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de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
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Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
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Zhang Y, Lan F, Zhang L. Update on pathomechanisms and treatments in allergic rhinitis. Allergy 2022; 77:3309-3319. [PMID: 35892225 DOI: 10.1111/all.15454] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/10/2022] [Accepted: 07/23/2022] [Indexed: 01/28/2023]
Abstract
Allergic rhinitis (AR) is a global health problem with increasing prevalence and association with an enormous medical and socioeconomic burden. New recognition of immune cells such as type 2 innate lymphocytes (ILC2s), T helper (Th2) 2 cells, follicular helper T cells, follicular regulatory T cells, regulatory T cells, B cells, dendritic cells, and epithelial cells in AR pathogenesis has been updated in this review paper. An in-depth understanding of the mechanisms underlying AR will aid the identification of biomarkers associated with disease and ultimately provide valuable parameters critical to guide personalized targeted therapy. As the only etiological treatment option for AR, allergen-specific immunotherapy (AIT) has attracted increasing attention, with evidence for effectiveness of AIT recently demonstrated in several randomized controlled trials and long-term real-life studies. The exploration of biologics as therapeutic options has only involved anti-IgE and anti-type 2 inflammatory agents; however, the cost-effectiveness of these agents remains to be elucidated precisely. In the midst of the currently on-going COVID-19 pandemic, a global life-threatening disease, although some studies have indicated that AR is not a risk factor for severity and mortality of COVID-19, this needs to be confirmed in multi-centre, real-life studies of AR patients from different parts of the world.
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Affiliation(s)
- Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Feng Lan
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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