters were directly taken from the clinical trials for mepolizumab and omalizumab. The savings were estimated due to drug acquisition costs (£269,900) and estimated reduction in exacerbation (n=15). One-way sensitivity analysis showed that the model results was most sensitive to changing the method of calculating omalizumab dose and varying the drug acquisition cost of omalizumab by ±20%. Conclusion The BIA showed that full accessibility of mepolizumab to eligible severe asthma patients is predicted to be budget saving in the Dubai Health Authority. This evaluation is relevant to healthcare decision making as it demonstrates that mepolizumab is budget saving for eligible patients, while reducing burden by improving their control and symptoms.
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Affiliation(s)
- Bassam Mahboub
- Pulmonary Medicine Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmed Mohy
- Medical Affairs Department, GSK, Jeddah, Kingdom of Saudi Arabia
| | - Islam El-Amir
- Medical Affairs Department, GSK, Jeddah, Kingdom of Saudi Arabia
| | - Tamara Lukić
- GSK Research and Development, Dubai, United Arab Emirates
| | - Raef Gouhar
- Medical Affairs Department, GSK, Dubai, United Arab Emirates
- Correspondence: Raef Gouhar, Medical Affairs Department, GSK, Dubai, United Arab Emirates, Email
| | - Saeed Noibi
- Medical Excellence and Value Access, Emerging Markets Region, GSK, Jeddah, Kingdom of Saudi Arabia
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23
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Fomina DS, Mukhina OA, Lebedkina MS, Gadzhieva MK, Bobrikova EN, Sinyavkin DO, Parshin VV, Chernov AA, Belevskiy AS. Analysis of predictors of response to anti-IgE therapy in patients with severe atopic bronchial asthma in real clinical practice. TERAPEVT ARKH 2022; 94:413-419. [DOI: 10.26442/00403660.2022.03.201437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Introduction. Guidelines on Biological Therapy for Bronchial Asthma of the European Academy of Allergy and Clinical Immunology (EAACI) identified a number of controversial issues for additional outcome analysis using randomized clinical trials and data from routine clinical practice. In particular, there is unmet need to clarify algorithms for prescribing biologicals using predictors of response and its timing, taking into account risk factors and multimorbidity. Omalizumab is a recombinant humanized monoclonal anti-IgE antibody of IgG1 class used for the treatment of severe refractory atopic bronchial asthma (BA) and a variety of IgE-mediated diseases. Among biological agents, this "pioneer molecule" has the greatest experience in the "allergology and immunology" profile. Detailed description of the "nonresponders" portraits will allow to perform the therapy response assessment on time and facilitate rational planning of individual therapy, which is a prerequisite for biologicals era. Using only routine methods, it is possible to perform initial and dynamic screening to phenotype a heterogeneous cohort of patients with severe asthma and chose the optimal strategy.
Aim. To identify predictors of nonresponse to omalizumab anti-IgE therapy in patients with severe atopic BA and to establish optimal timing of efficacy assessment using retrospective analysis of data from the Biologic Therapy Registry of Allergology and Immunology in routine clinical practice.
Materials and methods. A retrospective single-center registry study was conducted at the Allergy and Immunology Reference Center from June 2017 to August 2021. 135 patients with severe BA, with confirmed perennial sensitization, who received omalizumab according to the recommendations of the current version of GINA, were selected from the clinical and dynamic observational system (registry). Dosing regimen and administration frequency of omalizumab were determined in accordance with the instructions for the drug. Assessment of therapy efficacy was performed at the time point 4, 6 and 12 months. Patients were subgrouped into "responders" and "non-responders" according to the following criteria: ACT score less than 19 and/or difference between initial ACT score in dynamics less than 3 points; forced expiratory volume in the first second less than 80%; combination of these two criteria. Nonparametric methods of descriptive statistics were used in data processing: median, interquartile range. Differences were considered significant at p0.05. MannWhitney U-test, KruskalWallis one-way analysis of variance, and Fisher's 2 test were used to compare quantitative characteristics.
Results. Heterogeneous subgroups of patients differing in reaching the criteria of "non-responders" to treatment were identified; the informativity of modifiable and unmodifiable factors differed at time-points of dynamic observation. In the differential analysis, two profiles of "nonresponders" were defined in combination with the most significant predictors of "nonrsponse" to omalizumab. According to the data obtained, one of the clinical phenotypes, namely the combination of severe asthma with the Samters triad, corresponded to the characteristics of the patient "nonresponders": age of onset is about 30 years, females, severe exacerbations of BA while taking non-steroidal anti-inflammatory drugs, accompanied with high levels of eosinophilia.
Conclusion. The data obtained illustrates the hypothesis of pathogenetic heterogeneity of severe BA with the phenomenon of overlapping phenotypes and can serve as an additional orienteer for creating the individual plan of anti-IgE therapy in real clinical practice.
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Klimek L, Hagemann J, Welkoborsky HJ, Cuevas M, Casper I, Förster-Rurmann U, Klimek F, Hintschich CA, Huppertz T, Bergmann KC, Tomazic PV, Bergmann C, Becker S. T2-Inflammation bei entzündlichen Atemwegserkrankungen: Grundlage neuer Behandlungsoptionen. Laryngorhinootologie 2021; 101:96-108. [PMID: 34937094 DOI: 10.1055/a-1709-7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | | | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - T Huppertz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - K-Ch Bergmann
- Klinik für Dermatologie, Venerologie und Allergie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - P V Tomazic
- HNO-Universitätsklinik Graz, Medizinische Universität Graz
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25
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Switch from Omalizumab to Benralizumab in Allergic Patients with Severe Eosinophilic Asthma: A Real-Life Experience from Southern Italy. Biomedicines 2021; 9:biomedicines9121822. [PMID: 34944638 PMCID: PMC8698313 DOI: 10.3390/biomedicines9121822] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Background. The wide availability of monoclonal antibodies for the add-on therapy of severe asthma currently allows for the personalization of biologic treatment by selecting the most appropriate drug for each patient. However, subjects with overlapping allergic and eosinophilic phenotypes can be often eligible to more than one biologic, so that the first pharmacologic choice can be quite challenging for clinicians. Within such a context, the aim of our real-life investigation was to verify whether allergic patients with severe eosinophilic asthma, not adequately controlled by an initial biologic treatment with omalizumab, could experience better therapeutic results from a pharmacologic shift to benralizumab. Patients and methods. Twenty allergic patients with severe eosinophilic asthma, unsuccessfully treated with omalizumab and then switched to benralizumab, were assessed for at least 1 year in order to detect eventual changes in disease exacerbations, symptom control, oral corticosteroid intake, lung function, and blood eosinophils. Results. In comparison to the previous omalizumab therapy, after 1 year of treatment with benralizumab our patients experienced significant improvements in asthma exacerbation rate (p < 0.01), rescue medication need (p < 0.001), asthma control test (ACT) score (p < 0.05), forced expiratory volume in the first second (FEV1) (p < 0.05), and blood eosinophil count (p < 0.0001). Furthermore, with respect to the end of omalizumab treatment, the score of sino-nasal outcome test-22 (SNOT-22) significantly decreased after therapy with benralizumab (p < 0.05). Conclusion. The results of this real-life study suggest that the pharmacologic shift from omalizumab to benralizumab can be a valuable therapeutic approach for allergic patients with severe eosinophilic asthma, not adequately controlled by anti-IgE treatment.
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26
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Domingo Ribas C, Carrillo Díaz T, Blanco Aparicio M, Martínez Moragón E, Banas Conejero D, Sánchez Herrero MG. REal worlD Effectiveness and Safety of Mepolizumab in a Multicentric Spanish Cohort of Asthma Patients Stratified by Eosinophils: The REDES Study. Drugs 2021; 81:1763-1774. [PMID: 34586602 PMCID: PMC8550660 DOI: 10.1007/s40265-021-01597-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/23/2022]
Abstract
Background The efficacy of mepolizumab is well documented in severe eosinophilic asthma (SEA), although the stringent selection criteria adopted by SEA clinical trials limits the generalizability of results. Objective Our study evaluated the effectiveness and safety of mepolizumab in patients with SEA in Spain. The primary efficacy endpoint was the change in the rate of clinically significant asthma exacerbations 12 months after starting mepolizumab compared to the baseline rate in the 12 months prior to treatment. Patients were stratified by baseline blood eosinophil counts. Methods We conducted a multicentric observational cohort study of SEA patients treated with mepolizumab across 24 specialized hospital asthma units in Spain. Severe exacerbation rate, lung function, oral corticosteroid use (OCS) and asthma control test (ACT) were retrospectively collected and compared during the 12-month pre- and post-mepolizumab treatment. Adverse events were also investigated. Results A total of 318 patients with SEA were included (mean age: 56.6 years, 69.2% female). Exacerbation rates decreased by 77.5%, and 50.6% of patients did not suffer any exacerbations during the 12 months of treatment. The difference in forced expiratory volume in 1 s (FEV1) pre- and post-bronchodilator after starting mepolizumab was 0.21 (0.46) L (95% CI 0.14–0.27) (p < 0.001). Exacerbations and lung function significantly improved across all eosinophil subgroups. Among the 98 patients on OCS, 47.8% were able to discontinue this treatment and the mean daily dose was decreased by 59.9%. The baseline ACT score was 14.1, increasing by a mean (SD) of 6.7 points (1.9) at 12 months. Adverse events related to mepolizumab were uncommon. Conclusions This real-world study of SEA patients confirms that mepolizumab is effective in reducing clinically meaningful exacerbations, improving lung function, and decreasing OCS dependence and mean OCS dose at 12 months, irrespective of baseline eosinophil counts. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-021-01597-9.
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Affiliation(s)
- Christian Domingo Ribas
- Servei de Pneumologia, Corporació Sanitària Parc Taulí, Parc Taulí s/n, Sabadell, 08208, Barcelona, Spain. .,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Teresa Carrillo Díaz
- H. Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.,Universidad de Las Palmas Gran Canaria, Las Palmas de Gran Canaria, Spain
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27
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Rupani H, Fong WCG, Kyyaly A, Kurukulaaratchy RJ. Recent Insights into the Management of Inflammation in Asthma. J Inflamm Res 2021; 14:4371-4397. [PMID: 34511973 PMCID: PMC8421249 DOI: 10.2147/jir.s295038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.
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Affiliation(s)
- Hitasha Rupani
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Wei Chern Gavin Fong
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Aref Kyyaly
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Ramesh J Kurukulaaratchy
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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28
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Numata T, Araya J, Miyagawa H, Okuda K, Fujita Y, Utsumi H, Takekoshi D, Hashimoto M, Minagawa S, Ishikawa T, Hara H, Kuwano K. Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study. J Asthma Allergy 2021; 14:609-618. [PMID: 34113131 PMCID: PMC8184231 DOI: 10.2147/jaa.s311975] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/23/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In Japan, biologic therapy was initiated for patients with severe asthma in 2009. In recent years, four biologics with different mechanisms of action have become available in the clinical setting. However, the efficacy of switching between biologics remains uncertain. METHODS To elucidate the efficacy of switching between biologics, 97 patients were enrolled who had received any biologic therapy for severe asthma at Jikei University Hospital, Tokyo, Japan, from July 2009 to December 2020. We retrospectively examined the patient characteristics, biomarkers, pulmonary function test results, selected biologics, and efficacy. RESULTS Thirty-one males and 66 females received any biologics. The mean age was 53.3 years at the initiation of biologic therapy. Initially, 33, 41, 15 and eight patients received omalizumab, mepolizumab, benralizumab, and dupilumab, respectively. Among three representative indicators for biologics administration, the peripheral blood eosinophil count, serum IgE levels and fractional exhaled nitric oxide, 64% of the patients had two indicators, and 28% had three indicators. Thirty-four patients (35%) switched from the initial biologic to another, and the reasons for switching included persistent asthmatic symptoms (n=22), schedule of hospital visits (n=5), and other reasons. Thus, the treatment was effective in 11 patients after switching. In addition, two patients received combination therapy with different biologics. Eighteen patients (19%) interrupted treatment for various reasons. Regardless of whether the biologic was the initial therapy, the overall efficacy of the four biologics was 60% based on the global evaluation of treatment effectiveness. CONCLUSION Switching between biologics can be a promising option for severe asthma patients in whom treatment with an initial biologic is ineffective.
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Affiliation(s)
- Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hanae Miyagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Okuda
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Fujita
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Utsumi
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Takekoshi
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuo Hashimoto
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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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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30
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Pelaia C, Pelaia G, Crimi C, Longhini F, Lombardo N, Savino R, Sciacqua A, Vatrella A. Biologics in severe asthma. Minerva Med 2021; 113:51-62. [PMID: 33555158 DOI: 10.23736/s0026-4806.21.07296-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a chronic airway disease consisting of usually variable airflow limitation and bronchial hyperresponsiveness. Many different phenotypes characterize the clinical expression of asthma, determined by heterogeneous inflammatory patterns driven by distinct cellular and molecular mechanisms known as endotypes. Inside the complex framework of asthma pathobiology, several molecules such as immunoglobulins E (IgE), pro-inflammatory cytokines and their receptors can be targeted by present and future biological treatments of severe asthma. Within this context, already registered monoclonal antibodies including omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab may interfere at various levels with the pathogenic pathways responsible for type-2 airway inflammation. In particular, these drugs target IgE (omalizumab), IL-5 (mepolizumab and reslizumab), IL-5 receptor (benralizumab) and IL-4/IL-13 receptors (dupilumab), respectively. Moreover, other biological therapies are under evaluation in pre-marketing trials, mainly aimed to assess the efficacy and safety of monoclonal antibodies directed against innate cytokines such as IL-33 and thymic stromal lymphopoietin (TSLP). Among current and perspective therapeutic approaches, clinicians can choose phenotype/endotype-driven tailored treatments, able to pursue an effective control of difficult to treat type-2 asthma.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy -
| | - Giulia Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Rocco Savino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Papaioannou AI, Fouka E, Papakosta D, Papiris S, Loukides S. Switching between biologics in severe asthma patients. When the first choice is not proven to be the best. Clin Exp Allergy 2020; 51:221-227. [PMID: 33305478 DOI: 10.1111/cea.13809] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/28/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022]
Abstract
During the last decades, new treatments targeting disease mechanisms referred as biologics have been introduced in the therapy of asthma and currently, five monoclonal antibodies have been approved. Although these therapeutic agents have been formulated to target specific asthma endotypes, it is often difficult for the treating physician to identify which patient is the best candidate for each one of these specific treatments especially in the clinical scenario of a patient in whom clinical characteristics overlap between different endotypes, allowing the selection of more than one biologic agent. As no head-to-head comparisons between these biologics have been attempted, there is no evidence on the superiority of one biologic agent over the other. Furthermore, a physician's first therapeutic decision, no matter how carefully has been made, may often result in suboptimal clinical response and drug discontinuation, indicating the need for switching to a different biologic. In this short review, we discuss the available evidence regarding the switching between biologics in patients with severe asthma and we propose a simple algorithm on switching possibilities in case that the physicians' initial choice is proven not to be the best.
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Affiliation(s)
- Andriana I Papaioannou
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
| | - Evangelia Fouka
- Respiratory Medicine Department, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Papakosta
- Respiratory Medicine Department, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Papiris
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
| | - Stelios Loukides
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
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Pelaia C, Crimi C, Vatrella A, Tinello C, Terracciano R, Pelaia G. Molecular Targets for Biological Therapies of Severe Asthma. Front Immunol 2020; 11:603312. [PMID: 33329598 PMCID: PMC7734054 DOI: 10.3389/fimmu.2020.603312] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022] Open
Abstract
Asthma is a heterogeneous respiratory disease characterized by usually reversible bronchial obstruction, which is clinically expressed by different phenotypes driven by complex pathobiological mechanisms (endotypes). Within this context, during the last years several molecular effectors and signalling pathways have emerged as suitable targets for biological therapies of severe asthma, refractory to standard treatments. Indeed, various therapeutic antibodies currently allow to intercept at different levels the chain of pathogenic events leading to type 2 (T2) airway inflammation. In addition to pro-allergic immunoglobulin E (IgE), that chronologically represents the first molecule against which an anti-asthma monoclonal antibody (omalizumab) was developed, today other targets are successfully exploited by biological treatments of severe asthma. In particular, pro-eosinophilic interleukin 5 (IL-5) can be targeted by mepolizumab or reslizumab, whereas benralizumab is a selective blocker of IL-5 receptor. Moreover, dupilumab behaves as a dual receptor antagonist of pleiotropic interleukins 4 (IL-4) and 13 (IL-13). Besides these drugs that are already available in medical practice, other biologics are under clinical development such as those targeting innate cytokines, also including the alarmin thymic stromal lymphopoietin (TSLP), which plays a key role in the pathogenesis of type 2 asthma. Therefore, ongoing and future biological therapies are significantly changing the global scenario of severe asthma management. These new therapeutic options make it possible to implement phenotype/endotype-specific treatments, that are delineating personalized approaches precisely addressing the individual traits of asthma pathobiology. Such tailored strategies are thus allowing to successfully target the immune-inflammatory responses underlying uncontrolled T2-high asthma.
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Affiliation(s)
- Corrado Pelaia
- Respiratory Medicine Unit, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Caterina Tinello
- Pediatrics Unit, Provincial Outpatient Center of Catanzaro, Catanzaro, Italy
| | - Rosa Terracciano
- Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
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Menzella F, Ruggiero P, Ghidoni G, Fontana M, Bagnasco D, Livrieri F, Scelfo C, Facciolongo N. Anti-IL5 Therapies for Severe Eosinophilic Asthma: Literature Review and Practical Insights. J Asthma Allergy 2020; 13:301-313. [PMID: 32982318 PMCID: PMC7490042 DOI: 10.2147/jaa.s258594] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/22/2020] [Indexed: 01/01/2023] Open
Abstract
Severe refractory asthma (SRA) still has a high economic and social impact, including a reduction in quality of life (QoL), productivity, a greater risk of exacerbations and emergency department (ED) visits. Another major issue is the need of oral corticosteroids (OCS), often due to a poor response to standard therapies or the lack of indication for currently available biological drugs. A thorough understanding of the immunological pathways and eosinophilopoietic processes allows a correct application of the new pharmacological strategies and leads to better clinical responses. For these unmet needs, several monoclonal antibody (mAb) drugs have been introduced over the past few years. These are mainly available for allergic and especially eosinophilic uncontrolled refractory asthma. As the number of therapeutic options increases, the choice of biological drugs can be made only after careful considerations of the particular asthma endotype, patients’ comorbidities and clinical data. The selection of the correct therapeutic option can therefore be guided after a careful evaluation of the particular endotype and phenotype, from the combined evaluation of inflammatory biomarkers, clinical picture and comorbidities. The careful evaluation of all these parameters can therefore help the physician in the optimal management of these complex patients, for whom it is often possible to achieve exceptional results by managing the available options in the best possible way. The aim of this review is to define the positioning of the biological drugs currently available for type 2 asthma, with a special focus on options for eosinophilic asthma in the context of the most recent knowledge of immunological pathways.
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Affiliation(s)
- Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Patrizia Ruggiero
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Giulia Ghidoni
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Matteo Fontana
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Diego Bagnasco
- Allergy & Respiratory Diseases, University of Genoa, Genoa 16132, Italy
| | - Francesco Livrieri
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Chiara Scelfo
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
| | - Nicola Facciolongo
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy
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Bakakos A, Loukides S, Usmani OS, Bakakos P. Biologics in severe asthma: the overlap endotype - opportunities and challenges. Expert Opin Biol Ther 2020; 20:1427-1434. [PMID: 32779950 DOI: 10.1080/14712598.2020.1809651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with severe asthma experience a significant burden of symptoms, disease exacerbations and medication side-effects. Severe asthma interferes with the patients' quality of life and has high health-care costs. New targeted biologic therapies have improved the management of severe asthma by significantly reducing exacerbations and maintenance corticosteroid use, and also improving lung function and patient quality of life. AREAS COVERED Not all severe asthmatics are eligible for such therapies. Those with allergic and eosinophilic asthma, usually referred to as 'T2-high' asthma benefit from anti-IgE and anti-IL-5/5 R antibodies respectively, whereas some asthmatics are eligible for both: 'overlap' endotype. In this review, we present briefly the monoclonal antibodies that have been approved in the management of severe asthma and we focus on the 'overlap' endotype. EXPERT OPINION Since these therapies are costly, it is extremely important to choose the right treatment for the right patient especially in the 'overlapping' one. The decision is mainly based on the judgment of the clinician and is often driven by the most easily obtainable biomarker, thus the blood eosinophil count. Comorbidities, patient's input and administration frequency may aid the decision of choosing one over another biologic.
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Affiliation(s)
- A Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - S Loukides
- 2 University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - O S Usmani
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, & Royal Brompton Hospital , UK
| | - P Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
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