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Nanzer AM, Maynard-Paquette AC, Alam V, Green L, Thomson L, Lam J, Fernandes M, Roxas C, d'Ancona G, Hearn A, Gates J, Agarwal S, Kent BD, Fernando M, D'Cruz DP, Hopkins C, Ismail TF, Dhariwal J, Jackson DJ. Long-Term Effectiveness of Benralizumab in Eosinophilic Granulomatosis With Polyangiitis. J Allergy Clin Immunol Pract 2024; 12:724-732. [PMID: 38211889 DOI: 10.1016/j.jaip.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease characterized by eosinophilic tissue inflammation. Benralizumab, an anti-IL-5 receptor (anti-IL-5R) monoclonal antibody, induces rapid depletion of eosinophils; its longer-term effect in EGPA is unknown. OBJECTIVE To assess the real-world effectiveness and clinical remission rates of anti-IL-5R therapy in EGPA. METHODS We performed a retrospective cohort analysis of patients with EGPA, who commenced treatment with benralizumab. Clinical remission, assessed at 1 year and 2 years after the initiation of benralizumab, was defined as an absence of active vasculitis (Birmingham Vasculitis Activity Score of 0) and an oral corticosteroid (OCS) dose of ≤4 mg/d of prednisolone. "Super-responders" were defined as patients in remission and free of any significant relapses (asthma or extrapulmonary) over the preceding 12 months. The corticosteroid-sparing capacity of benralizumab, patient-reported outcome measures, and characteristics associated with clinical remission and super-responder status were also analyzed. RESULTS A total of 70 patients completed at least 1 year of treatment with benralizumab, of whom 53 completed 2 years. Of 70 patients, 47 (67.1%) met the definition for clinical remission at 1 year, with a similar proportion in remission at 2 years. Excluding asthma-related relapses, 61 of 70 (87.1%) patients were relapse free at 1 year, and of the 53 who completed 2 years, 45 (84.9%) were relapse free. A total of 67.9% of patients no longer needed any OCS for disease control. No significant difference was seen between antineutrophilic cytoplasmic antibody (ANCA)-positive and ANCA-negative subgroups. CONCLUSIONS In this real-world setting of patients with EGPA, treatment with benralizumab was well tolerated and resulted in corticosteroid-free clinical remission for the majority of patients.
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Affiliation(s)
- Alexandra M Nanzer
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | | | - Vardah Alam
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jodie Lam
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Grainne d'Ancona
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Andrew Hearn
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Jessica Gates
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sangita Agarwal
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Michelle Fernando
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - David P D'Cruz
- Rheumatology Department, Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Claire Hopkins
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Tevfik F Ismail
- Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jaideep Dhariwal
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Crossingham I, Richardson R, Hinks TSC, Spencer S, Couillard S, Maynard-Paquette AC, Thomassen D, Howell I. Biologics for chronic severe asthma: a network meta‐analysis. Cochrane Database of Systematic Reviews 2022; 2022:CD015411. [PMCID: PMC9535695 DOI: 10.1002/14651858.cd015411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of biological agents targeting type‐2 inflammation (benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, tezepelumab) in people with severe asthma, with a network meta‐analysis and to rank agents by effectiveness.
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Affiliation(s)
| | - Iain Crossingham
- Department of Respiratory MedicineEast Lancashire Hospitals NHS TrustBlackburnUK
| | - Rebekah Richardson
- Department of Respiratory MedicineEast Lancashire Hospitals NHS TrustBlackburnUK
| | - Timothy SC Hinks
- Respiratory Medicine Unit and NIHR Oxford Biomedical Research Centre, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Sally Spencer
- Health Research InstituteEdge Hill UniversityOrmskirkUK
| | - Simon Couillard
- Faculté de Médecine et des Sciences de la SantéUniversité de SherbrookeSherbrookeCanada
| | | | - Doranne Thomassen
- Department of Biomedical Data Sciences (Medical Statistics section)Leiden University Medical CenterLeidenNetherlands
| | - Imran Howell
- Respiratory Medicine Unit, Nuffield Department of MedicineUniversity of OxfordOxfordUK
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Gabrysz-Forget F, Maynard-Paquette AC, Kharat A, Tremblay F, Silviet-Carricart M, Lavoie A, Girard M, Dubé BP. Ultrasound-Derived Diaphragm Contractile Reserve as a Marker of Clinical Status in Patients With Cystic Fibrosis. Front Physiol 2022; 12:808770. [PMID: 35082696 PMCID: PMC8784523 DOI: 10.3389/fphys.2021.808770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In patients with cystic fibrosis (CF), the monitoring of respiratory muscle activity using electromyography can provide information on the demand-to-capacity ratio of the respiratory system and act as a clinical marker of disease activity, but this technique is not adapted to routine clinical care. Ultrasonography of the diaphragm could provide an alternative, simpler and more widely available alternative allowing the real-time assessment of the diaphragm contractile reserve (DCR), but its relationship with recognized markers of disease severity and clinical outcomes are currently unknown. Methods: Stable patients with CF were prospectively recruited. Diaphragm ultrasound was performed and compared to forced expiratory volume in 1 s (FEV1), residual volume (RV), handgrip strength, fat-free mass index (FFMI), serum vitamin levels, dyspnea levels and rate of acute exacerbation (AE). Diaphragm activity was reported as DCR (the ratio of tidal-to-maximal thickening fractions, representing the remaining diaphragm contractility available after tidal inspiration) and TFmax (representing maximal diaphragm contractile strength). Inter-observer reliability of the measurement of DCR was evaluated using intra-class correlation analysis. Results: 110 patients were included [61 males, median (interquartile range), age 31 (27–38) years, FEV1 66 (46–82)% predicted]. DCR was significantly correlated to FEV1 (rho = 0.46, p < 0.001), RV (rho = −0.46, p < 0.001), FFMI (rho = 0.41, p < 0.001), and handgrip strength (rho = 0.22, p = 0.02), but TFmax was not. In a multiple linear regression analysis, both RV and FFMI were independent predictors of DCR. DCR, but not TFmax, was statistically lower in patients with > 2 exacerbations/year (56 ± 25 vs. 71 ± 17%, p = 0.001) and significantly lower with higher dyspnea levels. A ROC analysis showed that DCR performed better than FEV1 (mean difference in AUROC 0.09, p = 0.04), RV (mean difference in AUROC 0.11, p = 0.03), and TFmax at identifying patients with an mMRC score > 2. Inter-observer reliability of DCR was high (ICC = 0.89, 95% CI 0.84–0.92, p < 0.001). Conclusion: In patients with CF, DCR is a reliable and non-invasive marker of disease severity that is related to respiratory and extra-pulmonary manifestations of the disease and to clinical outcomes. Future studies investigating the use of DCR as a longitudinal marker of disease progression, response to interventions or target for therapy would further validate its translation into clinical practice.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | | | - Aileen Kharat
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - François Tremblay
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Maité Silviet-Carricart
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Annick Lavoie
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Martin Girard
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département d'Anesthésiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Bruno-Pierre Dubé
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Carrefour de l'Innovation et de l'Évaluation en Santé, Montréal, QC, Canada
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Maynard-Paquette AC, Poirier C, Chartrand-Lefebvre C, Dubé BP. Ultrasound Evaluation of the Quadriceps Muscle Contractile Index in Patients with Stable Chronic Obstructive Pulmonary Disease: Relationships with Clinical Symptoms, Disease Severity and Diaphragm Contractility. Int J Chron Obstruct Pulmon Dis 2020; 15:79-88. [PMID: 32021146 PMCID: PMC6957010 DOI: 10.2147/copd.s222945] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
Rationale Chronic obstructive pulmonary disease (COPD) is associated with changes in the composition and function of peripheral and respiratory muscles, which can negatively impact quality of life. Ultrasonography can provide a non-invasive evaluation of the integrity of both peripheral muscles and diaphragm, but its use in patients with COPD is still being investigated. We aimed at evaluating the relationship between quadriceps size, using ultrasonography and symptoms, lung function and diaphragm contractility in a cohort of patients with COPD. Methods COPD patients were prospectively recruited and ultrasonography of the dominant quadriceps and of the diaphragm was performed. Quadriceps size was evaluated using three measurements: 1) cross-sectional area of the rectus femoris (Qcsa), 2) thickness (Qthick) and 3) contractile index (Qci), defined as the ratio of quadriceps thickness/total anterior thigh thickness. Diaphragm contractility was evaluated using thickening fraction (TFdi). Clinical characteristics and number of moderate-to-severe exacerbations in the previous year were retrieved from medical files. Dyspnea (mMRC scale) and disease impact on health status (COPD Assessment Test (CAT)) were measured at inclusion. Fat-free mass index (FFMI) was assessed using bioelectrical impedance. Results Forty patients were recruited (20 males, mean age and FEV1 66±6 years and 49±17%predicted, respectively). Mean Qcsa, Qthick and Qci were 336±145 mm2, 1.55±0.53 cm and 64±16%, respectively, and mean TFdi was 91±36%. Qci was significantly correlated with FFMI (rho=0.59, p=0.001), TFdi (rho=0.41, p=0.008), FEV1 (rho=0.43, p=0.001) but not with age (rho=0.18, p=0.28). Qci was significantly correlated to CAT score (rho=−0.47, p=0.002), even when controlled for FEV1, and was lower in patients with an mMRC score ≥2 (55±15 vs 70±14%, p=0.002). Qcsa and Qci were significantly lower in patients with frequent exacerbations. In a multiple linear regression analysis that included age, gender, FFMI, FEV1 and TFdi, only FFMI and TFdi were found to be significantly related to lower Qci values. Conclusion In patients with COPD, ultrasound evaluation of the quadriceps contractile index is feasible and related to disease severity, clinical symptoms, exacerbation history and diaphragm contractility. As such, it may provide a novel tool for the evaluation of the severity and burden of the disease in this population. Further studies are required to better delineate its potential role as a prognostic marker in this population.
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Affiliation(s)
| | - Claude Poirier
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Respiratory Medicine Division, Montreal, Quebec, Canada
| | - Carl Chartrand-Lefebvre
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Montréal, Québec, Canada.,Research Center of the CHUM (CRCHUM) - Imaging and Engineering Axis, Montreal, Quebec, Canada
| | - Bruno-Pierre Dubé
- Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Respiratory Medicine Division, Montreal, Quebec, Canada.,Research Center of the CHUM (CRCHUM) - Health Innovation and Evaluation Hub, Montreal, Quebec, Canada
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