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Murphy KR, Beuther DA, Chipps B, Wise RA, McCann W, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Ross M, Coyne KS, Zeiger RS. Impact of Clinical Characteristics and Biomarkers on AIRQ Exacerbation Prediction Ability. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00436-7. [PMID: 38705273 DOI: 10.1016/j.jaip.2024.04.050] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Complex models combining impairment-based control assessments with clinical characteristics and biomarkers have been developed to predict asthma exacerbations. The composite Asthma Impairment and Risk Questionnaire (AIRQ) with adjustments for demographics (age, sex, race, body mass index [BMI]) predicts 12-month exacerbation occurrence similarly to these more complex models. OBJECTIVE To examine whether AIRQ exacerbation prediction is enhanced when models are adjusted for a wider range of clinical characteristics and biomarkers. METHODS Patients aged ≥12 years completed monthly online surveys regarding exacerbation-related oral corticosteroid use, emergency-department/urgent-care visits, and hospitalizations. Univariate logistic regressions to predict exacerbations were performed with sociodemographics, comorbidities, exacerbation history, lung function, blood eosinophils, immunoglobulin E, and fractional exhaled nitric oxide. Significant (P≤0.05) variables were included in multivariable logistic regressions with and without AIRQ control categories to predict 12-month exacerbations (log odds ratio [OR], 95% Wald confidence interval [CI]). Model performances were compared. RESULTS Over 12 months, 1070 patients (70% female; mean[SD] age 43.9[19.4] years; 22% non-White; BMI[SD] 30.6[8.7]) completed ≥1 survey (mean[SD] 10.5[2.8]). In the multivariable analysis, AIRQ control category adjusted for significant clinical characteristics and biomarkers was predictive of ≥1 exacerbation: OR(95%CI) not well-controlled vs well-controlled: 1.93(1.41-2.62), very poorly controlled vs well-controlled: 3.81(2.65-5.47). Receiver operating characteristic area under the curve for this more complex model of exacerbation prediction (AUC=0.72) did not differ from AIRQ (AUC=0.70). Models with AIRQ performed better than those without AIRQ (AUC=0.67, P<0.05). CONCLUSION Costly and time-consuming complex modeling with clinical characteristics and biomarkers does not enhance the strong exacerbation prediction ability of AIRQ.
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Affiliation(s)
- Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, NE, United States.
| | | | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, United States.
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | | | - Joan Reibman
- New York University School of Medicine, New York, NY, United States.
| | - Maureen George
- Columbia University School of Nursing, New York, NY, United States.
| | | | | | | | | | | | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, United States.
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McCann W, Murphy KR, Zeiger RS, Beuther DA, Wise RA, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Cutts K, Coyne KS, Chipps B. Assessing meaningful change in the Asthma Impairment and Risk Questionnaire. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00085-1. [PMID: 38369256 DOI: 10.1016/j.anai.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, yes/no, equally weighted control tool. Lower scores indicate better control. Moreover, 7 impairment items reflect previous 2-week symptoms, and 3 risk items assess previous 12-month exacerbations. The Follow-up AIRQ for use between annual assessments has a 3-month recall period for exacerbation items. OBJECTIVE To evaluate the responsiveness of the AIRQ over time and identify a minimal important difference (MID). METHODS The AIRQ longitudinal study data were analyzed from patients with asthma aged 12 years and older. Anchor-based methods assessed differences in AIRQ scores relative to Patient Global Impression of Change, the accepted MIDs for St. George's Respiratory Questionnaire and Asthma Control Test, and exacerbation occurrence over 12 months. Baseline and 12-month data reflected 12-month recall AIRQ scores; Follow-up AIRQ scores were used for 3-, 6-, and 9-month analyses. RESULTS A total of 1070 patients were included. The Patient Global Impression of Change rating of "much improved" was associated with AIRQ mean score changes from baseline to months 3, 6, 9, and 12 of -2.0, -1.9, -1.9, and -1.8, respectively. The mean AIRQ score change among patients who met the St. George's Respiratory Questionnaire MID (≥4-point decrease) was -1.8 at 6 and 12 months. The AIRQ mean scores decreased from baseline by -2.2 to -2.5 points at months 3, 6, 9, and 12 for patients who met the Asthma Control Test MID (≥ 3-point increase). A 2-point higher baseline AIRQ score was associated with a 1.7 odds ratio of 12-month exacerbation occurrence (95% CI, 1.53-1.89). CONCLUSION A change score of 2 is recommended as the AIRQ MID.
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Affiliation(s)
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, California
| | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | - Katelyn Cutts
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Karin S Coyne
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
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Beasley R, Hughes R, Agusti A, Calverley P, Chipps B, del Olmo R, Papi A, Price D, Reddel H, Müllerová H, Rapsomaniki E. Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness. Am J Respir Crit Care Med 2024; 209:390-401. [PMID: 38029294 PMCID: PMC10878375 DOI: 10.1164/rccm.202308-1436oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale: The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. Objective: To explore this uncertainty in patients aged ⩾12 years with physician-assigned diagnoses of asthma, asthma and chronic obstructive pulmonary disease (COPD), or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries. Methods: The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (ΔFEV1 or ΔFVC ⩾12% and ⩾200 ml) and 2021 (ΔFEV1 or ΔFVC >10% predicted) European Respiratory Society/American Thoracic Society criteria. Measurements and Main Results: We studied 3,519 patients with a physician-assigned diagnosis of asthma, 833 with a diagnosis of asthma + COPD, and 2,436 with a diagnosis of COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma + COPD), and 24.7% (COPD) using 2005 criteria and 18.1%, 23.3%, and 18.0%, respectively, using 2021 criteria. Using 2021 criteria in patients diagnosed with asthma, BDR was associated with higher fractional exhaled nitric oxide; lower lung function; higher symptom burden; more frequent hospital admissions; and greater use of triple therapy, oral corticosteroids, or biologics. In patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden. Conclusions: BDR prevalence in patients with chronic airway diseases receiving treatment ranges from 18% to 30%, being modestly lower with the 2021 than with the 2005 European Respiratory Society/American Thoracic Society criteria, and it is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma and instead suggest that BDR be considered a treatable trait for chronic airway disease.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, Clinical, AstraZeneca, Cambridge, United Kingdom
| | - Alvar Agusti
- University of Barcelona, Respiratory Institute, Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
| | - Peter Calverley
- University of Liverpool Institute of Life Course and Medical Sciences, Liverpool, United Kingdom
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Ricardo del Olmo
- Diagnostic and Treatment Department of María Ferrer Hospital & IDIM CR, Buenos Aires, Argentina
| | - Alberto Papi
- Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, University of Ferrara, Ferrara, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Helen Reddel
- Woolcock Institute of Medical Research, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University
- Sydney Local Health District, Sydney, Australia; and
| | - Hana Müllerová
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
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Blaiss M, Oppenheimer J, Corbett M, Bacharier L, Bernstein J, Carr T, Chipps B, Couillard S, Forno E, Grant T, Lugogo N, May K, Schauberger E. Consensus of an American College of Allergy, Asthma, and Immunology, American Academy of Allergy, Asthma, and Immunology, and American Thoracic Society workgroup on definition of clinical remission in asthma on treatment. Ann Allergy Asthma Immunol 2023; 131:782-785. [PMID: 37690606 DOI: 10.1016/j.anai.2023.08.609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Michael Blaiss
- Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - John Oppenheimer
- Clinical Research at Pulmonary and Allergy Associates, Cedar Knolls, New Jersey; Department of Medicine at University of Medicine and Dentistry New Jersey-Rutgers, Newark, New Jersey.
| | - Mark Corbett
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Leonard Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jonathan Bernstein
- University of Cincinnati College of Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, Ohio
| | - Tara Carr
- Asthma and Airway Disease Research Center, The University of Arizona, Tucson, Arizona
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Simon Couillard
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Erick Forno
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Torie Grant
- Department of Pediatrics and Medicine, Division of Pediatric Allergy, Immunology, and Rheumatology, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Njira Lugogo
- Division of Pulmonary Critical Care Medicine University of Michigan, Ann Arbor, Michigan
| | | | - Eric Schauberger
- Department of Pediatrics, Allergy/Immunology Fellowship Program, University of Wisconsin-Madison, Madison, Wisconsin
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Wise RA, Chipps B, Murphy KR, Beuther DA, Reibman J, McCann W, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Cutts K, George M, Zeiger RS. Confirmatory cross-sectional validation of the Asthma Impairment and Risk Questionnaire. J Allergy Clin Immunol Pract 2023; 11:3531-3533.e1. [PMID: 37474101 DOI: 10.1016/j.jaip.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | | | | | - Joan Reibman
- New York University School of Medicine, New York, NY
| | | | | | | | | | | | | | | | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Bernard J. Tyson School of Medicine, Pasadena, Calif
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Chipps B, Zeiger RS, Beuther DA, Reibman J, Wise RA, McCann W, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Cutts K, George M, Murphy KR. The Asthma Impairment and Risk Questionnaire enhances the assessment of asthma control. Ann Allergy Asthma Immunol 2023; 131:436-443.e1. [PMID: 37105501 DOI: 10.1016/j.anai.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Asthma control is often overestimated in routine practice, and despite advances in the understanding of immunopathology and the availability of new precision therapies, the burden of disease remains unacceptably high. OBJECTIVE To compare the performance of the Asthma Impairment and Risk Questionnaire (AIRQ) with patient and physician assessments and the Asthma Control Test (ACT) in identifying asthma control. METHODS Baseline data from a longitudinal study of the AIRQ were analyzed. Patients with asthma in the United States aged 12 years and older followed in 24 specialty practices and 1 specialty-affiliated primary care clinic were enrolled between May and November 2019. At entry, participants completed AIRQ and ACT, and participants and physicians completed 5-point Likert scale assessments of control. RESULTS A total of 1112 participants were enrolled (mean [SD] age = 43.9 [19.3] years, 70% of the female sex, 78% White). Overall, 62% of participants rated themselves as well- or completely controlled, and 54% were rated comparably by physicians. The ACT classified 49% of participants as well-controlled, with 35% similarly categorized by AIRQ. Previous-year exacerbations were experienced by 32% of participants who self-rated as well- or completely controlled, 30% who were rated as well- or completely controlled by physicians, and 29% assessed as well-controlled by ACT, but only 15% of those classified as well-controlled by AIRQ. CONCLUSION The burden of asthma is substantial in patients cared for by asthma specialists, and asthma control is overestimated by patients, physicians, and the symptom-based ACT. The AIRQ assesses risk in addition to symptom control and may serve to improve asthma control determination by assessing previous exacerbations.
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Affiliation(s)
- Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California.
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | - Gale Harding
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Katelyn Cutts
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
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Chipps B, Papi A, Albers F, Cooper M, Gilbert I, Jorup C, Trudo F, Cappelletti C, Weinberg M. Albuterol-budesonide Fixed-dose Combination (FDC) Inhaler As-needed Reduces Progression from Symptomatic Deterioration to Severe Exacerbation in Patients with Moderate-to-severe Asthma: Analysis from MANDALA. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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McCann W, Chipps B, Beuther D, Zeiger R, Wise R, Reibman J, George M, Gilbert I, Eudicone J, Gandhi H, Harding G, Cutts K, Murphy K. The Asthma Impairment and Risk Questionnaire (AIRQ®) Predicts Short- and Long-term Risk of Exacerbations in Adolescents and Adults with Asthma. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Murphy K, Chipps B, Beuther D, McCann W, Wise R, Reibman J, George M, Gilbert I, Eudicone J, Gandhi H, Coyne K, Ross M, Zeiger R. Asthma Impairment and Risk Questionnaire (AIRQ®) Score Predicts Risk for Multiple Exacerbations Among Patients with Very Poorly Controlled Disease. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Carr W, Chipps B, Panettieri R, Soong W, Trevor J, Carstens D, Genofre E, Ambrose C. Biologic Outcomes Among US Subspecialist-treated Adults with Severe Asthma and Allergic Disease: Results from the CHRONICLE Study. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Beuther DA, Murphy KR, Zeiger RS, Wise RA, McCann W, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Ross M, Coyne KS, Chipps B. The Asthma Impairment and Risk Questionnaire (AIRQ) Control Level Predicts Future Risk of Asthma Exacerbations. J Allergy Clin Immunol Pract 2022; 10:3204-3212.e2. [PMID: 35998877 DOI: 10.1016/j.jaip.2022.08.017] [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] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, equally weighted, yes/no control tool validated in patients with asthma aged 12 years and older. OBJECTIVE To evaluate AIRQ's ability to predict patient-reported exacerbations over 12 months. METHODS Patients completed a baseline AIRQ during an in-person enrollment visit and reported exacerbations (ie, asthma-related courses of oral corticosteroids, emergency department/urgent care visits, and hospitalizations) via monthly online surveys. Logistic regressions were performed using AIRQ control level (well-controlled [WC], not well-controlled [NWC], very poorly controlled [VPC]), age, sex, race, and body mass index as covariates and 1 or more and 2 or more exacerbations as the dependent variables (adjusted odds ratios [OR] and 95% Wald CIs). Kaplan-Meier analyses of time to first exacerbation by AIRQ control level were performed. RESULTS A total of 1,112 patients were enrolled; 1,070 completed 1 or more surveys over 12 months (mean ± SD 10.5 ± 2.8 months); 70.5% female; age 43.9 ± 19.3 years; 20.4% non-White; body mass index 30.6 ± 8.7 kg/m2; AIRQ: WC 35.2%, NWC 38.1%, VPC 26.6%. A total of 45.7% of patients reported 1 or more exacerbations and 26.7% 2 or more exacerbations (WC 28.4% ≥ 1, 11.1% ≥ 2; NWC 46.3% ≥ 1, 27.9% ≥ 2; VPC 67.7% ≥ 1, 45.6% ≥ 2). The ORs for 1 or more exacerbations NWC versus WC were 2.1 (CI 1.6-2.9), and VPC versus WC were 4.6 (CI 3.3-6.5). The ORs for 2 or more exacerbations NWC versus WC were 3.1 (CI 2.1-4.6), and VPC versus WC were 6.1 (CI 4.0-9.1). Kaplan-Meier curves demonstrated clear differentiation of time to first exacerbation by AIRQ control level (P < .001). CONCLUSIONS The AIRQ control level predicts exacerbation risk over 12 months and probability of time to first exacerbation.
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Affiliation(s)
- David A Beuther
- Department of Medicine, National Jewish Health, Denver, Colo.
| | - Kevin R Murphy
- Department of Pediatrics, Boys Town National Research Hospital, Boys Town, Neb
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Joan Reibman
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Maureen George
- Department of Nursing, Columbia University, New York, NY
| | | | | | | | | | | | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA
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Soong W, Chipps B, Carr W, Trevor J, Clarke N, Carstens D, Genofre E, Ambrose C. QUALITY OF LIFE IMPROVEMENTS WITH BIOLOGIC INITIATION AMONG SPECIALIST-TREATED US PATIENTS WITH SEVERE ASTHMA. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chipps B, Soong W, Panettieri R, Carr W, Gandhi H, Zhou W, Llanos-Ackert J, Ambrose C. PATIENT-REPORTED TRIGGER NUMBER IS A STRONG PREDICTOR OF UNCONTROLLED DISEASE AMONG PATIENTS WITH SEVERE ASTHMA. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Golam SM, Janson C, Beasley R, FitzGerald JM, Harrison T, Chipps B, Hughes R, Müllerová H, Olaguibel JM, Rapsomaniki E, Reddel HK, Sadatsafavi M. The burden of mild asthma: Clinical burden and healthcare resource utilisation in the NOVELTY study. Respir Med 2022; 200:106863. [DOI: 10.1016/j.rmed.2022.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Chipps B, Lugogo N, Carr W, Genofre E, Trudo F, Ambrose C. Clinical Remission with Biologic Use Among US Subspecialist-treated Patients with Severe Asthma: Results from the CHRONICLE Study. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Murphy K, Beuther D, Chipps B, Wise R, McCann W, Reibman J, George M, Gilbert I, Eudicone J, Gandhi H, Ross M, Coyne K, Zeiger R. Impact of Clinical and Biomarker Covariates on the Ability of the Asthma Impairment and Risk Questionnaire (AIRQ®) to Predict Future Exacerbations. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chipps B, Soong W, Panettieri R, Carr W, Cook B, Llanos-Ackert J, Ambrose C. P065 DISEASE TRIGGERS AND ASSOCIATED QUALITY OF LIFE AMONG SPECIALIST-TREATED US PATIENTS WITH SEVERE ASTHMA. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Blaiss M, Berger W, Chipps B, Hernandez-Trujillo V, Phipatanakul W, Steward K. Review of efficacy of ciclesonide for the treatment of asthma in children. Allergy Asthma Proc 2021; 42:461-470. [PMID: 34871153 DOI: 10.2500/aap.2021.42.210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Ciclesonide (CIC) is an inhaled corticosteroid (ICS) approved for the maintenance treatment of asthma in patients ages ≥ 12 years. The prodrug aspect of CIC is associated with a safety profile that may make it ideal for children. Objective: The objective was to summarize efficacy results from the eight phase III, randomized, double-blind, controlled trials in children with asthma conducted during CIC clinical development. Methods: Four trials compared CIC 40, 80, or 160 µg/day with placebo. Two trials compared CIC 160 µg/day with fluticasone propionate 200 µg/day, one trial compared CIC 80 or 160 µg/day with fluticasone 200 µg/day, and one trial compared CIC 160 µg/day with budesonide 400 µg/day. Results: The primary end point was met by at least two CIC doses versus placebo in the trials in which the primary end point was the change from baseline in lung function outcome (forced expiratory volume in 1 second [FEV1] % predicted or morning peak expiratory flow [PEF]). A trial that compared CIC with placebo did not meet the primary end point of superiority in time-to-first severe wheeze exacerbation or lack of improvement. The primary end point of noninferiority to the active control (fluticasone or budesonide) in the change from baseline in a lung function outcome (FEV1, morning PEF, evening PEF) was met with the CIC 160-µg dose in all active control trials. CIC generally demonstrated statistically significant improvements in forced expiratory flow at 25%-75% of forced vital capacity, asthma symptoms, rescue medication use, and asthma control when compared with placebo and noninferiority for these outcomes compared with fluticasone or budesonide. Conclusion: In children with asthma, once-daily CIC significantly improved large and small airway function, asthma symptoms, and asthma control, and reduced rescue medication use compared with placebo. CIC was comparable with other ICS used to treat asthma in children, which demonstrated its worth for the pediatric population.
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Affiliation(s)
- Michael Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta Georgia
| | - William Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, California
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
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Panettieri R, Lugogo N, Moore W, Chipps B, Jepson B, Zhou W, Ambrose C, Genofre E, Carstens D. P062 BENRALIZUMAB REAL-WORLD EFFECTIVENESS ON EXACERBATIONS AMONG US SPECIALIST-TREATED PATIENTS WITH SEVERE ASTHMA: DATA FROM CHRONICLE. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
An estimated 7 million children in the United States have asthma, which causes a significant health care burden and affects quality of life. The minority of these children have asthma that does not respond to Global Initiative for Asthma steps 4 and 5 care, and biological medications are recommended at this level in the 2019 Global Initiative for Asthma recommendations. In addition, biologics have been introduced into the care of children with allergic skin diseases. Omalizumab and mepolizumab are approved for children as young as 6 years, and benralizumab and dupilumab are approved for people aged ≥12 years. Reslizumab is approved only for people aged ≥18 years. These monoclonal antibodies may be added for appropriate patients when asthma or allergic skin diseases are not well controlled. Pediatricians and pediatric subspecialists should work together and be aware of the benefits and risks of these medications for their patients, as well as the practical implications of providing these options for their patients. This clinical report serves as an evaluation of the current literature on these types of medications in the treatment of children with asthma and allergic skin disease.
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Affiliation(s)
- Heather Hoch De Keyser
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, School of Medicine, University of Colorado Anschutz, Breathing Institute at Children's Hospital Colorado, Denver, Colorado
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Chitra Dinakar
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
- Deceased
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21
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Blaiss M, Berger W, Chipps B, Hernandez-Trujillo V, Phipatanakul W, Steward K. Safety of ciclesonide in children with asthma: A review of randomized controlled trials. Allergy Asthma Proc 2021; 42:471-480. [PMID: 34871154 DOI: 10.2500/aap.2021.42.210085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Parental concerns about the adverse effects of asthma medications can lead to nonadherence and uncontrolled asthma in children. Ciclesonide (CIC) is a prodrug, with low oropharyngeal deposition and bioavailability that may minimize the risk of local and systemic adverse effects. CIC is U.S. Food and Drug Administration approved for asthma in children ages ≥ 12 years. Objective: To summarize safety results from the 13 phase II or III randomized controlled trials conducted in children with asthma during CIC clinical development. Methods: Four 12- to 24-week trials compared the safety of once-daily CIC 40, 80, or 160 µg/day with placebo; four 12-week trials compared the safety of CIC 80 or 160 µg/day with either fluticasone or budesonide; one 12-month trial compared the long-term safety of CIC 40, 80, or 160 µg/day with fluticasone; one 12-month trial compared growth velocity of CIC 40 or 160 µg/day with placebo; and three cross-over trials compared short-term growth velocity and hypothalamic-pituitary-adrenal (HPA) axis effects of CIC 40, 80, or 160 µg/day with placebo or fluticasone. Results: In all, 4399 children were treated with CIC. The incidence of treatment-emergent adverse events (AE) was similar among the CIC doses and between CIC and placebo in short-term studies and between CIC and fluticasone in the long-term safety study. No CIC-related serious AEs were reported in any study. The incidence of treatment-related oral candidiasis was low and similar between CIC (≤0.5%) and placebo (≤0.7%) or active controls (≤0.5%) in the short-term studies. There was no clinically relevant HPA axis suppression or reduction in growth velocity associated with CIC. Conclusion: Data from 13 studies demonstrate that CIC is associated with low rates of oropharyngeal AEs, with no indication of clinically relevant systemic effects in children with asthma. The favorable safety profile and demonstrated improvements in asthma control make CIC an ideal inhaled corticosteroid for the treatment of asthma in children.
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Affiliation(s)
- Michael Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - William Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, California
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
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Liu MC, Chipps B, Munoz X, Devouassoux G, Bergna M, Smith SG, Price RG, Galkin DV, Azmi J, Mouneimne D, Albers FC, Chapman KR. Benefit of switching to mepolizumab from omalizumab in severe eosinophilic asthma based on patient characteristics. Respir Res 2021; 22:144. [PMID: 33971856 PMCID: PMC8111733 DOI: 10.1186/s12931-021-01733-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/25/2021] [Accepted: 04/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background The OSMO study assessed the efficacy of switching to mepolizumab in patients with severe eosinophilic asthma that was uncontrolled whilst receiving omalizumab. The objective of this analysis was to assess the proportion of patients achieving pre-defined improvements in up to four efficacy outcomes and the relationship between patient baseline characteristics and treatment response. Methods This was a post hoc analysis of OSMO study data (GSK ID:204471; ClinicalTrials.gov No. NCT02654145). Patients with severe eosinophilic asthma uncontrolled by high-dose inhaled corticosteroids, other controller(s) and omalizumab subcutaneously (≥ 4 months) were switched to mepolizumab 100 mg administered subcutaneously. Endpoints included the proportion of responders—i.e. patients achieving a pre-defined clinical improvement in ≥ 1 of the following outcomes: (1) Asthma Control Questionnaire (ACQ)-5 score (≥ 0.5-points), (2) St George’s Respiratory Questionnaire (SGRQ) total score (≥ 4-points), (3) pre-bronchodilator forced expiratory volume in 1s (FEV1; ≥ 100 mL), all at Week 32, and (4) annualised rate of clinically significant exacerbations (≥ 50% reduction). Results Of the 145 patients included, 94%, 83%, 63% and 31% were responders for ≥ 1, ≥ 2, ≥ 3 and 4 outcomes, respectively; 75% and 78% were ACQ-5 and SGRQ score responders, and 50% and 69% were FEV1 and exacerbation responders. Subgroup analyses demonstrated improvements irrespective of baseline blood eosinophil count, prior omalizumab treatment regimen/duration, comorbidities, prior exacerbation history, maintenance oral corticosteroid use, ACQ-5 and SGRQ scores, and body weight/body mass index. Conclusions After switching to mepolizumab, almost all patients with uncontrolled severe eosinophilic asthma on omalizumab achieved a beneficial response in ≥ 1 clinical outcome. Improvements were observed regardless of baseline characteristics. Trial registration This manuscript is a post hoc analysis of data from the OSMO study. ClinicalTrials.gov, NCT02654145. Registered January 13, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01733-9.
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Affiliation(s)
- Mark C Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, CA, USA
| | - Xavier Munoz
- Pulmonology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Ciber Enfermedades Respiratorias, Madrid, Spain
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, UCB Lyon, Lyon, France
| | - Miguel Bergna
- Respiratory Research, CEMER, Vicente Lopez, Buenos Aires, Argentina
| | - Steven G Smith
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | | | - Dmitry V Galkin
- Global Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.,Chiesi USA, Cary, NC, USA
| | - Jay Azmi
- Respiratory TAU, GSK, Uxbridge, Middlesex, UK
| | | | - Frank C Albers
- Global Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA.,Avillion US Inc, Northbrook, IL, USA
| | - Kenneth R Chapman
- Asthma and Airway Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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Beuther D, Murphy K, Zeiger R, Wise R, McCann W, Reibman J, George M, Gilbert I, Eudicone J, Ghandi H, Coyne K, Ross M, Chipps B. Baseline Asthma Impairment and Risk Questionnaire (AIRQ™) Control Level is Associated with Future Risk of Exacerbations. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lugogo N, Judson E, Haight E, Trudo F, Chipps B, Trevor J, Ambrose C. Effects of Sex and Age on Characteristics of United States Patients With Severe Asthma. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schwartz Z, Skowronski C, Roc A, Chipps B, Hanania N, Rogers L, Wang E, Wechsler M. Expert Advice on Managing Severe Asthma: An Interactive Decision Support Tool Provides Real-Time Expert Recommendations. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chipps B, Murphy K, Wise R, McCann W, Beuther D, Reibman J, George M, Eudicone J, Gandhi H, Harding G, Ross M, Zeiger R. P223 EVALUATING PERFORMANCE OF THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ™) AT 3-MONTH INTERVALS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chapman K, Devouassoux G, Liu M, Chipps B, Munoz X, Bergna M, Gruber A, Price R, Smith S, Bourdin A. P205 SWITCH FROM OMALIZUMAB TO MEPOLIZUMAB IN SEVERE EOSINOPHILIC ASTHMA: EFFECT OF WEIGHT AND BMI. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chipps B, Murphy K, Beuther D, Reibman J, Wise R, McCann W, Gilbert I, Eudicone J, Gandhi H, Coyne K, Cutts K, George M, Zeiger R. CONFIRMATORY CROSS-SECTIONAL VALIDATION OF THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ). Chest 2020. [DOI: 10.1016/j.chest.2020.08.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chipps B, Mosnaim G, Mathur SK, Shaikh A, Khoury S, Gopalan G, Palli SR, Lamerato L, Casciano J, Dotiwala Z, Settipane R. Add-on tiotropium versus step-up inhaled corticosteroid plus long-acting beta-2-agonist in real-world patients with asthma. Allergy Asthma Proc 2020; 41:248-255. [PMID: 32414426 DOI: 10.2500/aap.2020.41.200036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: A step-up approach (increasing inhaled corticosteroid [ICS] dose and/or add-on treatment) is recommended for asthma that is uncontrolled despite ICS plus long-acting beta-2-agonist (LABA) combination treatment. Understanding the impact of different treatment options on health outcomes can help guide treatment decision-making. Objective: To compare the effectiveness of add-on tiotropium 1.25 µg (two puffs once daily) versus an increased ICS plus LABA dose in a real-world cohort of patients with asthma initiated on ICS plus LABA. Methods: De-identified data from patients ages ≥12 years and with asthma who were initiated on ICS plus LABA, and then had tiotropium added (Tio group; index date) or an ICS plus LABA dose increased (inc-ICS group; index date) were collected from two medical and pharmacy claims data bases (2014-2018). To account for population/group differences, propensity score matching was performed. The primary end point was the exacerbation risk after the index date. Secondary end points included exacerbation rates 6 and 12 months postindex, health-care resource utilization, costs, and short-acting beta-2-agonist (SABA) refills 12 months postindex. Results: Overall, 7857 patients (Tio group, 2619; inc-ICS group, 5238) were included. The exacerbation risk was 35% lower in the Tio group than in the inc-ICS group (hazard ratio 0.65 [95% confidence interval, 0.43-0.99]; p = 0.044). Exacerbation rates in the Tio group also were significantly lower within 6 and 12 months postindex (64% and 73%, respectively). All-cause and asthma-related emergency department (ED) visits were 47% and 74% lower, respectively (p < 0.0001 for both), and all-cause and asthma-related hospitalizations were 48% (p < 0.01) and 76% (p < 0.001) lower, respectively, in the Tio group. Also, significantly fewer patients in the Tio group versus the inc-ICS group required SABA refills (56% versus 67%, p < 0.0001). Conclusion: Add-on tiotropium significantly decreased the risk and rate of exacerbations, decreased all-cause and asthma-related ED visits and hospitalizations, and reduced SABA refills compared with increasing the ICS plus LABA dose. The findings supported the use of add-on tiotropium for patients with uncontrolled asthma taking ICS plus LABA.
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Affiliation(s)
- Bradley Chipps
- From the Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University HealthSystem, Chicago, Illinois
| | - Sameer K. Mathur
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Samir Khoury
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Gokul Gopalan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Swetha R. Palli
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | | | - Russell Settipane
- Allergy and Immunology, The Allergy and Asthma Center, East Providence, Rhode Island
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Chipps B, Taylor B, Bayer V, Shaikh A, Mosnaim G, Trevor J, Rogers S, Del Aguila M, Paek D, Wechsler ME. Relative efficacy and safety of inhaled corticosteroids in patients with asthma: Systematic review and network meta-analysis. Ann Allergy Asthma Immunol 2020; 125:163-170.e3. [PMID: 32302768 DOI: 10.1016/j.anai.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICSs) are recommended as first-line controller medications for persistent asthma. However, guidelines on the initial ICS doses, step-up and step-down algorithms, and when to switch to combination therapy vary. OBJECTIVE To understand the ideal starting doses of ICS therapy based on current evidence and to systematically compare low, moderate, and high starting doses of ICSs as monotherapy and in combination with long-acting β-agonists with respect to efficacy and safety. METHODS MEDLINE, Embase, and Cochrane databases were searched for relevant English-language articles published from 1980 to November 17, 2018. Randomized controlled trials with adult, steroid-naive, ICS-free (for ≥4 weeks) patients with asthma and a duration of 4 weeks or longer with an ICS treatment arm (monotherapy or combination therapy) were included. Separate fixed-effects Bayesian network meta-analyses were conducted on the extracted data for peak expiratory flow, forced expiratory volume in 1 second, nighttime rescue medication use, nighttime symptom score, and study withdrawal because of an adverse event. RESULTS A total of 31 randomized controlled trials were analyzed. All starting doses of ICSs were comparable with respect to nighttime rescue medication use, nighttime symptom score, change in forced expiratory volume in 1 second, and study withdrawal because of an adverse event. Significant improvement in morning peak expiratory flow was observed with high-dose ICSs and with low- and moderate-dose ICSs and long-acting β-agonists than with low-dose ICSs. CONCLUSION Overall, a high starting dose of ICSs had no additional clinical benefit in 3 of the 4 efficacy parameters compared with low or moderate ICS doses for controlling moderate to severe asthma but might have potential safety concerns.
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Affiliation(s)
- Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Ben Taylor
- Doctor Evidence, Santa Monica, California
| | - Valentina Bayer
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Jennifer Trevor
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Sheri Rogers
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | | | - Dara Paek
- Doctor Evidence, Santa Monica, California
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Wechsler M, Peters S, Chipps B, Hill T, Ariely R, Depietro M, Terasawa E, Thomason D, Panettieri R. Real-World Evidence of Reductions in Health Resource Utilization (HRU) and Improved Efficacy Outcomes Associated with Reslizumab Treatment in Adults with Severe Eosinophilic Asthma (SEA) in the United States. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peters S, Wechsler M, Chipps B, Hill T, Ariely R, Depietro M, Terasawa E, Thomason D, Panettieri R. Real-world Evidence of Improved Patient Outcomes With Reslizumab in Non-exacerbating Patients With Severe Eosinophilic Asthma (SEA): A Subgroup Analysis. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu M, Chipps B, Muñoz X, Devouassoux G, Bergna M, Smith S, Albers F, Price R, Azmi J, Galkin D, Chapman K. Therapeutic switch from omalizumab to mepolizumab in patients with uncontrolled severe eosinophilic asthma: treatment effect by exacerbations in previous year and maintenance use of OCS. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Luskin A, Rajput Y, Haselkorn T, Yang M, Dang J, Chipps B. Treatment Response To Omalizumab And Reduced Asthma Exacerbations And Asthma-Related Healthcare Resource Use From The Real-World PROSPERO Study. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Soong W, Chipps B, Trevor J, Carr W, O’Quinn S, Trudo F, Ambrose C. Health-related Quality of Life and Productivity Among a Real-World Cohort of Severe Asthma Patients in the United States. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chipps B, Corren J, Israel E, Barker P, Kreindler J, Newbold P. P104 TOTAL NASAL SYMPTOM SCORE IMPROVEMENT WITH BENRALIZUMAB FOR PATIENTS WITH SEVERE, EOSINOPHILIC ASTHMA. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chipps B, Ambrose C, Trevor J, Belton L, Gandhi H, Lugogo N, Soong W, Carr W, Moore W, Trudo F, Panettieri R. P204 FACTORS ASSOCIATED WITH BIOLOGIC OR MAINTENANCE SYSTEMIC CORTICOSTEROID TREATMENT AMONG UNITED STATES SEVERE ASTHMA PATIENTS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wechsler M, Peters S, Chipps B, Hill T, Ariely R, DePietro M, Terasawa E, Thomason D, Panettieri R. P224 REAL-WORLD EVIDENCE OF IMPROVED PATIENT OUTCOMES WITH RESLIZUMAB IN ADULTS WITH SEVERE EOSINOPHILIC ASTHMA (SEA). Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Panettieri R, Chipps B, Moore W, Soong W, Carr W, Kreindler J, O'Quinn S, Trudo F, Ambrose C. COMPARISON OF ASTHMA CONTROL AND TREATMENT EFFECTIVENESS ASSESSMENTS BETWEEN US PATIENTS WITH ASTHMA AND TREATING SUBSPECIALISTS: REAL-WORLD DATA FROM THE CHRONICLE STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hanania N, Haselkorn T, Ortiz B, Yoo B, Holweg C, Iqbal A, Chipps B. RESPONSE TO OMALIZUMAB TREATMENT IN PATIENTS WITH FIXED AIRFLOW OBSTRUCTION. Chest 2019. [DOI: 10.1016/j.chest.2019.08.869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Panettieri R, Chipps B, Moore W, Soong W, Carr W, Kreindler J, O'Quinn S, Trudo F, Ambrose C. COMPARISON OF ASTHMA CONTROL AND TREATMENT EFFECTIVENESS ASSESSMENTS BETWEEN US PATIENTS WITH ASTHMA AND TREATING SUBSPECIALISTS: REAL-WORLD DATA FROM THE CHRONICLE STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chapman KR, Albers FC, Chipps B, Muñoz X, Devouassoux G, Bergna M, Galkin D, Azmi J, Mouneimne D, Price RG, Liu MC. The clinical benefit of mepolizumab replacing omalizumab in uncontrolled severe eosinophilic asthma. Allergy 2019; 74:1716-1726. [PMID: 31049972 PMCID: PMC6790683 DOI: 10.1111/all.13850] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [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: 11/12/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Background Mepolizumab and omalizumab are treatments for distinct but overlapping severe asthma phenotypes. Objective To assess if patients eligible for both biologics but not optimally controlled with omalizumab experience improved asthma control when switched directly to mepolizumab. Methods OSMO was a multicenter, open‐label, single‐arm, 32‐week trial in patients with ≥2 asthma exacerbations in the year prior to enrollment, despite receiving high‐dose inhaled corticosteroids and other controller(s), plus omalizumab (≥4 months). At baseline, patients with blood eosinophil counts ≥150 cells/µL (or ≥300 cells/µL in the prior year) and an Asthma Control Questionnaire (ACQ)‐5 score ≥1.5 discontinued omalizumab and immediately commenced mepolizumab 100 mg subcutaneously every 4 weeks. Endpoints included change from baseline in ACQ‐5 score (primary), St George's Respiratory Questionnaire (SGRQ) score and the proportions of ACQ‐5 and SGRQ responders, all at Week 32, and the annualized exacerbation rate over the study period. Results At Week 32 (intent‐to‐treat population [n = 145]), the least squares (LS) mean changes (standard error [SE]) in ACQ‐5 and SGRQ total scores were −1.45 (0.107) and −19.0 (1.64) points; with 77% and 79% of patients achieving the minimum clinically important differences (ACQ‐5: ≥0.5 points; SGRQ: ≥4 points), respectively. The annualized rate of clinically significant exacerbations was 1.18 events/year, a 64% reduction from 3.26 events/year during the previous year. Safety and immunogenicity profiles were consistent with previous trials. Conclusion After directly switching from omalizumab to mepolizumab, patients with uncontrolled severe eosinophilic asthma experienced clinically significant improvements in asthma control, health status, and exacerbation rate, with no tolerability issues reported.
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Affiliation(s)
- Kenneth R. Chapman
- Asthma and Airway Centre University Health Network, University of Toronto Toronto Ontario Canada
| | - Frank C. Albers
- Global Respiratory Medical Franchise GSK Research Triangle Park North Carolina
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center Sacramento California
| | - Xavier Muñoz
- Pulmonology Department Hospital Universitari Vall d'Hebron Barcelona Spain
- Ciber Enfermedades Respiratorias Madrid Spain
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon UCB Lyon 1 Lyon France
| | - Miguel Bergna
- Respiratory Research CEMER, Vicente Lopez Buenos Aires Argentina
| | - Dmitry Galkin
- Global Respiratory Medical Franchise GSK Research Triangle Park North Carolina
| | | | | | | | - Mark C. Liu
- Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine Johns Hopkins Asthma and Allergy Center Baltimore Maryland
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Szefler SJ, Chipps B. Challenges in the treatment of asthma in children and adolescents. Ann Allergy Asthma Immunol 2018; 120:382-388. [PMID: 29625664 DOI: 10.1016/j.anai.2018.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Despite the availability of effective treatments, asthma control in children and adolescents remains inadequate and rates of health care use are high. This follow-up to a recent review (O'Byrne et al, Eur Respir J. 2017;50[3]) examines a number of challenges in current pediatric asthma management compared with that of an adult perspective and discusses possible alternative strategies that might improve pediatric asthma management and control. DATA SOURCES The evidence base for this review is limited because, historically, much of the research has been performed in adults. STUDY SELECTIONS Not applicable. RESULTS Pediatric asthma management is complicated by variability in asthma severity and control and difficulty in measuring pulmonary function and airway inflammation. Current challenges in pediatric asthma management include the recommended initial therapy treating only the symptoms rather than the underlying inflammation and switching to controller therapy only when asthma subsequently worsens. CONCLUSION Alternative strategies that might improve pediatric asthma management and control include replacement of short-acting β2-agonist relievers by an inhaled corticosteroid plus a fast-acting β2-agonist (short-acting β2-agonist or fast- and long-acting β2-agonist) combination at Global Initiative for Asthma step 1 or 2 to ensure that patients receive an inhaled corticosteroid whenever they feel the need for symptomatic relief. Such an approach could eliminate the problem of learned overuse or over-reliance on short-acting β2-agonist reliever medication and address the other challenges in current pediatric asthma management. Clinical studies in pediatric patients or large studies involving a proportion of pediatric patients are required to provide the supporting evidence needed to help advance such new approaches and improve asthma control from a pediatric perspective.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program and The Breathing Institute, Children's Hospital Colorado, University Colorado School of Medicine, Aurora, Colorado
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
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Sher E, Ciaccio C, Griffin N, Rosen K, Chipps B. APPLICATION OF ORAL IMMUNOTHERAPY (OIT) CLINICAL TRIAL ENDPOINTS TO A REAL-WORLD SETTING. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chipps B, Casale T, Yang M, Holweg C, Haselkorn T, Griffin N, Hanania N. EFFECTS OF OMALIZUMAB ON MARKERS OF TYPE 2 INFLAMMATION: RESULTS FROM THE EXTRA STUDY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parikh N, Chipps B, Messina J, Carothers J, Sacks H, Mahmoud R. EDS-FLU (EXHALATION DELIVERY SYSTEM WITH FLUTICASONE) BENEFITS ON NASAL POLYP DISEASE RELATIVE TO MONOCLONAL ANTIBODIES. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haselkorn T, Szefler S, Chipps B, Bleecker E, Mink D, Kianifard F, Ortiz B, Zeiger R. PREDICTORS OF A FUTURE SEVERE ASTHMA EXACERBATION AFTER A DECADE FOLLOW-UP: RESULTS FROM TENOR II. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ariely R, Chipps B, Stoyanov S, Wang L, Shrestha S, Baser O. P235 Budgetary impact model on a medicare plan adopting short-acting beta-agonist inhalers with integrated dose counters. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chipps B, Newbold P, Hirsch I, Trudo F, Goldman M. P221 Efficacy of benralizumab for patients with severe, uncontrolled atopic asthma by serum immunoglobulin E concentrations. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zeiger R, Chipps B, Ortiz B, Kianifard F, Paknis B, Haselkorn T, Foreman A, Szefler S. P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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