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Martinez-Moragon E, Chiner E, Suliana Mogrovejo A, Palop Cervera M, Lluch Tortajada I, Boira Enrique I, Sánchez Vera AF. Real-world clinical remission of severe asthma with benralizumab in Spanish adults with severe asthma. J Asthma 2024:1-15. [PMID: 38520265 DOI: 10.1080/02770903.2024.2332351] [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: 10/02/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Patients with severe eosinophilic asthma experience high risk of exacerbations and reduced quality of life. Benralizumab, a monoclonal antibody binding to IL-5 receptor α subunit, is an approved drug for its treatment. The objective was to describe clinical remission after benralizumab prescription in routine clinical practice. METHODS Retrospective multicenter study with data from four hospitals in Valencian Community (Spain) with asthma units between 2019 and 2020. Data was gathered at baseline and after 12 months. We considered clinical remission after 1 year if the patient remained without exacerbations and use of systemic corticosteroids and with good clinical control and normal lung function. RESULTS Data from 139 patients was gathered. At the 12-month follow-up, 44.1% were in clinical remission, since 84.0%, 77.5%, 51.0% and 95.5% of patients did not experience exacerbations, had total asthma control test score of ≥20, prebronchodilator FEV1 of ≥80% and did not use systemic corticosteroids. A significant reduction of long-acting muscarinic antagonists (p = 0.0001), leukotriene receptor antagonists (p = 0.0326), oral corticosteroids (p < 0.0001) and short-acting beta agonists (p = 0.0499) was observed. Baseline factors with greatest individual influence on clinical remission were employment situation, tobacco use, comorbidity number, eosinophil value, number of exacerbations, FEV1, emergency visit number, and ACT, MiniAQLQ and TAI scores. Final analysis of multiple logistic regression indicated that having baseline FEV1 value below 80% increases remission chance 9.7 times a year compared to FEV1 >80%. CONCLUSION Clinical remission after treatment with benralizumab is achievable in a high percentage of patients with severe asthma eosinophilia not controlled in real life.
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Affiliation(s)
| | - Eusebi Chiner
- Neumologia, Hospital Universitario Sant Joan, Alicante, Spain
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Casale TB, Corbridge T, Germain G, Laliberté F, MacKnight SD, Boudreau J, Duh MS, Deb A. Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:25. [PMID: 38532489 DOI: 10.1186/s13223-024-00882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications. OBJECTIVE Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma. METHODS This retrospective, longitudinal study used claims data from the Optum Clinformatics Data Mart database (GSK ID: 214469). Eligible patients (≥ 12 years old) had an asthma diagnosis and were divided into two cohorts: SCS use and non/burst-SCS use. Patients in the SCS use cohort had a claim for a daily prednisone-equivalent dose ≥ 5 mg SCS following ≥ 6 months of continuous SCS use; those in the non/burst-SCS cohort had no evidence of continuous SCS use and had a non-SCS controller/rescue medication initiation claim. For each cohort, the date of the qualifying claim was the index date. SCS users were further stratified by SCS use during each quarter of follow-up: low (≤ 6 mg/day), medium (> 6-12 mg/day), high (> 12 mg/day), and continuous high (≥ 20 mg/day for 90 days). SCS-related complications were evaluated in the quarter following SCS exposure. The adjusted odds ratios (OR) of experiencing SCS-related complications during follow-up in each of the SCS use groups versus the non/burst SCS cohort were calculated using generalized estimating equations models. RESULTS SCS and non/burst-SCS use cohorts included 7473 and 89,281 patients (mean follow-up: 24.6 and 24.2 months), respectively. Compared with the non/burst-SCS use cohort, medium, high, and continuous high SCS use was associated with greater odds of any SCS-related complication (adjusted OR [95% confidence interval]: 1.30 [1.21, 1.39], 1.49 [1.35, 1.64] and 1.63 [1.40, 1.89], respectively) including increased acute gastrointestinal, cardiovascular, and immune system-related complications, and chronic cardiovascular, metabolic/endocrine, central nervous system, bone-/muscle-related, ophthalmologic, and hematologic/oncologic complications. Low-dose SCS use was also associated with significantly increased odds of acute gastrointestinal and immune system-related complications, and chronic bone-/muscle-related and hematologic/oncologic complications versus the non/burst-SCS use cohort. CONCLUSION SCS use, even at low doses, is associated with increased risk of SCS-related complications among patients with severe asthma.
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Affiliation(s)
- Thomas B Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
| | | | - Guillaume Germain
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - François Laliberté
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Sean D MacKnight
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Julien Boudreau
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Mei S Duh
- Health Economics and Outcomes Research, Analysis Group Inc, Boston, MA, USA
| | - Arijita Deb
- Value Evidence and Outcomes, GSK, Upper Providence, PA, USA.
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Martinez-Moragon E. Cost-Effectiveness of Biologic Therapies in Asthma in Spain. Arch Bronconeumol 2023; 59:621-622. [PMID: 37270405 DOI: 10.1016/j.arbres.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
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Padilla-Galo A, Moya Carmona I, Ausín P, Carazo Fernández L, García-Moguel I, Velasco-Garrido JL, Andújar-Espinosa R, Casas-Maldonado F, Martínez-Moragón E, Martínez Rivera C, Vera Solsona E, Sánchez-Toril López F, Trisán Alonso A, Blanco Aparicio M, Valverde-Monge M, Valencia Azcona B, Palop Cervera M, Nuevo J, Sánchez Tena J, Resler G, Luzón E, Levy Naon A. Achieving clinical outcomes with benralizumab in severe eosinophilic asthma patients in a real-world setting: orbe II study. Respir Res 2023; 24:235. [PMID: 37770889 PMCID: PMC10540395 DOI: 10.1186/s12931-023-02539-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The ORBE II study aimed to describe the characteristics and clinical outcomes of adult patients with severe eosinophilic asthma (SEA) treated with benralizumab in a real-world setting in Spain. METHODS ORBE II (NCT04648839) was an observational, retrospective cohort study in adult SEA patients who had been prescribed benralizumab. Demographic and clinical data of 204 SEA patients were collected 12 months prior to benralizumab initiation (baseline) and at follow-up. Exacerbation rate, asthma symptoms, maintenance oral corticosteroid (OCS) use and lung function were evaluated, among other variables. RESULTS A total of 204 SEA patients were evaluated. Mean (standard deviation, SD) age of the study population was 56.4 (12.4) years, 62.3% were women and mean (SD) duration of asthma was 15.1 (12.7) years. Median (Q1-Q3) follow-up duration was 19.5 (14.2-24.2) months. At baseline, 72.6% of the overall population (OP) presented blood eosinophil counts ≥ 300 cells/µL; 36.8% had comorbid chronic rhinosinusitis with nasal polyps (CRSwNP); 84.8% reported at least one severe exacerbation, and 29.1% were OCS-dependent. At 1 year of follow-up, patients receiving benralizumab treatment had a 85.6% mean reduction in exacerbations from baseline, and 81.4% of patients achieved zero exacerbations. We also found a clinically relevant mean (SD) increase in pre-bronchodilator (BD) FEV1 of 331 (413) mL, with 66.7% of patients achieving a pre-BD FEV1 increase ≥ 100 mL, and 46.3% of patients achieving a pre-BD FEV1 ≥ 80% of predicted. Regarding symptom control, 73.8% of the OP obtained an ACT score ≥ 20 points. After 1 year of follow-up, mean reduction in the daily OCS dose was 70.5%, and complete OCS withdrawal was achieved by 52.8% of the OCS-dependent patients. Almost half (43.7%) of the OP on benralizumab met all four criteria for clinical remission. Patients with concomitant CRSwNP obtained similar or enhanced outcomes. CONCLUSIONS These data support the real-world benefits of benralizumab in SEA patients, and particularly in those with concomitant CRSwNP. TRIAL REGISTRATION NCT04648839.
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Affiliation(s)
| | | | - Pilar Ausín
- H. del Mar, Universidad Pompeu Fabra University (UPF), Barcelona, Spain
| | | | - Ismael García-Moguel
- H. U. 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Javier Nuevo
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
| | | | - Gustavo Resler
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
| | - Elisa Luzón
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
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Drick N, Brinkmann L, Fuge J, Welte T, Suhling H. Influence of anti-interleukin (IL)-5/anti-IL-5 receptor-α treatment on work productivity in patients with severe eosinophilic asthma. ERJ Open Res 2023; 9:00665-2022. [PMID: 37143840 PMCID: PMC10152247 DOI: 10.1183/23120541.00665-2022] [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: 12/08/2022] [Accepted: 02/16/2023] [Indexed: 05/06/2023] Open
Abstract
This retrospective study shows that treatment with anti-eosinophilic antibodies in patients with severe eosinophilic asthma is associated with an increase in work productivity and a decrease in missed days at work https://bit.ly/3IIPppR.
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Affiliation(s)
- Nora Drick
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Nora Drick ()
| | - Lina Brinkmann
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Hendrik Suhling
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Alves S, Rufo JC, Crispim J. Economic evaluation of biological treatments in patients with severe asthma: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:733-747. [PMID: 37265078 DOI: 10.1080/14737167.2023.2221435] [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: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Asthma is a highly prevalent disease, one of the chronic diseases with the highest economic costs; thus, it imposes a high economic burden on society, the healthcare system, patients, and third-party payers. Contrary to this study, until now, systematic reviews of economic evaluations (EEs) of treatments for severe asthma have not been exclusively focused on biological treatments, and have included a small number of studies and only model-based EEs. METHODS This study systematically reviews EEs of biological therapies for severe asthma published until December 2022 using PRISMA guidelines. The review analyzes the cost-effectiveness of biologicals in comparison to SOC, or SOC plus OCS. The quality of the EEs is assessed using Consensus on Health Economics Checklist extended (CHEC-extended). RESULTS Thirty-nine studies were eligible: 15 based on a Markov model, and 19 trial-based; eight adopting societal and NHS perspectives, and seven the payer's perspective. The reviewed EEs addressed cost-effectiveness, cost-utility, and incremental costs and outcomes comparison. Their findings were mainly expressed through ICER-incremental cost-effectiveness ratio (24 studies: 13 concluded that biological were cost-effective) and cost comparison analysis (14 studies: 6 concluded that biological were cost-effective), and were sensitive to a wide variety of factors (e.g. medication cost, treatment response, time horizon, utility benefits, mortality, exacerbation rate, discount rate, etc.). CONCLUSIONS There has been some ambiguity concerning the EE of biological therapies due to variation in choice of study design and contradictory results. Nevertheless, it can be concluded that biological treatments improve health outcomes, in many contexts at a high cost.
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Affiliation(s)
- Sara Alves
- Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Unidade de Epidemiologia, Instituto de Saúde Pública, Porto, Portugal
- Serviço E Laboratório de Imunologia Básica E Clínica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - José Crispim
- NIPE, Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
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Veettil SK, Vincent V, Shufelt T, Behan E, Syeed MS, Thakkinstian A, Young DC, Chaiyakunapruk N. Incremental net monetary benefit of biologic therapies in moderate to severe asthma: a systematic review and meta-analysis of economic evaluation studies. J Asthma 2023:1-13. [PMID: 36825403 DOI: 10.1080/02770903.2023.2183407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma. METHODS We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6-11 years). Heterogeneity was assessed using the I2 statistic. RESULTS A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP (n = 8, INB, -6,341 (95% CI, -$25,000 to $12,210), I2=86.18%) and SP (n = 5, -$14,000 (-$170,000 to $140,000), I2=75.64%). A similar finding was observed in those aged 6-11 years from the HCPP in LMICs (n = 2, -$45,000 (-$73,000 to $17,000), I2=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity. CONCLUSION The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,School of Medicine, Taylor's University, Selangor, Malaysia
| | - Vanessa Vincent
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Taylor Shufelt
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Emma Behan
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - M Sakil Syeed
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi, Hospital, Mahidol University, Bangkok, Thailand.,Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
| | - David C Young
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Menzella F, Ballarin A, Sartor M, Floriani AF, Corsi L, Dartora C, Tonin S, Romagnoli M. Comparison between clinical trials and real-world evidence studies on biologics for severe asthma. J Int Med Res 2022; 50:3000605221133689. [PMID: 36420737 PMCID: PMC9703569 DOI: 10.1177/03000605221133689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2023] Open
Abstract
In recent years, the more widespread availability of biological drugs with specific mechanisms of action has led to significant breakthroughs in the management of severe asthma. Over time, numerous randomised clinical trials have been conducted to evaluate the efficacy and safety of these biologics and define the eligibility criteria of patients suitable for various therapeutic options. These studies were conducted under controlled conditions not always applicable to real life. For this and other reasons, real-world evidence and pragmatic studies are required to provide useful information on the effectiveness of biological drugs and their safety, even in the long term. Because differences in outcomes have sometimes emerged between clinical trials and real-life studies, it is important to clarify the causes of these discrepancies and define the significance of the results of studies conducted in the course of daily clinical practice. Thus, a scientific debate is ongoing, and no consensus has been reached. The purpose of this narrative review is to analyse the differences between randomised trials and real-world evidence studies, focusing on their roles in guiding clinicians among different therapeutic options and understanding the reasons for the large discrepancies often found in the results obtained.
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Affiliation(s)
| | - Andrea Ballarin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Maria Sartor
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | | | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Cristina Dartora
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Silvia Tonin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Micaela Romagnoli
- Pulmonology Unit, Cà Foncello Hospital, AULSS2 Marca Trevigiana, Italy
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Faverio P, Monzio Compagnoni M, Ronco R, Franchi M, Della Zoppa M, Bonaiti G, Bonifazi M, Mei F, Luppi F, Pesci A, Corrao G. Economic impact of anti-IL-5 agents in patients with severe eosinophilic asthma: A population-based cohort study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3026-3028.e2. [PMID: 35961616 DOI: 10.1016/j.jaip.2022.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Paola Faverio
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy.
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Giulia Bonaiti
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Luppi
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Alberto Pesci
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Vivarelli E, Matucci A, Parronchi P, Liotta F, Cosmi L, Rossi O, Cavigli E, Alessandra V. Primary antibody deficiencies represent an underestimated comorbidity in asthma patients: efficacy of immunoglobulin replacement therapy in asthma control. J Asthma 2022; 60:1227-1236. [PMID: 36282045 DOI: 10.1080/02770903.2022.2140435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Primary antibody deficiencies (PAD) are an underestimated comorbidity in asthma and its treatment could improve disease control. METHODS a retrospective cohort of asthmatics, affected by IgG subclass deficiency or unclassified antibody deficiency and treated with low-dose intravenous immunoglobulin replacement therapy (IRT) was recruited. Demographic and clinical data, chest CT scan, blood eosinophils, atopy, chronic oral corticosteroid (OCS) therapy were evaluated at baseline. Asthma exacerbations, lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI) and asthma-related hospitalizations were assessed after one and two years of IRT. RESULTS 57 moderate-to-severe asthmatics were enrolled, mostly affected by T2 low asthma (39/57, 68.4%). After one year, IRT was effective in improving, irrespective of bronchiectasis, atopy, eosinophils and PAD type: 1) trough IgG (826.9 ± 221.3 vs 942.2 ± 195.1 mg/dl; p < 0.0001) and IgG subclasses (IgG1 355.4 ± 88.4 vs 466.7 ± 122.3, p < 0.0001; IgG2 300.1 ± 130.1 vs 347.6 ± 117.3, p < 0.0005) serum levels. 2) asthma exacerbations (6.4 ± 4.1 vs 2.4 ± 1.9, p < 0.0001), LRTI (4.3 ± 3.9 vs 1.3 ± 1.5, p < 0.0001) and hospitalization rate (0.26 ± 0.7 vs 0.05 ± 0.2, p < 0.01). These results persisted after 2 years of therapy. Estimated mean cumulative OCS exposure was reduced by 4500 mg over the 2-year period. CONCLUSIONS low-dose IRT is effective in improving asthma control and lessening OCS burden in asthmatics affected by PAD.
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Affiliation(s)
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
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García-Moguel I, Rosado A, Gómez-Cardeñosa A, Gandolfo-Cano M, Robledo Echarren T, Moro Moro MDM, Reaño Martos MDM, Pineda-Pineda R, Valverde-Monge M, Martin-Arriscado Arroba C, Domínguez-Ortega J. Reliability, Satisfaction and Effectiveness of Benralizumab Home Self-Administration in Patients with Severe Eosinophilic Asthma in Real-World Practice: The Auto-Benra Study. J Asthma Allergy 2022; 15:623-632. [PMID: 35592384 PMCID: PMC9113658 DOI: 10.2147/jaa.s358738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The increase in drugs available for severe uncontrolled asthma and the lifestyle of these patients make it necessary to implement self-administration programs of these therapies at home. Benralizumab, a monoclonal antibody targeting IL5R, was authorized in Spain for poorly controlled severe eosinophilic asthma. The possibility of administration at home was approved in March 2020 in Spain. The aim of the Auto-Benra study was to evaluate the usability and satisfaction of the benralizumab prefilled syringe and autoinjector and assessing the effectivity of these devices in uncontrolled severe eosinophilic asthma (SEA) in home-self administration. Methods This is a retrospective, observational multicenter study uncontrolled SEA patients treated with benralizumab at least with 3 doses self-administered at home before April 30, 2021. Reliability and satisfaction with benralizumab at home were evaluated with subcutaneous administration assessment questionnaire (SQAAQ) and visual analogic scales (VAS). Effectiveness was evaluated in all patients with asthma control test (ACT), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), annual exacerbation rate, oral corticosteroid treatment (OCS) and asthma-related hospitalizations and emergency visits. Results Fifty-four patients across 9 hospitals in Spain were included. The mean SQAAQ score was 6.89 (±0.16) points. Patients and their caregivers and doctors report excellent satisfaction by VAS, with no differences between benralizumab devices used (prefilled syringe and autoinjector). Severe exacerbation rate decreased by 65% (p = 0.0007) after benralizumab treatment. ACT score improved on average 6.27 ± 5.35 points (p < 0.0001) and the mean MiniAQLQ increased up to 1.58 ± 1.47 points (p < 0.0001). Twenty-four patients were OCS-dependent and at the end of study 14 patients get complete OCS withdrawal. Conclusion AUTO-BENRA study supports the use of benralizumab at home given the excellent results of satisfaction and usability by patients and their caregivers.
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Affiliation(s)
- Ismael García-Moguel
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Correspondence: Ismael García-Moguel, Tel +34 645852229, Email
| | - Ana Rosado
- Department of Allergy, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aída Gómez-Cardeñosa
- Department of Allergy, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- Centro de investigación biomédica en enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
| | - Mar Gandolfo-Cano
- Department of Allergy, Hospital Universitario de Fuenlabrada, Madrid, Spain
- RETIC ARADyAL, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Robledo Echarren
- Department of Allergy, Hospital Clinico San Carlos (HCSC), Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | | | | | | | - Marcela Valverde-Monge
- Department of Allergy, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- Centro de investigación biomédica en enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
| | - Cristina Martin-Arriscado Arroba
- Research and Science Support Unit, Instituto de investigación Biomédica del Hospital Universitario 12 de Octubre I+12, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain
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Aguilar-Serra J, Gimeno-Ballester V, Pastor-Clerigues A, Milara J, Trigo-Vicente C, Cortijo J. Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with advanced EGFR-mutated non-small-cell lung cancer. Expert Rev Pharmacoecon Outcomes Res 2021; 22:637-646. [PMID: 34602008 DOI: 10.1080/14737167.2022.1987220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the cost-effectiveness of first-line treatments, such as erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib, for patients diagnosed with stage IIIB/IV NSCLC harboring EGFR mutations. MATERIALS & METHODS A partitioned survival model was developed to estimate quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER) from the perspective of the Spanish National Health System. Two Bayesian NMAs were performed independently, by using the polynomial fraction method to fit Kaplan-Meier curves for overall survival and progression-free survival. Deterministic and probabilistic sensitivity analyses were performed to evaluate the uncertainty. RESULTS The ICER was calculated for the four first-line treatments by comparing them with gefitinib, and the ratios obtained were as follows: €166,416/QALY for osimertinib, €183,682/QALY for dacomitinib, €167,554/QALY for afatinib, €36,196/QALY for erlotinib. It was seen that patients who received osimertinib presented higher QALYs (0.49), followed by dacomitinib (0.33), afatinib (0.32), erlotinib (0.31), and gefitinib (0.28). CONCLUSIONS Gefitinib is the most cost-effective treatment. In terms of QALYs gained, Osimertinib was more effective than all other TKIs. Nevertheless, with a Spanish threshold of €24,000/QALY, the reduction in the acquisition cost of osimertinib will have to be greater than 70%, to obtain a cost-effectiveness alternative.
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Affiliation(s)
- J Aguilar-Serra
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - V Gimeno-Ballester
- Department of Pharmacy, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Pastor-Clerigues
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - J Milara
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,Department of Pharmacy, Research Foundation of General Hospital of Valencia, Valencia, Spain.,CIBERES, Health Institute Carlos III, Valencia, Spain
| | - C Trigo-Vicente
- Department of Pharmacy, C.r.p. Nuestra Señora Del Pilar, Zaragoza, Spain.,Department of Pharmacy, Universidad San Jorge, Zaragoza, Spain
| | - J Cortijo
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,CIBERES, Health Institute Carlos III, Valencia, Spain
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