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Bachert C, Laidlaw TM, Cho SH, Mullol J, Swanson BN, Naimi S, Classe M, Harel S, Jagerschmidt A, Laws E, Ruddy M, Praestgaard A, Amin N, Mannent LP. Effect of Dupilumab on Type 2 Biomarkers in Chronic Rhinosinusitis With Nasal Polyps: SINUS-52 Study Results. Ann Otol Rhinol Laryngol 2023; 132:1649-1661. [PMID: 37322842 PMCID: PMC10571440 DOI: 10.1177/00034894231176334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) are frequent coexisting conditions and share type 2 inflammatory pathophysiology, with interleukin (IL)-4 and IL-13 as key cytokines. Dupilumab is a monoclonal antibody that blocks the shared receptor for IL-4 and IL-13. The objective of this analysis was to evaluate dupilumab's effect on type 2 inflammation biomarkers in patients with CRSwNP with/without coexisting asthma or NSAID-ERD from the SINUS-52 (NCT02898454) study. METHODS Patients received treatment with dupilumab or placebo for 52 weeks. Blood and urinary biomarkers were evaluated through 52 weeks, and nasal secretions and mucosa brushings through 24 weeks. RESULTS Of 447 patients, 60% had coexisting asthma and 27% had coexisting NSAID-ERD. At baseline, blood eotaxin-3, eosinophils, and periostin, nasal secretion eotaxin-3, and urinary leukotriene E4 were significantly higher in patients with coexisting NSAID-ERD than without. Dupilumab reduced eotaxin-3, thymus and activation-regulated chemokine, periostin, and total immunoglobulin E in blood, eotaxin-3, periostin, IL-5, and eosinophil cationic protein in nasal secretions, and leukotriene E4 in urine. Reductions were generally similar or greater in the subgroups with asthma and NSAID-ERD than without. Dupilumab also reduced MUC5AC and mast cell counts in nasal mucosa brushings. CONCLUSION Dupilumab reduced local and systemic type 2 inflammatory biomarkers in patients with CRSwNP, including mast cells in nasal mucosa and cysteinyl leukotrienes in urine. These findings provide insight into the processes driving CRSwNP and the mechanisms of dupilumab's therapeutic effects. CLINICAL TRIAL REGISTRY NAME SINUS-52 https://www.clinicaltrials.gov/ct2/show/NCT02898454. CLINICALTRIALS.GOV IDENTIFIER NCT02898454.
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Affiliation(s)
- Claus Bachert
- Department of Otorhinolaryngology — Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong H. Cho
- Division of Allergy-Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Brian N. Swanson
- College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
- Research and Development, Sanofi, Bridgewater, NJ, USA
| | - Souad Naimi
- Molecular and Digital Histopathology, Sanofi, Vitry-sur-Seine, France
| | - Marion Classe
- Pathology Department, Institut Gustave Roussy, Villejuif, France
- Translational Sciences, Sanofi, Chilly-Mazarin, France
| | - Sivan Harel
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Elizabeth Laws
- Immunology and Inflammation Global Development, Sanofi, Bridgewater, NJ, USA
| | - Marcella Ruddy
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Nikhil Amin
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Dellon ES, Rothenberg ME, Collins MH, Hirano I, Chehade M, Bredenoord AJ, Lucendo AJ, Spergel JM, Aceves S, Sun X, Kosloski MP, Kamal MA, Hamilton JD, Beazley B, McCann E, Patel K, Mannent LP, Laws E, Akinlade B, Amin N, Lim WK, Wipperman MF, Ruddy M, Patel N, Weinreich DR, Yancopoulos GD, Shumel B, Maloney J, Giannelou A, Shabbir A. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med 2022; 387:2317-2330. [PMID: 36546624 DOI: 10.1056/nejmoa2205982] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody, blocks interleukin-4 and interleukin-13 signaling, which have key roles in eosinophilic esophagitis. METHODS We conducted a three-part, phase 3 trial in which patients 12 years of age or older underwent randomization in a 1:1 ratio to receive subcutaneous dupilumab at a weekly dose of 300 mg or placebo (Part A) or in a 1:1:1 ratio to receive 300 mg of dupilumab either weekly or every 2 weeks or weekly placebo (Part B) up to week 24. Eligible patients who completed Part A or Part B continued the trial in Part C, in which those who completed Part A received dupilumab at a weekly dose of 300 mg up to week 52 (the Part A-C group); Part C that included the eligible patients from Part B is ongoing. The two primary end points at week 24 were histologic remission (≤6 eosinophils per high-power field) and the change from baseline in the Dysphagia Symptom Questionnaire (DSQ) score (range, 0 to 84, with higher values indicating more frequent or more severe dysphagia). RESULTS In Part A, histologic remission occurred in 25 of 42 patients (60%) who received weekly dupilumab and in 2 of 39 patients (5%) who received placebo (difference, 55 percentage points; 95% confidence interval [CI], 40 to 71; P<0.001). In Part B, histologic remission occurred in 47 of 80 patients (59%) with weekly dupilumab, in 49 of 81 patients (60%) with dupilumab every 2 weeks, and in 5 of 79 patients (6%) with placebo (difference between weekly dupilumab and placebo, 54 percentage points; 95% CI, 41 to 66 [P<0.001]; difference between dupilumab every 2 weeks and placebo, 56 percentage points; 95% CI, 43 to 69 [not significant per hierarchical testing]). The mean (±SD) DSQ scores at baseline were 33.6±12.41 in Part A and 36.7±11.22 in Part B; the scores improved with weekly dupilumab as compared with placebo, with differences of -12.32 (95% CI, -19.11 to -5.54) in Part A and -9.92 (95% CI, -14.81 to -5.02) in Part B (both P<0.001) but not with dupilumab every 2 weeks (difference in Part B, -0.51; 95% CI, -5.42 to 4.41). Serious adverse events occurred in 9 patients during the Part A or B treatment period (in 7 who received weekly dupilumab, 1 who received dupilumab every 2 weeks, and 1 who received placebo) and in 1 patient in the Part A-C group during the Part C treatment period who received placebo in Part A and weekly dupilumab in Part C. CONCLUSIONS Among patients with eosinophilic esophagitis, subcutaneous dupilumab administered weekly improved histologic outcomes and alleviated symptoms of the disease. (Funded by Sanofi and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT03633617.).
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Affiliation(s)
- Evan S Dellon
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Marc E Rothenberg
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Margaret H Collins
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Ikuo Hirano
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Mirna Chehade
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Albert J Bredenoord
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Alfredo J Lucendo
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jonathan M Spergel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Seema Aceves
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Xian Sun
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Matthew P Kosloski
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Mohamed A Kamal
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jennifer D Hamilton
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Bethany Beazley
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Eilish McCann
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Kiran Patel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Leda P Mannent
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Elizabeth Laws
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Bolanle Akinlade
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Nikhil Amin
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Wei Keat Lim
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Matthew F Wipperman
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Marcella Ruddy
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Naimish Patel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - David R Weinreich
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - George D Yancopoulos
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Brad Shumel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jennifer Maloney
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Angeliki Giannelou
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Arsalan Shabbir
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
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Sher LD, Wechsler ME, Rabe KF, Maspero JF, Daizadeh N, Mao X, Ortiz B, Mannent LP, Laws E, Ruddy M, Pandit-Abid N, Jacob-Nara JA, Gall R, Rowe PJ, Deniz Y, Lederer DJ, Hardin M. Dupilumab Reduces Oral Corticosteroid Use in Patients With Corticosteroid-Dependent Severe Asthma. Chest 2022; 162:46-55. [DOI: 10.1016/j.chest.2022.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/10/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022] Open
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Mullol J, Laidlaw TM, Bachert C, Mannent LP, Canonica GW, Han J, Maspero JF, Picado C, Daizadeh N, Ortiz B, Li Y, Ruddy M, Laws E, Amin N. Efficacy and safety of dupilumab in patients with uncontrolled severe chronic rhinosinusitis with nasal polyps and a clinical diagnosis of NSAID-ERD: Results from two randomized placebo-controlled phase 3 trials. Allergy 2022; 77:1231-1244. [PMID: 34459002 PMCID: PMC9292324 DOI: 10.1111/all.15067] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 12/22/2020] [Accepted: 08/12/2021] [Indexed: 12/19/2022]
Abstract
Background About one‐tenth of patients with difficult‐to‐treat chronic rhinosinusitis with nasal polyps (CRSwNP) have comorbid non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (NSAID‐ERD). Dupilumab, a fully human monoclonal antibody that blocks the shared interleukin (IL)‐4/IL‐13 receptor component, is an approved add‐on treatment in severe CRSwNP. This post hoc analysis evaluated dupilumab efficacy and safety in patients with CRSwNP with/without NSAID‐ERD. Methods Data were pooled from the phase 3 SINUS‐24 and SINUS‐52 studies in adults with uncontrolled severe CRSwNP who received dupilumab 300 mg or placebo every 2 weeks. CRSwNP, nasal airflow, lung function, and asthma control outcomes at Week 24 were evaluated, and treatment–subgroup interactions were assessed for patients with and without NSAID‐ERD. Results Of 724 patients, 204 (28.2%) had a diagnosis of NSAID‐ERD. At Week 24, least squares mean treatment differences demonstrated significant improvements in nasal polyp score, nasal congestion (NC), Lund–Mackay computed tomography, 22‐item Sinonasal Outcome Test (SNOT‐22), Total Symptom Score (TSS), rhinosinusitis severity visual analog scale, peak nasal inspiratory flow (PNIF), six‐item Asthma Control Questionnaire score, and improvement in smell with dupilumab versus placebo (all p < .0001) in patients with NSAID‐ERD. Treatment comparisons demonstrated significantly greater improvements with dupilumab in patients with versus without NSAID‐ERD for NC (p = .0044), SNOT‐22 (p = .0313), TSS (p = .0425), and PNIF (p = .0123). Conclusions In patients with uncontrolled severe CRSwNP, dupilumab significantly improved objective measures and patient‐reported symptoms to a greater extent in the presence of comorbid NSAID‐ERD than without. Dupilumab was well tolerated in patients with/without NSAID‐ERD.
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Affiliation(s)
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department Hospital ClínicIDIBAPSUniversitat de BarcelonaCIBERES Barcelona Catalonia Spain
| | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology Brigham and Women's Hospital, and Harvard Medical School Boston Massachusetts USA
| | - Claus Bachert
- Upper Airways Research Laboratory and Department of Otorhinolaryngology Ghent University Ghent Belgium
- Division of ENT Diseases, CLINTEX Karolinska Institutet Stockholm Sweden
- First Affiliated Hosptial Sun Yat‐sen University Guangzhou China
| | | | - G. Walter Canonica
- Department of Biomedical Sciences Humanitas University, Personalized Medicine Asthma & Allergy Unit‐IRCCS Humanitas Research Hospital, Rozzano Milan Italy
| | - Joseph K. Han
- Department of Otolaryngology & Head and Neck Surgery Eastern Virginia Medical School Norfolk Virginia USA
| | - Jorge F. Maspero
- Allergy and Respiratory Medicine Fundación CIDEA Buenos Aires Argentina
| | - Cesar Picado
- Clinical & Experimental Respiratory Immunoallergy IDIBAPS, Universitat de Barcelona, CIBERES Barcelona Catalonia Spain
| | | | - Benjamin Ortiz
- Immunology and Allergy Medical Affairs Regeneron Pharmaceuticals, Inc. New York USA
| | - Yongtao Li
- Global Medical Affairs Respiratory Sanofi Bridgewater New Jersey USA
| | - Marcella Ruddy
- Clinical Sciences Global Development Regeneron Pharmaceuticals, Inc. Tarrytown New Jersey USA
| | - Elizabeth Laws
- Immunology and Inflammation Sanofi Bridgewater New Jersey USA
| | - Nikhil Amin
- Clinical Sciences Global Development Regeneron Pharmaceuticals, Inc. Tarrytown New Jersey USA
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Wechsler ME, Souza-Machado A, Xu C, Mao X, Kapoor U, Khokhar FA, O’Malley JT, Petro CD, Casullo VM, Mannent LP, Rowe PJ, Jacob-Nara JA, Ruddy M, Laws E, Purcell LA, Hardin M. Preclinical and clinical experience with dupilumab on the correlates of live attenuated vaccines. J Allergy Clin Immunol Glob 2022; 1:9-15. [PMID: 37780074 PMCID: PMC10509883 DOI: 10.1016/j.jacig.2021.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 10/03/2023]
Abstract
Background The safety and tolerability of live attenuated vaccines in patients administered dupilumab for moderate-to-severe asthma have not been previously evaluated. During the LIBERTY ASTHMA TRAVERSE open-label extension study (ClinicalTrials.gov identifier NCT02134028), a yellow fever outbreak in Brazil required administration of a live attenuated vaccine to at-risk individuals. Objective Our aim was to evaluate immune response to a live attenuated vaccine in the context of IL-4 receptor blockade (REGN1103, a dupilumab surrogate) in mice and in dupilumab-treated patients with moderate-to-severe asthma who participated in TRAVERSE. Methods In the preclinical study, mice were coadministered REGN1103/isotype control and live attenuated influenza vaccine/control, followed by influenza virus challenge. During TRAVERSE, 37 patients discontinued dupilumab treatment and were administered 17D live attenuated yellow fever vaccine (YFV). Safety and tolerability data, dupilumab serum concentrations, and plaque reduction neutralization titers before and after vaccination were collected. Results In the preclinical study, there was no impact of REGN1103 on vaccine efficacy in mice. In TRAVERSE, all 37 patients who received YFV achieved seroprotection despite most having therapeutic levels of dupilumab, with the magnitude of response appearing unrelated to prevaccination dupilumab concentrations. No instances of vaccine-related adverse events or vaccine hypersensitivity were reported in 36 patients; 1 patient reported nonserious body ache, malaise, and dizziness 7 days after vaccination but recovered fully. Conclusion The preclinical model suggested that dupilumab does not affect the efficacy of live attenuated influenza vaccine. The live attenuated YFV did not raise safety concerns and appeared to be well tolerated in patients with asthma who recently discontinued dupilumab treatment, and dupilumab concentrations had no apparent impact on immunologic response to the vaccine.
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Affiliation(s)
- Michael E. Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
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Bacharier LB, Maspero JF, Katelaris CH, Fiocchi AG, Gagnon R, de Mir I, Jain N, Sher LD, Mao X, Liu D, Zhang Y, Khan AH, Kapoor U, Khokhar FA, Rowe PJ, Deniz Y, Ruddy M, Laws E, Patel N, Weinreich DM, Yancopoulos GD, Amin N, Mannent LP, Lederer DJ, Hardin M. Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma. N Engl J Med 2021; 385:2230-2240. [PMID: 34879449 DOI: 10.1056/nejmoa2106567] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with moderate-to-severe asthma continue to have disease complications despite the receipt of standard-of-care therapy. The monoclonal antibody dupilumab has been approved for the treatment of adults and adolescents with asthma as well as with other type 2 inflammatory diseases. METHODS In this 52-week phase 3, randomized, double-blind, placebo-controlled trial, we assigned 408 children between the ages of 6 and 11 years who had uncontrolled moderate-to-severe asthma to receive a subcutaneous injection of dupilumab (at a dose of 100 mg for those weighing ≤30 kg and 200 mg for those weighing >30 kg) or matched placebo every 2 weeks. All the children continued to receive a stable dose of standard background therapy. The primary end point was the annualized rate of severe asthma exacerbations. Secondary end points included the change from baseline in the percentage of predicted prebronchodilator forced expiratory volume in 1 second (ppFEV1) at week 12 and in the score on the Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) at week 24. End points were evaluated in the two primary efficacy populations who had either a type 2 inflammatory asthma phenotype (≥150 blood eosinophils per cubic millimeter or a fraction of exhaled nitric oxide of ≥20 ppb at baseline) or a blood eosinophil count of at least 300 cells per cubic millimeter at baseline. RESULTS In patients with the type 2 inflammatory phenotype, the annualized rate of severe asthma exacerbations was 0.31 (95% confidence interval [CI], 0.22 to 0.42) with dupilumab and 0.75 (95% CI, 0.54 to 1.03) with placebo (relative risk reduction in the dupilumab group, 59.3%; 95% CI, 39.5 to 72.6; P<0.001). The mean (±SE) change from baseline in the ppFEV1 was 10.5±1.0 percentage points with dupilumab and 5.3±1.4 percentage points with placebo (mean difference, 5.2 percentage points; 95% CI, 2.1 to 8.3; P<0.001). Dupilumab also resulted in significantly better asthma control than placebo (P<0.001). Similar results were observed in the patients with an eosinophil count of at least 300 cells per cubic millimeter at baseline. The incidence of serious adverse events was similar in the two groups. CONCLUSIONS Among children with uncontrolled moderate-to-severe asthma, those who received add-on dupilumab had fewer asthma exacerbations and better lung function and asthma control than those who received placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; Liberty Asthma VOYAGE ClinicalTrials.gov number, NCT02948959.).
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Affiliation(s)
- Leonard B Bacharier
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Jorge F Maspero
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Constance H Katelaris
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Alessandro G Fiocchi
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Remi Gagnon
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Ines de Mir
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Neal Jain
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Lawrence D Sher
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Xuezhou Mao
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Dongfang Liu
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yi Zhang
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Asif H Khan
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Upender Kapoor
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Faisal A Khokhar
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Paul J Rowe
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yamo Deniz
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Marcella Ruddy
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Elizabeth Laws
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Naimish Patel
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David M Weinreich
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - George D Yancopoulos
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Nikhil Amin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Leda P Mannent
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David J Lederer
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Megan Hardin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
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7
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Kamal MA, Franchetti Y, Lai C, Xu C, Wang CQ, Radin AR, O'Brien MP, Ruddy M, Davis JD. Pharmacokinetics and Concentration-Response of Dupilumab in Patients with Seasonal Allergic Rhinitis. J Clin Pharmacol 2021; 62:689-695. [PMID: 34791679 PMCID: PMC9303412 DOI: 10.1002/jcph.2004] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/13/2021] [Indexed: 11/07/2022]
Abstract
Patients with moderate to severe allergic rhinitis may benefit from subcutaneous immunotherapy (SCIT), despite the risk of systemic allergic reaction. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin (IL)-4 and IL-13, key drivers of the type 2 inflammation seen in allergic rhinitis, thereby inhibiting their signaling. In the LIBERTY Grass AID trial (NCT03558997), 16 weeks of treatment with 300 mg dupilumab every 2 weeks plus Timothy grass (TG) SCIT did not reduce TG allergen challenge nasal symptom scores compared with SCIT only but did improve tolerability of SCIT up-titration in patients with a history of grass pollen-induced seasonal allergic rhinitis. Here we present the pharmacokinetics of functional serum dupilumab and concentration-response relationships in 52 patients enrolled in this trial. Functional dupilumab concentrations and concentrations of TG-specific immunoglobulin E (IgE) and IgG4 were assessed in blood samples collected from dupilumab-only and SCIT+dupilumab-treated groups. Mean functional dupilumab concentrations were similar in both groups and reached a steady state of approximately 70-80 mg/L at week 5. One week after the end of treatment, TG-specific IgG4 concentrations were increased in the SCIT+dupilumab group, but not in the dupilumab-only group, over the range of dupilumab concentrations evaluated, whereas no changes were seen for TG-specific IgE concentrations. This study demonstrates that SCIT does not alter functional concentrations of serum dupilumab, and the impact of SCIT on TG-specific immunoglobulins is not affected by functional dupilumab concentrations over the range studied, indicating that maximum response was achieved in all patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Ching‐Ha Lai
- Regeneron Pharmaceuticals, Inc.TarrytownNew YorkUSA
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8
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Mullol J, Bachert C, Amin N, Desrosiers M, Hellings PW, Han JK, Jankowski R, Vodicka J, Gevaert P, Daizadeh N, Khan AH, Kamat S, Patel N, Graham NMH, Ruddy M, Staudinger H, Mannent LP. Olfactory Outcomes with Dupilumab in Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract 2021; 10:1086-1095.e5. [PMID: 34628065 DOI: 10.1016/j.jaip.2021.09.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Loss of smell (LoS) is one of the most troublesome and difficult-to-treat symptoms of severe chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE To assess the impact of dupilumab on sense of smell in severe CRSwNP. METHODS In the randomized SINUS-24 and SINUS-52 studies, adults with severe CRSwNP received dupilumab 300 mg subcutaneously or matching placebo every 2 weeks for 24 or 52 weeks, respectively. Smell was assessed using daily patient-reported LoS score (0-3) and University of Pennsylvania Smell Identification Test (UPSIT; 0-40). Data from the 2 studies were pooled through week 24. Relationships between patient phenotypes and smell outcomes were also assessed. RESULTS We randomized 724 patients (286 placebo, 438 dupilumab); mean CRSwNP duration was 11 years; 63% had prior sinonasal surgery. Mean baseline LoS was 2.74. Dupilumab produced rapid improvement in LoS, evident by day 3, which improved progressively throughout the study periods (least squares mean difference vs placebo -0.07 [95% CI -0.12 to -0.02]; nominal P < .05 at day 3, and -1.04 [-1.17 to -0.91]; P < .0001 at week 24). Dupilumab improved mean UPSIT by 10.54 (least squares mean difference vs placebo 10.57 [9.40-11.74]; P < .0001) at week 24 from baseline (score 13.90). Improvements were unaffected by CRSwNP duration, prior sinonasal surgery, or comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. Baseline olfaction scores correlated with all measured local and systemic type 2 inflammatory markers except serum total immunoglobulin E. CONCLUSIONS Dupilumab produced rapid and sustained improvement in sense of smell, alleviating a cardinal symptom of severe CRSwNP.
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Affiliation(s)
- Joaquim Mullol
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.
| | - Claus Bachert
- Ghent University, Ghent, Belgium; Karolinska Institutet, Stockholm, Sweden
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Martin Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada
| | | | | | | | - Jan Vodicka
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
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9
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Wambre ER, Farrington M, Bajzik V, DeBerg HA, Ruddy M, DeVeaux M, Meier P, Robinson D, Cantor M, Huang C, Orengo JM, Wang CQ, Radin A. Clinical and immunological evaluation of cat-allergic asthmatics living with or without a cat. Clin Exp Allergy 2021; 51:1624-1633. [PMID: 34599624 PMCID: PMC9293312 DOI: 10.1111/cea.14024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/23/2021] [Revised: 05/04/2021] [Accepted: 09/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Characterising the clinical and immunological impact of daily cat exposure in cat-allergic subjects with asthma who live with cats (WC) and those who do not (WoC) may provide understanding of the drivers of the allergic response. METHODS Clinical and immunological characteristics (skin prick test, spirometry, symptom assessments, immunological markers) were compared between asthmatic subjects WC (n = 10) and WoC (n = 9). RESULTS WC subjects had greater use of long-acting beta agonists (p < .05) and high-potency corticosteroids. No differences were observed in lung function, nasal and ocular symptoms, or asthma control between the groups. Cat dander- and Fel d 1-specific IgG4 concentrations were higher in WC than WoC subjects (both p < .05). Total IgE and cat dander-, Fel d 1- and Fel d 7-specific IgE concentrations were similar, but Fel d 4-sIgE was higher in WC subjects (p < .05) versus WoC. Basophil sensitivity to cat dander extract and Fel d 1 was lower in WC versus WoC subjects (p < .05) and correlated with higher IgG4 concentrations (r = 0.63; p = .009). Fel d 1-specific CD4+ T-cell responses polarised toward Th2A responses in WC versus WoC subjects; Fel d 1-specific IgE correlated with surface expression of CRTH2 and CD200R (both p ≤ .05). CONCLUSION Immunological differences observed in WC versus WoC did not reflect clinical tolerance with natural cat exposure. The ability to live with a cat despite allergy could be driven by higher preventative medication use. This study may support design of novel therapeutics for allergy management.
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Affiliation(s)
- Erik R Wambre
- Benaroya Research Institute at Virginia Mason Medical Center, Seattle, Washington, USA
| | - Mary Farrington
- Benaroya Research Institute at Virginia Mason Medical Center, Seattle, Washington, USA.,Virginia Mason Medical Center, Seattle, Washington, USA
| | - Veronique Bajzik
- Benaroya Research Institute at Virginia Mason Medical Center, Seattle, Washington, USA
| | - Hannah A DeBerg
- Benaroya Research Institute at Virginia Mason Medical Center, Seattle, Washington, USA
| | | | | | - Pretty Meier
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | | | | | | | | | | | - Allen Radin
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
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10
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Corren J, Saini SS, Gagnon R, Moss MH, Sussman G, Jacobs J, Laws E, Chung ES, Constant T, Sun Y, Maloney J, Hamilton JD, Ruddy M, Wang CQ, O'Brien MP. Short-Term Subcutaneous Allergy Immunotherapy and Dupilumab are Well Tolerated in Allergic Rhinitis: A Randomized Trial. J Asthma Allergy 2021; 14:1045-1063. [PMID: 34429614 PMCID: PMC8379710 DOI: 10.2147/jaa.s318892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/06/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background Subcutaneous immunotherapy (SCIT) has been proven as an effective therapy against some allergens for seasonal allergic rhinitis (SAR) patients unresponsive to intranasal corticosteroids and/or antihistamines but carries risk of systemic allergic reactions. Dupilumab blocks the shared receptor component for interleukin-4 and interleukin-13, key and central drivers of type 2 inflammation in multiple diseases. Objective To evaluate the efficacy and safety of SCIT+dupilumab vs SCIT alone. Methods This phase 2a, multicenter, double-blind, placebo-controlled parallel-group study conducted in 103 adults with grass pollen-induced SAR (NCT03558997) randomized patients 1:1:1:1 to SCIT, dupilumab (300 mg every 2 weeks), SCIT+dupilumab, or placebo. SCIT was administered using an 8-week cluster protocol followed by 8 weeks of maintenance injections. Primary endpoint was change from pre-treatment baseline in area under the curve (AUC) in total nasal symptom score (TNSS) 0-1 h following nasal allergen challenge (NAC) with timothy grass extract at Week 17. Results Although 16 weeks of treatment with SCIT+dupilumab did not significantly improve TNSS AUC (0-1 h) following NAC at Week 17 vs SCIT (least squares mean -56.76% vs -52.03%), a higher proportion of SCIT+dupilumab-treated patients (61.5%) achieved SCIT maintenance dose vs SCIT (46.2%). A lower proportion of SCIT+dupilumab-treated patients (7.7%) required epinephrine rescue treatment vs SCIT (19.2%). There were significantly fewer withdrawals in the SCIT+dupilumab group than in the SCIT group (n = 2 [7.7%] vs n = 8 [30.8%]; P = 0.0216); the majority of SCIT group withdrawals were due to SCIT-related intolerability, compared with no discontinuations from the SCIT+dupilumab group. Conclusion In SAR patients, 16 weeks of SCIT+dupilumab may improve SCIT tolerability but did not incrementally reduce post-allergen challenge nasal symptoms compared with SCIT alone. Clinical Study Number NCT03558997.
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Affiliation(s)
- Jonathan Corren
- Departments of Medicine and Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sarbjit S Saini
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, QC, Canada
| | - Mark H Moss
- Departments of Medicine and Pediatrics, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gordon Sussman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joshua Jacobs
- Allergy and Asthma Clinical Research, Inc, Walnut Creek, CA, USA
| | | | | | | | - Yiping Sun
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
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11
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Zhao Y, Wu L, Lu Q, Gao X, Zhu X, Yao X, Li L, Li W, Ding Y, Song Z, Liu L, Dang N, Zhang C, Liu X, Gu J, Wang J, Geng S, Liu Q, Guo Y, Dong L, Su H, Bai L, O'Malley JT, Luo J, Laws E, Mannent L, Ruddy M, Amin N, Bansal A, Ota T, Wang M, Zhang J. The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol 2021; 186:633-641. [PMID: 34358343 PMCID: PMC9298048 DOI: 10.1111/bjd.20690] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD). OBJECTIVES To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD. METHODS In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16. RESULTS Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group. CONCLUSIONS In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.
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Affiliation(s)
- Y Zhao
- Peking University People's Hospital, Beijing, China
| | - L Wu
- Hangzhou First People's Hospital, Hangzhou, China
| | - Q Lu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - X Gao
- The First Hospital of China Medical University, Shenyang, China
| | - X Zhu
- Wuxi Second People's Hospital, Jiangsu, China
| | - X Yao
- Hospital for skin diseases, Institute of Dermatology, Chinese Academy of medical sciences, Nanjing, China
| | - L Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - W Li
- Huashan Hospital, Fudan University, Shanghai, China
| | - Y Ding
- Shanghai Skin Disease Hospital, Shanghai, China
| | - Z Song
- The Southwest Hospital of AMU, Chongqing, China
| | - L Liu
- Peking University First Hospital, Beijing, China
| | - N Dang
- Jinan Central Hospital, Jinan, China
| | - C Zhang
- Peking University Third Hospital, Beijing, China
| | - X Liu
- University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - J Gu
- Changhai Hospital of Shanghai, Shanghai, China
| | - J Wang
- Ningbo No.2 Hospital, Ningbo, China
| | - S Geng
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Q Liu
- Tianjin Medical University General Hospital, Tianjin, China
| | - Y Guo
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - L Dong
- Research & Development, Sanofi, Shanghai, China
| | - H Su
- Research & Development, Sanofi, Shanghai, China
| | - L Bai
- Research & Development, Sanofi, Shanghai, China
| | | | - J Luo
- Research & Development, Sanofi, Indianapolis, USA
| | - E Laws
- Research & Development, Sanofi, Bridgewater, USA
| | - L Mannent
- Research & Development, Sanofi, Paris, France
| | - M Ruddy
- Research & Development, Regeneron, New York, USA
| | - N Amin
- Research & Development, Regeneron, New York, USA
| | - A Bansal
- Research & Development, Regeneron, New York, USA
| | - T Ota
- Research & Development, Regeneron, New York, USA
| | - M Wang
- Medical, Sanofi China, Shanghai, China
| | - J Zhang
- Peking University People's Hospital, Beijing, China
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12
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Busse WW, Kraft M, Rabe KF, Deniz Y, Rowe PJ, Ruddy M, Castro M. Understanding the key issues in the treatment of uncontrolled persistent asthma with type 2 inflammation. Eur Respir J 2021; 58:13993003.03393-2020. [PMID: 33542055 PMCID: PMC8339540 DOI: 10.1183/13993003.03393-2020] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
Asthma is a complex respiratory disease that varies in severity and response to treatment. Several asthma phenotypes with unique clinical and inflammatory characteristics have been identified. Endotypes, based on distinct molecular profiles, help to further elucidate the heterogeneity within asthma. Type 2 inflammation, involving both the innate (type 2 innate lymphoid cell) and adaptive (T-helper type 2 cells) immune systems, underpins the complex pathophysiology of chronic inflammation in asthma, as well as the presence of comorbid disease (e.g. chronic rhinosinusitis with nasal polyps, allergic rhinitis and atopic dermatitis). Type 2 inflammation is characterised by upregulation of the type 2 cytokines interleukin (IL)-4, IL-5 and IL-13, IgE-mediated release of immune mediators and dysfunction of epithelial or epidermal barriers. Targeting these key proximal type 2 cytokines has shown efficacy in recent studies adopting a personalised approach to treatment using targeted biologics. Elevated levels of biomarkers downstream of type 2 cytokines, including fractional exhaled nitric oxide, serum IgE and blood and sputum eosinophils, have been linked to mechanisms involved in type 2 inflammation. They have the potential to aid diagnosis, and to predict and monitor response to treatment. The objective of this review is to summarise the current understanding of the biology of type 2 inflammation in asthma, examine its influence on type 2 inflammatory comorbidities, and discuss how type 2 inflammatory biomarkers can be harnessed to further personalise treatments in the age of biologic medicines. This review covers the pathophysiology of type 2 inflammation in asthma, its influence on type 2 comorbidities, and ways in which type 2 biomarkers can be harnessed to improve diagnosis and further personalise treatments in the age of biologic medicineshttps://bit.ly/2MSOI2O
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Affiliation(s)
- William W Busse
- UW Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Monica Kraft
- University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - Klaus F Rabe
- LungenClinic Grosshansdorf (member of the German Center for Lung Research, DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany.,Christian-Albrechts University (member of the German Center for Lung Research, DZL), Airway Research Center North (ARCN), Kiel, Germany
| | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - Mario Castro
- University of Kansas School of Medicine, Kansas City, KS, USA
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Maspero JF, FitzGerald JM, Pavord ID, Rice MS, Maroni J, Rowe PJ, Pirozzi G, Amin N, Ruddy M, Graham NMH, Teper A, Hardin M. Dupilumab efficacy in adolescents with uncontrolled, moderate-to-severe asthma: LIBERTY ASTHMA QUEST. Allergy 2021; 76:2621-2624. [PMID: 33905544 PMCID: PMC8360078 DOI: 10.1111/all.14872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Ian D. Pavord
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health Research Biomedical Research CentreUniversity of Oxford Oxford UK
| | | | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc. Tarrytown NY USA
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Hamilton JD, Harel S, Swanson BN, Brian W, Chen Z, Rice MS, Amin N, Ardeleanu M, Radin A, Shumel B, Ruddy M, Patel N, Pirozzi G, Mannent L, Graham NMH. Dupilumab suppresses type 2 inflammatory biomarkers across multiple atopic, allergic diseases. Clin Exp Allergy 2021; 51:915-931. [PMID: 34037993 PMCID: PMC8362102 DOI: 10.1111/cea.13954] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type 2 inflammation is common in numerous atopic/allergic diseases and can be identified by elevated biomarker levels. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key and central drivers of type 2 inflammation. OBJECTIVE Assessment of dupilumab effect on type 2 inflammatory biomarkers in atopic dermatitis (AD), asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic esophagitis (EoE). METHODS Data were extracted from three randomized placebo-controlled trials of dupilumab in AD (NCT02277743, N = 671; NCT02277769, N = 708; NCT02260986, N = 740); and one each in asthma (NCT02414854, N = 1902); CRSwNP (NCT02898454, N = 448); and EoE (NCT02379052, N = 47). Biomarkers assessed were serum thymus and activation-regulated chemokine (TARC), plasma eotaxin-3, serum total immunoglobulin E (IgE), serum periostin and blood eosinophil count. RESULTS Dupilumab versus placebo significantly suppressed most type 2 inflammatory biomarker levels across all studies/indications where data were assessed. Reductions in serum TARC, plasma eotaxin-3 and serum periostin occurred rapidly, whereas reductions in serum total IgE were more gradual. Across diseases, at the end of treatment, median percentage change from baseline in TARC levels ranged from -24.8% to -88.6% (placebo +2.6% to -53.6%); -38.2% to -51.5% (placebo +8.3% to -0.16%) in eotaxin-3; -24.8% to -76.7% (placebo +8.3% to -4.4%) in total IgE; and -13.6% to -41.1% (placebo +10.1% to -6.94%) in periostin levels. Blood eosinophil responses to dupilumab varied by disease, with minimal changes in AD in the SOLO studies (median percentage change from baseline to end of treatment: 0% [95% CI: -15.8, 0]); transient increases followed by decreases to below-baseline levels in asthma (-14.6% [-20.0, -7.7]) and CRSwNP (-29.4% [-40.0, -16.3]); and significant decreases in EoE (-50.0% [-50.0, -33.3]). CONCLUSION AND CLINICAL RELEVANCE Dupilumab reduced levels of type 2 biomarkers across clinical studies in patients with AD, asthma, CRSwNP and EoE.
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Affiliation(s)
| | - Sivan Harel
- Regeneron Pharmaceuticals, IncTarrytownNYUSA
| | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, IncTarrytownNYUSA
| | | | - Nikhil Amin
- Regeneron Pharmaceuticals, IncTarrytownNYUSA
| | | | - Allen Radin
- Regeneron Pharmaceuticals, IncTarrytownNYUSA
| | - Brad Shumel
- Regeneron Pharmaceuticals, IncTarrytownNYUSA
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15
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Desrosiers M, Mannent LP, Amin N, Canonica GW, Hellings PW, Gevaert P, Mullol J, Lee SE, Fujieda S, Han JK, Hopkins C, Fokkens W, Jankowski R, Cho SH, Mao X, Zhang M, Rice MS, Khan AH, Kamat S, Patel N, Graham NMH, Ruddy M, Bachert C. Dupilumab reduces systemic corticosteroid use and sinonasal surgery rate in CRSwNP. Rhinology 2021; 59:301-311. [PMID: 33847325 DOI: 10.4193/rhin20.415] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease with a high symptom burden and poor quality of life. Treatment options include recurrent surgeries and/or frequent systemic corticosteroids (SCS). Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2-mediated inflammation. We report results of pooled analyses from 2 randomised, double-blind, placebo-controlled phase 3 studies (SINUS 24 [NCT02912468]; SINUS-52 [NCT02898454]) to evaluate dupilumab effect versus placebo in adults with CRSwNP with/without SCS use and sinonasal surgery. METHODOLOGY SINUS-24 patients were randomised 1:1 to subcutaneous dupilumab 300 mg (n=143) or placebo (n=133) every 2 weeks (q2w) for 24 weeks. SINUS-52 patients were randomised 1:1:1 to 52 weeks of subcutaneous dupilumab 300 mg q2w (n=150), 24 weeks q2w followed by 28 weeks of dupilumab 300 mg every 4 weeks (n=145) or 52 weeks of placebo q2w (n=153). RESULTS Dupilumab reduced the number of patients undergoing sinonasal surgery (82.6%), the need for in-study SCS use (73.9%), and SCS courses (75.3%). Significant improvements were observed with dupilumab vs placebo regardless of prior sinonasal surgery or SCS use in nasal polyp, nasal congestion, Lund-MacKay, and Sinonasal Outcome Test (22-items) scores, and the University of Pennsylvania Smell Identification Test. CONCLUSIONS Dupilumab demonstrated significant improvements in disease signs and symptoms and reduced the need for sino-nasal surgery and SCS use versus placebo in patients with severe CRSwNP, regardless of SCS use in the previous 2 years, or prior sinonasal surgery.
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Affiliation(s)
- M Desrosiers
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montreal, QC, Canada
| | | | - N Amin
- Regeneron Pharmaceuticals, Inc. Tarrytown, NY, USA
| | - G W Canonica
- Regeneron Pharmaceuticals, Inc. Tarrytown, NY, USA
| | | | | | - J Mullol
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - S E Lee
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - J K Han
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - C Hopkins
- Guy's and St Thomas' Hospitals, London, UK
| | - W Fokkens
- Academic Medical Center, Amsterdam, Netherlands
| | - R Jankowski
- University Hospital of Nancy, University of Lorraine, Nancy, France
| | - S H Cho
- University of South Florida, Tampa, FL, USA
| | - X Mao
- Sanofi, Bridgewater, NJ, USA
| | - M Zhang
- Sanofi, Bridgewater, NJ, USA
| | | | | | - S Kamat
- Regeneron Pharmaceuticals, Inc. Tarrytown, NY, USA
| | - N Patel
- Sanofi, Bridgewater, NJ, USA
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc. Tarrytown, NY, USA
| | - M Ruddy
- Regeneron Pharmaceuticals, Inc. Tarrytown, NY, USA
| | - C Bachert
- Ghent University, Ghent, Belgium; Karolinska Institutet, Stockholm, Sweden; Sun Yat-sen University, First Affiliated Hospital, Guangzhou, China
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16
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Laidlaw TM, Bachert C, Amin N, Desrosiers M, Hellings PW, Mullol J, Maspero JF, Gevaert P, Zhang M, Mao X, Khan AH, Kamat S, Patel N, Graham NMH, Ruddy M, Staudinger H, Mannent LP. Dupilumab improves upper and lower airway disease control in chronic rhinosinusitis with nasal polyps and asthma. Ann Allergy Asthma Immunol 2021; 126:584-592.e1. [PMID: 33465455 DOI: 10.1016/j.anai.2021.01.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 asthma share the same inflammatory pathophysiology and are frequent comorbidities. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin 4 and interleukin 13, which are key and central drivers of type 2 inflammation. OBJECTIVE We report the effect of dupilumab vs placebo on outcome measures of the upper and lower airways and health-related quality of life (HRQoL) in the pooled population of patients with CRSwNP and comorbid asthma from the phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies. METHODS In these randomized, double-blind, placebo-controlled trials, patients received subcutaneous dupilumab 300 mg (n = 438) or placebo (n = 286) every 2 weeks on a background of mometasone furoate nasal spray. Changes from baseline at week 24 in the upper and lower airway outcome measures are reported. RESULTS Of the 724 patients randomized, 428 (59.1%) had comorbid asthma. In patients with asthma at week 24, dupilumab vs placebo improved the nasal polyp score (-2.04), patient-reported nasal congestion score (-1.04), Lund-Mackay computed tomography scan score (-6.43), peak nasal inspiratory flow (46.15 L/min), and 22-item sinonasal outcome test score (-21.42; all P < .001). The forced expiratory volume in 1 second and 6-item asthma control questionnaire scores were also markedly improved with dupilumab vs placebo. The most common adverse events (nasopharyngitis, headache, injection-site erythema, worsening of nasal polyposis, and asthma) were more frequent with placebo than dupilumab. CONCLUSION Dupilumab improved upper and lower airway outcome measures and HRQoL in patients with severe CRSwNP and comorbid asthma and was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02912468 (SINUS-24) and NCT02898454 (SINUS-52).
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Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Claus Bachert
- Department of Head & Skin, Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium; Division of Ear, Nose and Throat (ENT) Diseases, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Nikhil Amin
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Martin Desrosiers
- Department of Otolaryngology, Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada
| | - Peter W Hellings
- Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic, The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, Ciber De Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Philippe Gevaert
- Department of Head & Skin, Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
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17
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Pavord I, Busse W, Israel E, Szefler S, Chen Z, Daizadeh N, Lederer D, Mannent L, Amin N, Laws E, Ruddy M, Rowe P, Deniz Y, Khan A, Zhang Y. Dupilumab Treatment Leads to Clinical Asthma Remission in Patients With Uncontrolled Moderate-to-Severe Asthma With Type 2 Inflammation. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.061] [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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18
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Wechsler M, Klion A, Paggiaro P, Nair P, Staumont-Salle D, Radwan A, Johnson R, Kapoor U, Khokhar FA, Daizadeh N, Chen Z, Laws E, Jacob-Nara J, Mannent L, Ruddy M, Rowe P, Deniz Y. Effect of Dupilumab Treatment on Blood Eosinophil Levels in Patients With Asthma, Chronic Rhinosinusitis With Nasal Polyps (CRSwNP), Eosinophilic Esophagitis (EoE), or Atopic Dermatitis (AD). J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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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19
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Boguniewicz M, Beck LA, Sher L, Guttman-Yassky E, Thaçi D, Blauvelt A, Worm M, Corren J, Soong W, Lio P, Rossi AB, Lu Y, Chao J, Eckert L, Gadkari A, Hultsch T, Ruddy M, Mannent LP, Graham NMH, Pirozzi G, Chen Z, Ardeleanu M. Dupilumab Improves Asthma and Sinonasal Outcomes in Adults with Moderate to Severe Atopic Dermatitis. J Allergy Clin Immunol Pract 2021; 9:1212-1223.e6. [PMID: 33453450 DOI: 10.1016/j.jaip.2020.12.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dupilumab has demonstrated efficacy with acceptable safety in clinical trials in patients with moderate to severe atopic dermatitis (AD). OBJECTIVE To assess dupilumab's impact on asthma and sinonasal conditions in adult patients with moderate to severe AD in four randomized, double-blinded, placebo-controlled trials. METHODS In LIBERTY AD SOLO 1 (NCT02277743), SOLO 2 (NCT02755649), CHRONOS (NCT02260986), and CAFÉ (NCT02755649), patients received placebo, dupilumab 300 mg every 2 weeks (q2w), or dupilumab 300 mg weekly (qw). In CHRONOS and CAFÉ, patients received concomitant topical corticosteroids. This post hoc analysis assessed Asthma Control Questionnaire-5 (ACQ-5) scores in patients with asthma, Sino-Nasal Outcome Test-22 (SNOT-22) scores in patients with sinonasal conditions, and AD signs and symptoms in all patients. RESULTS Of the 2444 patients, 463 had asthma with baseline ACQ-5 ≥ 0.5 (19%); 1171 had sinonasal conditions (48%); and 311 had both (13%). At week 16, ACQ-5 scores (least squares mean change from baseline [standard error]) improved by 0.27 (0.07), 0.59 (0.08), and 0.56 (0.07) in placebo-, q2w-, and qw-treated patients with asthma, respectively, whereas SNOT-22 scores improved by 5.1 (0.8), 9.9 (0.9), and 10.8 (0.8) in patients with sinonasal conditions (P < .01 for all dupilumab vs placebo). Improvements in ACQ-5 and SNOT-22 were also seen in patients with both conditions. Dupilumab also significantly improved AD signs and symptoms among all subgroups. CONCLUSIONS In this first analysis of patients with comorbid moderate to severe AD, asthma, and/or chronic sinonasal conditions, dupilumab improved all three diseases in a clinically meaningful and statistically significant manner (vs placebo), based on validated outcome measures.
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Affiliation(s)
- Mark Boguniewicz
- National Jewish Health, Denver, Colo; University of Colorado School of Medicine, Denver, Colo.
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, Calif
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | - Margitta Worm
- Division of Allergy and Immunology, Allergy Center Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Weily Soong
- Alabama Allergy and Asthma Center, Birmingham, Ala
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | | | | | | | | | | | | | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
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20
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Pavord ID, Siddiqui S, Papi A, Corren J, Sher LD, Bardin P, Langton D, Park HS, Rice MS, Deniz Y, Rowe P, Staudinger HW, Patel N, Ruddy M, Graham NMH, Teper A. Dupilumab Efficacy in Patients Stratified by Baseline Treatment Intensity and Lung Function. J Asthma Allergy 2020; 13:701-711. [PMID: 33364789 PMCID: PMC7751293 DOI: 10.2147/jaa.s275068] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The Phase 3 LIBERTY ASTHMA QUEST study in patients aged ≥12 years with uncontrolled, moderate-to-severe asthma demonstrated the efficacy and safety of dupilumab 200 mg and 300 mg every 2 weeks (q2w) vs matched placebo in the overall population. This post hoc analysis assessed dupilumab efficacy by disease severity as evidenced by baseline % predicted forced expiratory volume in 1 second (FEV1) and dose of inhaled corticosteroids (ICS). Patients and Methods Severe asthma exacerbation rates, change from baseline in FEV1, asthma control, quality of life, and fractional exhaled nitric oxide (FeNO) levels over the 52-week treatment period were assessed in patients with elevated type 2 inflammation biomarkers stratified by ICS dose and FEV1% predicted at baseline. Results In patients with elevated baseline eosinophils, dupilumab 200 mg and 300 mg q2w vs placebo reduced severe exacerbation rates by 50% (P=0.06) and 67% (P=0.001), respectively, in those with medium-dose ICS/FEV1% predicted 60–90%, and by 59% (P<0.001) and 47% (P=0.006) in those with high-dose ICS/FEV1% predicted <60%, improved pre-bronchodilator FEV1 at Week 12 by 0.16L (P=0.005) and 0.08L (P=0.13), and by 0.20L (P=0.003) and 0.21L (P<0.001), respectively, in the same subgroups. Dupilumab vs placebo also improved asthma control and quality of life and suppressed FeNO levels in all patient subgroups with similar results observed irrespective of baseline biomarker status or disease severity. Conclusion Dupilumab reduced severe exacerbations and improved lung function, asthma control and quality of life in patients with elevated baseline eosinophils irrespective of baseline ICS dose or FEV1% predicted.
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Affiliation(s)
- Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Salman Siddiqui
- University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre (Respiratory Theme), Leicester, UK
| | - Alberto Papi
- Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lawrence D Sher
- Peninsula Research Associates, Rolling Hills Estate, CA, USA
| | - Philip Bardin
- Department of Lung and Sleep Medicine, Monash University and Medical Centre, Clayton, Melbourne, VIC, Australia
| | - David Langton
- Department of Thoracic Medicine, Frankston Hospital, Frankston, Melbourne, VIC, Australia
| | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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21
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Blauvelt A, Hussain I, Beazley BA, Patel N, Genzyme S, Ruddy M, Staudinger H, Graham NM, BradShumel. 16292 Dupilumab treatment for up to 3 years demonstrates sustained efficacy in adult patients with moderate to severe atopic dermatitis: Results from LIBERTY AD Adult OLE. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.787] [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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22
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Huang C, Izmailova ES, Jackson N, Ellis R, Bhatia G, Ruddy M, Singh D. Remote FEV1 Monitoring in Asthma Patients: A Pilot Study. Clin Transl Sci 2020; 14:529-535. [PMID: 33048470 PMCID: PMC7993258 DOI: 10.1111/cts.12901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Forced expiratory volume in one second (FEV1 ) is a critical parameter for the assessment of lung function for both clinical care and research in patients with asthma. While asthma is defined by variable airflow obstruction, FEV1 is typically assessed during clinic visits. Mobile spirometry (mSpirometry) allows more frequent measurements of FEV1 , resulting in a more continuous assessment of lung function over time and its variability. Twelve patients with moderate asthma were recruited in a single-center study and were instructed to perform pulmonary function tests at home twice daily for 28 days and weekly in the clinic. Daily and mean subject compliances were summarized. The agreement between clinic and mobile FEV1 was assessed using correlation and Bland-Altman analyses. The test-retest reliability for clinic and mSpirometry was assessed by interclass correlation coefficient (ICC). Simulation was conducted to explore if mSpirometry could improve statistical power over clinic counterparts. The mean subject compliance with mSpirometry was 70% for twice-daily and 85% for at least once-daily. The mSpirometry FEV1 were highly correlated and agreed with clinic ones from the same morning (r = 0.993) and the same afternoon (r = 0.988) with smaller mean difference for the afternoon (0.0019 L) than morning (0.0126 L) measurements. The test-retest reliability of mobile (ICC = 0.932) and clinic (ICC = 0.942) spirometry were comparable. Our simulation analysis indicated greater power using dense mSpirometry than sparse clinic measurements. Overall, we have demonstrated good compliance for repeated at-home mSpirometry, high agreement and comparable test-retest reliability with clinic counterparts, greater statistical power, suggesting a potential for use in asthma clinical research.
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Affiliation(s)
| | | | | | | | | | | | - Dave Singh
- Medicines Evaluation Unit, Manchester, UK.,University of Manchester, Manchester University NHS Foundations Trust, Manchester, UK
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23
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Paller AS, Siegfried EC, Simpson EL, Cork MJ, Lockshin B, Kosloski MP, Kamal MA, Davis JD, Sun X, Pirozzi G, Graham NMH, Gadkari A, Eckert L, Ruddy M, Bansal A. A phase 2, open-label study of single-dose dupilumab in children aged 6 months to <6 years with severe uncontrolled atopic dermatitis: pharmacokinetics, safety and efficacy. J Eur Acad Dermatol Venereol 2020; 35:464-475. [PMID: 32893393 PMCID: PMC7894166 DOI: 10.1111/jdv.16928] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dupilumab has demonstrated efficacy and acceptable safety in adults and children (aged 6-17 years) with moderate-to-severe atopic dermatitis (AD), but effective systemic therapy with a favorable risk-benefit profile in younger children remains a significant unmet need. OBJECTIVES To determine the pharmacokinetics, safety and efficacy of single-dose dupilumab in children with severe AD aged ≥6 months to <6 years. METHODS This open-label, multicenter, phase 2, sequential, two-age cohort, two-dose level study (LIBERTY AD PRE-SCHOOL; NCT03346434) included an initial cohort of older children aged ≥2 to <6 years, followed by a younger cohort aged ≥6 months to <2 years. Pharmacokinetic sampling, safety monitoring and efficacy assessments were performed during the 4-week period after a single subcutaneous injection of dupilumab, in two sequential dosing groups (3 mg/kg, then 6 mg/kg). The use of standardized, low-to-medium potency topical corticosteroids was allowed. RESULTS Forty patients were enrolled (20/age cohort, 10/dose level within a cohort) between December 20, 2017 and July 22, 2019. Within each age cohort, pharmacokinetic exposures after a single injection of dupilumab increased in a greater than dose-proportional manner. At week 3, treatment with 3 and 6 mg/kg dupilumab reduced scores of mean Eczema Area and Severity Index by -44.6% and -49.7% (older cohort) and -42.7% and -38.8% (younger cohort), and mean Peak Pruritus NRS scores by -22.9% and -44.7% (older cohort) and -11.1% and -18.2% (younger cohort), respectively. At week 4, improvements in most efficacy outcomes diminished in both age groups, particularly with the lower dose. The safety profile was comparable to that seen in adults, adolescents and children. CONCLUSIONS Single-dose dupilumab was generally well tolerated and substantially reduced clinical signs/symptoms of AD. Slightly better responses were seen in older than younger children. The pharmacokinetics of dupilumab were non-linear, consistent with previous studies in adults and adolescents.
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Affiliation(s)
- A S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - E L Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - M J Cork
- University of Sheffield, Sheffield, UK
| | - B Lockshin
- Georgetown University, Rockville, MD, USA
| | - M P Kosloski
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - M A Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - J D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - X Sun
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - A Gadkari
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - M Ruddy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - A Bansal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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24
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Simpson EL, Paller AS, Siegfried EC, Boguniewicz M, Sher L, Gooderham MJ, Beck LA, Guttman-Yassky E, Pariser D, Blauvelt A, Weisman J, Lockshin B, Hultsch T, Zhang Q, Kamal MA, Davis JD, Akinlade B, Staudinger H, Hamilton JD, Graham NMH, Pirozzi G, Gadkari A, Eckert L, Stahl N, Yancopoulos GD, Ruddy M, Bansal A. Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial. JAMA Dermatol 2020; 156:44-56. [PMID: 31693077 PMCID: PMC6865265 DOI: 10.1001/jamadermatol.2019.3336] [Citation(s) in RCA: 249] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Adolescents with atopic dermatitis (AD) have high disease burden negatively affecting quality of life, with limited treatment options. The efficacy and safety of dupilumab, a monoclonal antibody, approved for treatment in adolescent patients with inadequately controlled AD, remain unknown in this patient population. Objective To assess the efficacy and safety of dupilumab monotherapy in adolescents with moderate to severe inadequately controlled AD. Design, Setting, and Participants A randomized, double-blind, parallel-group, phase 3 clinical trial was conducted at 45 US and Canadian centers between March 21, 2017, and June 5, 2018. A total of 251 adolescents with moderate to severe AD inadequately controlled by topical medications or for whom topical therapy was inadvisable were included. Interventions Patients were randomized (1:1:1; interactive-response system; stratified by severity and body weight) to 16-week treatment with dupilumab, 200 mg (n = 43; baseline weight <60 kg), or dupilumab, 300 mg (n = 39; baseline weight ≥60 kg), every 2 weeks; dupilumab, 300 mg, every 4 weeks (n = 84); or placebo (n = 85). Main Outcomes and Measures Proportion of patients with 75% or more improvement from baseline in Eczema Area and Severity Index (EASI-75) (scores range from 0 to 72, with higher scores indicating greater severity) and Investigator's Global Assessment (IGA) 0 or 1 on a 5-point scale (scores range from 0 to 4, with higher scores indicating greater severity) at week 16. Results A total of 251 patients were randomized (mean [SD] age, 14.5 [1.7] years; 148 [59.0%] male). Of 250 patients with data available on concurrent allergic conditions, most had comorbid type 2 diseases (asthma, 134 [53.6%]; food allergies, 60.8%; allergic rhinitis, 65.6%). A total of 240 patients (95.6%) completed the study. Dupilumab achieved both coprimary end points at week 16. The proportion of patients with EASI-75 improvement from baseline increased (every 2 weeks, 41.5%; every 4 weeks, 38.1%; placebo, 8.2%) with differences vs placebo of 33.2% (95% CI, 21.1%-45.4%) for every 2 weeks and 29.9% (95% CI, 17.9%-41.8%) for every 4 weeks (P < .001). Efficacy of the every-2-week regimen was generally superior to the every-4-week regimen. Patients in the dupilumab arms had higher percentage values of conjunctivitis (every 2 weeks, 9.8%; every 4 weeks, 10.8%; placebo, 4.7%) and injection-site reactions (every 2 weeks, 8.5%; every 4 weeks, 6.0%; placebo, 3.5%), and lower nonherpetic skin infections (every 2 weeks, 9.8%; every 4 weeks, 9.6%; placebo, 18.8%). Conclusions and Relevance In this study, dupilumab significantly improved AD signs, symptoms, and quality of life in adolescents with moderate to severe AD, with an acceptable safety profile. Placebo-corrected efficacy and safety of dupilumab were similar in adolescents and adults. Trial Registration ClinicalTrials.gov identifier: NCT03054428.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine C Siegfried
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Melinda J Gooderham
- Skin Centre for Dermatology, Peterborough, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Probity Medical Research, Waterloo, Ontario, Canada
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.,Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.,Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | | | | | - Benjamin Lockshin
- US Dermatology Partners, Rockville, Maryland.,Georgetown University, Washington, District of Columbia
| | | | - Qin Zhang
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - John D Davis
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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Paller AS, Siegfried EC, Thaçi D, Wollenberg A, Cork MJ, Arkwright PD, Gooderham M, Beck LA, Boguniewicz M, Sher L, Weisman J, O'Malley JT, Patel N, Hardin M, Graham NM, Ruddy M, Sun X, Davis JD, Kamal MA, Khokhar FA, Weinreich DM, Yancopoulos GD, Beazley B, Bansal A, Shumel B. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol 2020; 83:1282-1293. [DOI: 10.1016/j.jaad.2020.06.054] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
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Beck LA, Silverberg JI, Simpson EL, Yosipovitch G, Eckert L, Guillemin I, Chen Z, Ardeleanu M, Plaum S, Graham N, Ruddy M, Pirozzi G, Gadkari A. Dupilumab significantly improves sleep outcomes in adult patients with atopic dermatitis: results from five randomized clinical trials. J Eur Acad Dermatol Venereol 2020; 35:e130-e133. [PMID: 32789996 PMCID: PMC7891630 DOI: 10.1111/jdv.16865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - J I Silverberg
- Department of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC, USA.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA
| | - E L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - G Yosipovitch
- Miami Itch Center, Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Z Chen
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - S Plaum
- Sanofi, Bridgewater, NJ, USA
| | - N Graham
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - M Ruddy
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - A Gadkari
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Beck LA, Thaçi D, Deleuran M, Blauvelt A, Bissonnette R, de Bruin-Weller M, Hide M, Sher L, Hussain I, Chen Z, Khokhar FA, Beazley B, Ruddy M, Patel N, Graham NMH, Ardeleanu M, Shumel B. Dupilumab Provides Favorable Safety and Sustained Efficacy for up to 3 Years in an Open-Label Study of Adults with Moderate-to-Severe Atopic Dermatitis. Am J Clin Dermatol 2020; 21:567-577. [PMID: 32557382 PMCID: PMC7371647 DOI: 10.1007/s40257-020-00527-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Management of moderate-to-severe atopic dermatitis (AD) commonly requires long-term treatment. OBJECTIVE The aim of this study was to report the safety and efficacy of dupilumab treatment for up to 3 years in adults with moderate-to-severe AD. METHODS This ongoing, multicenter, open-label extension study (LIBERTY AD OLE; NCT01949311) assessed dupilumab treatment in adults previously enrolled in dupilumab trials. Patients received dupilumab 300 mg weekly up to 148 weeks. The primary outcome was safety. RESULTS Of 2677 patients enrolled and treated, 347 reached week 148. Mean self-reported drug compliance was 98.2%. Safety data were consistent with previously reported trials (270.1 adverse events [AEs]/100 patient-years; 6.9 serious AEs/100 patient-years) and the known dupilumab safety profile. Common AEs (≥ 5% of patients) included nasopharyngitis, AD, upper respiratory tract infection, conjunctivitis, headache, oral herpes, and injection-site reactions. AD signs and symptoms showed sustained improvements during treatment with mean (standard deviation, mean percentage change from parent study baseline) Eczema Area and Severity Index 1.4 (3.2, - 95.4%) and weekly Pruritus Numerical Rating Scale 2.2 (1.8, - 65.4%) at week 148. LIMITATIONS No control arm; fewer patients at later time points; regimen different from the approved 300 mg every 2 weeks dose. CONCLUSION These safety and efficacy results support dupilumab as a continuous long-term treatment for adults with moderate-to-severe AD. TRIAL REGISTRATION ClinicalTrials.gov: NCT01949311. Dupilumab provides favorable safety and sustained efficacy for up to 3 years in an open-label study of adults with moderate-to-severe atopic dermatitis (MP4 139831 kb).
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Affiliation(s)
- Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michihiro Hide
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, CA, USA
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Faisal A Khokhar
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Bethany Beazley
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Marcella Ruddy
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | | | - Neil M H Graham
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Marius Ardeleanu
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Brad Shumel
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA.
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Vanhoutte F, Liang S, Ruddy M, Zhao A, Drewery T, Wang Y, DelGizzi R, Forleo-Neto E, Rajadhyaksha M, Herman G, Davis JD. Pharmacokinetics and Pharmacodynamics of Garetosmab (Anti-Activin A): Results From a First-in-Human Phase 1 Study. J Clin Pharmacol 2020; 60:1424-1431. [PMID: 32557665 PMCID: PMC7586962 DOI: 10.1002/jcph.1638] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/21/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
Abstract
We describe outcomes from the first‐in‐human study of garetosmab (a fully human monoclonal antibody that inhibits activin A) under development for the treatment of fibrodysplasia ossificans progressiva (FOP). In a double‐blind, placebo‐controlled phase 1 study, 40 healthy women of nonchildbearing potential were randomized to receive a single dose of intravenous garetosmab 0.3, 1, 3, or 10 mg/kg; subcutaneous garetosmab 300 mg; or placebo. Serum concentrations of functional garetosmab (with ≥1 arm free to bind to target), total activin A, and antidrug antibodies were measured predose and up to 113 days post–first dose. Garetosmab demonstrated an acceptable safety profile with no dose‐limiting toxicities. Garetosmab displayed nonlinear pharmacokinetics with target‐mediated elimination. With increasing doses of intravenous garetosmab, mean peak concentration increased in a dose‐proportional manner; mean steady‐state estimates ranged from 41.4 to 47.8 mL/kg. A greater than dose‐proportional increase in mean area under the concentration‐time curve from time zero extrapolated to infinity (range, 72.2‐7520 mg*day/L) was observed, consistent with decreasing mean clearance (range, 4.35‐1.34 mL/day/kg). Following administration of intravenous garetosmab, mean concentrations of total activin A increased in a dose‐dependent manner. At 10 mg/kg, total activin A levels reached a state of little or no change between weeks 4 and 12, suggesting saturation of the target‐mediated pathway. No safety signals were seen in this study to preclude investigation in patients. Following intravenous administration, garetosmab concentrations decreased quickly, then decreased over time (reflecting linear elimination), and finally decreased in a nonlinear phase, reflecting target‐mediated elimination. Results here support further investigation. Garetosmab 10 mg/kg every 4 weeks intravenously is being evaluated in patients with FOP (NCT03188666).
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Affiliation(s)
| | - Su Liang
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Marcella Ruddy
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - An Zhao
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Tiera Drewery
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Yuhuan Wang
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | | | - Gary Herman
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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Busse WW, Maspero JF, Lu Y, Corren J, Hanania NA, Chipps BE, Katelaris CH, FitzGerald JM, Quirce S, Ford LB, Rice MS, Kamat S, Khan AH, Jagerschmidt A, Harel S, Rowe P, Pirozzi G, Amin N, Ruddy M, Graham NMH, Teper A. Efficacy of dupilumab on clinical outcomes in patients with asthma and perennial allergic rhinitis. Ann Allergy Asthma Immunol 2020; 125:565-576.e1. [PMID: 32474156 DOI: 10.1016/j.anai.2020.05.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Comorbid perennial allergic rhinitis (PAR) or year-round aeroallergen sensitivity substantially contributes to disease burden in patients with asthma. Dupilumab blocks the shared receptor for interleukin (IL) 4 and IL-13, key drivers of type 2 inflammation that play important roles in asthma and PAR. In the LIBERTY ASTHMA QUEST trial (NCT02414854), dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma, with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline (blood eosinophils and fractional exhaled nitric oxide). OBJECTIVE To assess dupilumab efficacy in LIBERTY ASTHMA QUEST patients with comorbid PAR. METHODS Severe asthma exacerbation rates, FEV1, asthma control (5-item Asthma Control Questionnaire), rhinoconjunctivitis-specific health-related quality of life (Standardized Rhinoconjunctivitis Quality of Life Questionnaire +12 scores), and type 2 inflammatory biomarkers during the 52-week treatment period were assessed. RESULTS A total of 814 of the 1902 patients (42.8%) had comorbid PAR (defined as an allergic rhinitis history and ≥1 perennial aeroallergen specific immunoglobulin E (IgE) level ≥0.35 kU/L at baseline). Dupilumab, 200 and 300 mg every 2 weeks, vs placebo reduced severe exacerbations rates by 32.2% and 34.6% (P < .05 for both) and improved FEV1 at week 12 by 0.14 L and 0.18 L (P < .01 for both); greater efficacy was observed in patients with elevated baseline blood eosinophil counts (≥300 cells/μL) and fractional exhaled nitric oxide. Dupilumab treatment also numerically improved the 5-item Asthma Control Questionnaire and Standardized Rhinoconjunctivitis Quality of Life Questionnaire +12 scores and suppressed type 2 inflammatory biomarkers. CONCLUSION Dupilumab improved key asthma-related outcomes, asthma control, and rhinoconjunctivitis-specific health-related quality of life while suppressing type 2 inflammatory biomarkers and perennial allergen-specific IgE in patients with moderate-to-severe asthma and comorbid PAR, highlighting its dual inhibitory effects on IL-4 and IL-13 and its role in managing asthma and PAR.
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Affiliation(s)
- William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | - Jonathan Corren
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Nicola A Hanania
- Baylor College of Medicine, Texas Medical Center, Houston, Texas
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | | | | | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | | | | | | | | | - Sivan Harel
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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Wambre E, Bajzik V, DeVeaux M, Meier P, Ruddy M, DeBerg H, Wang CQ, Farrington M, Radin A. Clinical and immunological evaluation of cat-allergic asthmatics living with or without a cat. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.65.25] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Rationale
We aimed to evaluate the impact of daily cat exposure in cat allergic asthmatics by both clinical symptom and immunological measures.
Methods
Twenty adults with history of cat-induced asthma and rhinitis, positive serum cat dander-specific IgE (sIgE>0.35kU/L) and Skin Prick Test (SPT) were enrolled at a 1:1 ratio according to cat ownership. For comparison, cat extract- and Fel d1- specific basophil sensitivity test (BST), serum sIgE, sIgG4 and SPT were measured on Day 1 and 28; ambulatory spirometry and symptom measures were obtained daily. Feld1 and 4-reactive CD4+ T cells were profiled using a CD154 upregulation assay.
Results
Cat owners had higher clinical symptom scores & medication use and a trend toward lower FEV1 vs. those not living with cats. Significantly higher levels of cat dander sIgG4 were observed among cat owners, but no significant difference was observed for cat-dander sIgE or SPT. All subjects tested positive on BST to Fel d1 and cat dander. Cat-ownership was associated with reduced basophil sensitivity to Fel d1, but had positive BST to Fel d4 and 7. T-cell response to Fel d1 and 4 were differentially polarized, with Fel d1 responses strongly polarized toward Th2 in both groups. No significant correlation was observed between basophil and T cell responses against cat allergen components.
Conclusions
Cat allergic subjects living with a cat demonstrated reduced pulmonary function and greater clinical symptom severity, despite higher medication use and sIgG4. An immunological difference between cat-owners vs. non cat-owners was detected by basophil assay but not by T-cell response.
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Rabe K, FitzGerald J, Bateman E, Castro M, Pavord I, Maspero J, Busse W, Rice M, Deniz Y, Rowe P, Patel N, Amin N, Ruddy M, Graham N, Teper A. Dupilumab Efficacy in GINA-Defined Difficult-to-Treat Type 2 Asthma Patients. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.785] [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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Castro M, Maspero J, Sher L, Rabe K, Casale T, Rice M, Ruddy M, Rowe P, Deniz Y. Dupilumab Reduces Oral Corticosteroid Use and Severe Exacerbations and Improves Lung Function in Patients With Oral Corticosteroid-Dependent Severe Asthma With and Without Comorbid Allergic Rhinitis in the Phase 3 LIBERTY ASTHMA VENTURE Study. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.361] [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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Paller AS, Bansal A, Simpson EL, Boguniewicz M, Blauvelt A, Siegfried EC, Guttman-Yassky E, Hultsch T, Chen Z, Mina-Osorio P, Lu Y, Rossi AB, He X, Kamal M, Graham NMH, Pirozzi G, Ruddy M, Eckert L, Gadkari A. Clinically Meaningful Responses to Dupilumab in Adolescents with Uncontrolled Moderate-to-Severe Atopic Dermatitis: Post-hoc Analyses from a Randomized Clinical Trial. Am J Clin Dermatol 2020; 21:119-131. [PMID: 31823222 PMCID: PMC6989562 DOI: 10.1007/s40257-019-00478-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Atopic dermatitis is a chronic inflammatory condition with substantial burden and limited treatment options for adolescents with moderate-to-severe disease. Significantly more patients treated with dupilumab vs. placebo achieved Investigator’s Global Assessment 0/1 at week 16. Objective The objective of this study was to assess the impact of dupilumab treatment vs. placebo on the achievement of clinically meaningful improvements in atopic dermatitis signs, symptoms and quality of life. Methods R668-AD-1526 LIBERTY AD ADOL was a randomized, double-blinded, parallel-group, phase III clinical trial. Two hundred and fifty-one adolescents with moderate-to-severe atopic dermatitis received dupilumab 300 mg every 4 weeks (q4w; n = 84), dupilumab 200 or 300 mg every 2 weeks (q2w; n = 82), or placebo (n = 85). A post-hoc subgroup analysis was performed on 214 patients with Investigator’s Global Assessment > 1 at week 16. Measures of atopic dermatitis signs, symptoms, and quality of life were assessed. Clinically meaningful improvement in one or more of three domains of signs, symptoms, and quality of life was defined as an improvement of ≥ 50% in Eczema Area and Severity Index, ≥ 3 points in Peak Pruritus Numerical Rating Scale, or ≥ 6 points in the Children’s Dermatology Life Quality Index from baseline. Results Of patients receiving dupilumab q2w, 80.5% [66/82] experienced clinically meaningful improvements in atopic dermatitis signs, symptoms, or quality of life at week 16 (vs. placebo, 20/85 [23.5%], difference 57.0% [95% confidence interval 44.5–69.4]; q4w vs. placebo, 53/84 [63.1%], difference 39.6% [95% confidence interval 25.9–53.3]; both p < 0.0001). Results were similar in adolescents with Investigator’s Global Assessment > 1 at week 16 (q2w, 46/62 [74.2%] vs. placebo, 18/83 [21.7%], difference 52.5% [95% confidence interval 38.5–66.6]; q4w, 38/69 [55.1%] vs. placebo, difference 33.4% [95% confidence interval 18.7–48.1]; both p < 0.0001). Conclusions Dupilumab provided clinically meaningful improvements in signs, symptoms, and quality of life in adolescents with moderate-to-severe atopic dermatitis among patients with Investigator’s Global Assessment > 1 at week 16. Treatment responses should be interpreted in the context of such clinically relevant patient-reported outcome measures. Trial Registration ClinicalTrials.gov; NCT03054428. Video abstract Adolescents with atopic dermatitis: does dupilumab improve their signs, symptoms, and quality of life? (MP4 212916 kb)
Electronic supplementary material The online version of this article (10.1007/s40257-019-00478-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 1600, Chicago, IL, 60611, USA.
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, CO, USA
| | | | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai and Laboratory for Investigative Dermatology, Rockefeller University, New York, NY, USA
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Xinyi He
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Castro M, Rabe KF, Corren J, Pavord ID, Katelaris CH, Tohda Y, Zhang B, Rice MS, Maroni J, Rowe P, Pirozzi G, Amin N, Ruddy M, Akinlade B, Graham NMH, Teper A. Dupilumab improves lung function in patients with uncontrolled, moderate-to-severe asthma. ERJ Open Res 2020; 6:00204-2019. [PMID: 32010719 PMCID: PMC6983496 DOI: 10.1183/23120541.00204-2019] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/13/2019] [Indexed: 01/07/2023] Open
Abstract
Background Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation. In the phase 3 LIBERTY ASTHMA QUEST trial (NCT02414854) in patients with uncontrolled, moderate-to-severe asthma, add-on dupilumab 200 mg or 300 mg every 2 weeks reduced exacerbations and improved forced expiratory volume in 1 s (FEV1) and quality of life over 52 weeks. This analysis evaluates dupilimab's effect on lung function in the overall population, and subgroups with baseline elevated type 2 inflammatory biomarkers. Methods Patients were randomised to 52 weeks of subcutaneous dupilumab 200 mg every 2 weeks, 300 mg every 2 weeks, or matched-volume placebos. Lung function outcomes were analysed in the overall population, in patients with ≥150 eosinophils·µL−1, ≥300 eosinophils·µL−1, ≥25 ppb fractional exhaled nitric oxide (FeNO), and both ≥150 eosinophils·µL−1 and ≥25 ppb FeNO, at baseline. Results Dupilumab treatment (200 mg and 300 mg every 2 weeks) resulted in significant improvements versus placebo after 52 weeks in pre-bronchodilator FEV1 (0.20 and 0.13 L, respectively, versus placebo) and post-bronchodilator FEV1 (0.19 and 0.13 L, respectively), forced vital capacity (FVC) (0.20 and 0.14 L, respectively), forced expiratory flow (0.19 and 0.13 L·s−1, respectively) and pre-bronchodilator FEV1/FVC ratio (1.75% and 1.61%, respectively) in the overall population (p<0.001). Difference versus placebo in post-bronchodilator FEV1 slope of change (weeks 4–52) was significant (0.04 L·year−1; p<0.05). Greater improvements were achieved in patients with elevated baseline blood eosinophil and/or FeNO levels for most outcomes. Conclusions Dupilumab improves lung function outcomes, including large and small airway measurements and fixed airway obstruction, in patients with uncontrolled, moderate-to-severe asthma; particularly in patients with elevated biomarkers of type 2 inflammation. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation, improving lung function outcomes in patients with uncontrolled, moderate-to-severe asthmahttp://bit.ly/2OhKMpi
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Affiliation(s)
- Mario Castro
- Washington University School of Medicine, St Louis, MO, USA
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Christian Albrechts University, members of the German Center for Lung Research (DZL), Kiel, Germany
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ian D Pavord
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Constance H Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | | | | | - Jaman Maroni
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Cork M, Thaçi D, Eichenfield L, Arkwright P, Hultsch T, Davis J, Zhang Y, Zhu X, Chen Z, Li M, Ardeleanu M, Teper A, Akinlade B, Gadkari A, Eckert L, Kamal M, Ruddy M, Graham N, Pirozzi G, Stahl N, DiCioccio A, Bansal A. 一项关于 dupilumab 治疗湿疹青少年患者的研究. Br J Dermatol 2020. [DOI: 10.1111/bjd.18678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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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Cork M, Thaçi D, Eichenfield L, Arkwright P, Hultsch T, Davis J, Zhang Y, Zhu X, Chen Z, Li M, Ardeleanu M, Teper A, Akinlade B, Gadkari A, Eckert L, Kamal M, Ruddy M, Graham N, Pirozzi G, Stahl N, DiCioccio A, Bansal A. A study of dupilumab in the treatment of adolescents with eczema. Br J Dermatol 2020. [DOI: 10.1111/bjd.18661] [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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Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, Mullol J, Greos LS, Bosso JV, Laidlaw TM, Cervin AU, Maspero JF, Hopkins C, Olze H, Canonica GW, Paggiaro P, Cho SH, Fokkens WJ, Fujieda S, Zhang M, Lu X, Fan C, Draikiwicz S, Kamat SA, Khan A, Pirozzi G, Patel N, Graham NMH, Ruddy M, Staudinger H, Weinreich D, Stahl N, Yancopoulos GD, Mannent LP. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019; 394:1638-1650. [PMID: 31543428 DOI: 10.1016/s0140-6736(19)31881-1] [Citation(s) in RCA: 674] [Impact Index Per Article: 134.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) generally have a high symptom burden and poor health-related quality of life, often requiring recurring systemic corticosteroid use and repeated sinus surgery. Dupilumab is a fully human monoclonal antibody that inhibits signalling of interleukin (IL)-4 and IL-13, key drivers of type 2 inflammation, and has been approved for use in atopic dermatitis and asthma. In these two studies, we aimed to assess efficacy and safety of dupilumab in patients with CRSwNP despite previous treatment with systemic corticosteroids, surgery, or both. METHODS LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 were two multinational, multicentre, randomised, double-blind, placebo-controlled, parallel-group studies assessing dupilumab added to standard of care in adults with severe CRSwNP. SINUS-24 was done in 67 centres in 13 countries, and SINUS-52 was done in 117 centres in 14 countries. Eligible patients were 18 years or older with bilateral CRSwNP and symptoms despite intranasal corticosteroid use, receiving systemic corticosteroids in the preceding 2 years, or having had sinonasal surgery. Patients in SINUS-24 were randomly assigned (1:1) to subcutaneous dupilumab 300 mg or placebo every 2 weeks for 24 weeks. Patients in SINUS-52 were randomly assigned (1:1:1) to dupilumab 300 mg every 2 weeks for 52 weeks, dupilumab every 2 weeks for 24 weeks and then every 4 weeks for the remaining 28 weeks, or placebo every 2 weeks for 52 weeks. All patients were randomly assigned centrally with a permuted block randomisation schedule. Randomisation was stratified by asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease status at screening, previous surgery at screening, and country. Patients with or without comorbid asthma were included. Coprimary endpoints were changes from baseline to week 24 in nasal polyp score (NPS), nasal congestion or obstruction, and sinus Lund-Mackay CT scores (a coprimary endpoint in Japan), done in an intention-to-treat population. Safety was assessed in a pooled population of both dupilumab groups in SINUS-52 up to week 24 and the dupilumab group in SINUS-24 and the placebo groups in both studies until week 24. The trials are complete and registered at ClinicalTrials.gov, NCT02912468 and NCT02898454. FINDINGS Between Dec 5, 2016, and Aug 3, 2017, 276 patients were enrolled in SINUS-24, with 143 in the dupilumab group and 133 in the placebo group receiving at least one study drug dose. Between Nov 28, 2016, and Aug 28, 2017, 448 patients were enrolled in SINUS-52, with 150 receiving at least one dose of dupilumab every 2 weeks, 145 receiving at least one dose of dupilumab every 2 weeks for 24 weeks and every 4 weeks until week 52, and 153 receiving at least one dose of placebo. Dupilumab significantly improved the coprimary endpoints in both studies. At 24 weeks, least squares mean difference in NPS of dupilumab treatment versus placebo was -2·06 (95% CI -2·43 to -1·69; p<0·0001) in SINUS-24 and -1·80 (-2·10 to -1·51; p<0·0001) in SINUS-52; difference in nasal congestion or obstruction score was -0·89 (-1·07 to -0·71; p<0·0001) in SINUS-24 and -0·87 (-1·03 to -0·71; p<0·0001) in SINUS-52; and difference in Lund-Mackay CT scores was -7·44 (-8·35 to -6·53; p<0·0001) in SINUS-24 and -5·13 (-5·80 to -4·46; p<0·0001) in SINUS-52. The most common adverse events (nasopharyngitis, worsening of nasal polyps and asthma, headache, epistaxis, and injection-site erythema) were more frequent with placebo. INTERPRETATION In adult patients with severe CRSwNP, dupilumab reduced polyp size, sinus opacification, and severity of symptoms and was well tolerated. These results support the benefits of adding dupilumab to daily standard of care for patients with severe CRSwNP who otherwise have few therapeutic options. FUNDING Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Claus Bachert
- Faculty of Medicine, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Joseph K Han
- Division of Allergy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Martin Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Peter W Hellings
- Laboratory of Experimental Immunology, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joaquim Mullol
- Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - Leon S Greos
- Colorado Allergy and Asthma Centers, Centennial, CO, USA
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Tanya M Laidlaw
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Anders U Cervin
- Faculty of Medicine, University of Queensland and Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Claire Hopkins
- Department of Ear, Nose, and Throat, Guy's and St Thomas' Hospitals, London, UK
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy, Humanitas University, Clinical and Research Center, IRCCS, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Seong H Cho
- Division of Allergy-Immunology, University of South Florida, Tampa, FL, USA
| | | | - Shigeharu Fujieda
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | | | - Xin Lu
- Sanofi, Bridgewater, NJ, USA
| | | | | | | | | | | | | | | | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Cork MJ, Thaçi D, Eichenfield LF, Arkwright PD, Hultsch T, Davis JD, Zhang Y, Zhu X, Chen Z, Li M, Ardeleanu M, Teper A, Akinlade B, Gadkari A, Eckert L, Kamal MA, Ruddy M, Graham NMH, Pirozzi G, Stahl N, DiCioccio AT, Bansal A. Dupilumab in adolescents with uncontrolled moderate-to-severe atopic dermatitis: results from a phase IIa open-label trial and subsequent phase III open-label extension. Br J Dermatol 2019; 182:85-96. [PMID: 31595499 PMCID: PMC6972638 DOI: 10.1111/bjd.18476] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2019] [Indexed: 12/15/2022]
Abstract
Background Dupilumab (monoclonal antibody inhibiting IL‐4/IL‐13 signalling) is approved for use in adolescents aged ≥ 12 years with inadequately controlled moderate‐to‐severe atopic dermatitis (AD). Dupilumab significantly improved AD signs/symptoms in a 16‐week, randomised, placebo‐controlled phase III trial in adolescents (NCT03054428). Objectives To characterize the pharmacokinetics of dupilumab, and long‐term safety and efficacy in adolescents. Methods This was a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study with a phase III open‐label extension (OLE) in adolescents with moderate‐to‐severe AD. In the phase IIa study, patients received one dupilumab dose (2 mg kg−1 or 4 mg kg−1) and 8 weeks of pharmacokinetic sampling. Thereafter, patients received the same dose weekly for 4 weeks, with 8‐week safety follow‐up. Patients then enrolled in the OLE, continuing 2 mg kg−1 or 4 mg kg−1 dupilumab weekly. Primary end points were dupilumab concentration–time profile and incidence of treatment‐emergent adverse events (TEAEs). Secondary outcomes included Eczema Area and Severity Index (EASI). Results Forty adolescents received dupilumab in the phase IIa study; 36 enrolled in the OLE. Dupilumab showed nonlinear, target‐mediated pharmacokinetics. Mean ± SD trough dupilumab concentrations in serum at week 48 (OLE) were 74 ± 19 mg L−1 and 161 ± 60 mg L−1 for 2 mg kg−1 and 4 mg kg−1, respectively. Dupilumab was well tolerated over 52 weeks; the most common TEAEs were nasopharyngitis (week 52: 41% [2 mg kg−1], 47% [4 mg kg−1]) and AD exacerbation (29%, 42%). After one dupilumab dose in the phase IIa study, EASI improved from baseline to week 2 [mean ± SD reduction −34% ± 20% (2 mg kg−1) and −51% ± 29% (4 mg kg−1)]. With continuing treatment, EASI scores improved further [week 52: −85% ± 12% (2 mg kg−1) and −84% ± 20% (4 mg kg−1)]. Conclusions In adolescents with moderate‐to‐severe AD, dupilumab's pharmacokinetic profile was similar to that in adults. These 52‐week safety and efficacy data support long‐term use of dupilumab in this patient population. What's already known about this topic? Adolescents with moderate‐to‐severe atopic dermatitis (AD) have high unmet medical need, with significant disease burden and limited treatment options. Dupilumab (monoclonal antibody against interleukin‐4 receptor α) is approved for the treatment of adolescents with moderate‐to‐severe AD who are inadequately responsive to standard of care (U.S.A.) or candidates for systemic therapy (European Union). A 16‐week, randomized, placebo‐controlled phase III trial in adolescents demonstrated significant improvements in AD signs/symptoms with an acceptable safety profile.
What does this study add? These studies demonstrate the long‐term safety and efficacy of dupilumab in adolescents with moderate‐to‐severe AD for up to 52 weeks of treatment, thus extending and reinforcing the findings from the 16‐week dupilumab phase III trial. The data from these studies also support the use of dupilumab in combination with current standard of care (topical corticosteroids), which was not evaluated in the 16‐week phase III monotherapy trial.
Linked Comment: https://doi.org/10.1111/bjd.18627. https://doi.org/10.1111/bjd.18661 available online
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Affiliation(s)
- M J Cork
- The University of Sheffield, Sheffield Children's Hospital, Sheffield, U.K
| | - D Thaçi
- University of Lübeck, Lübeck, Germany
| | - L F Eichenfield
- University of California San Diego, Rady Children's Hospital, San Diego, CA, U.S.A
| | - P D Arkwright
- University of Manchester, Royal Manchester Children's Hospital, Manchester, U.K
| | - T Hultsch
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - J D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - Y Zhang
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - X Zhu
- Regeneron Pharmaceuticals, Inc., Basking Ridge, NJ, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Li
- Sanofi, Bridgewater, NJ, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Teper
- Sanofi, Bridgewater, NJ, U.S.A
| | - B Akinlade
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Gadkari
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - M A Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Ruddy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - N Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A T DiCioccio
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Bansal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
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Corren J, Castro M, O'Riordan T, Hanania NA, Pavord ID, Quirce S, Chipps BE, Wenzel SE, Thangavelu K, Rice MS, Harel S, Jagerschmidt A, Khan AH, Kamat S, Maroni J, Rowe P, Lu Y, Amin N, Pirozzi G, Ruddy M, Graham NMH, Teper A. Dupilumab Efficacy in Patients with Uncontrolled, Moderate-to-Severe Allergic Asthma. J Allergy Clin Immunol Pract 2019; 8:516-526. [PMID: 31521831 DOI: 10.1016/j.jaip.2019.08.050] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dupilumab blocks the shared receptor component for IL-4 and IL-13, key drivers of type 2 inflammation, including IgE-mediated allergic inflammation in asthma. In the LIBERTY ASTHMA QUEST (NCT02414854) study, dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers (blood eosinophils and fractional exhaled nitric oxide) at baseline. OBJECTIVE We assessed dupilumab's effect on key asthma outcomes in QUEST patients with/without evidence of allergic asthma (total serum IgE ≥30 IU/mL and ≥1 perennial aeroallergen-specific IgE ≥0.35 kU/L at baseline). METHODS Severe exacerbation rates and change from baseline in FEV1, asthma control, and markers of type 2 inflammation during the 52-week treatment period were assessed. RESULTS In the allergic asthma subgroup (n = 1083), dupilumab 200/300 mg every 2 weeks versus placebo reduced severe asthma exacerbation rates (-36.9%/-45.5%; both P < .01), improved FEV1 at week 12 (0.13 L/0.16 L; both P < .001; improvements were evident by the first evaluation at week 2) with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline, and improved asthma control. Dupilumab treatment also resulted in rapid and sustained reductions in type 2 inflammatory biomarkers. Comparable results were observed in patients without evidence of allergic asthma (n = 819). CONCLUSION Dupilumab reduced severe exacerbation rates, improved FEV1 and asthma control, and suppressed type 2 inflammatory biomarkers in patients with uncontrolled, moderate-to-severe asthma with or without evidence of allergic asthma, highlighting the key role of IL-4 and IL-13 in airway inflammation.
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Affiliation(s)
- Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, Calif.
| | - Mario Castro
- Washington University School of Medicine, St. Louis, Mo
| | | | | | - Ian D Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Santiago Quirce
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Sally E Wenzel
- University of Pittsburgh Asthma Institute, Pittsburgh, Pa
| | | | | | - Sivan Harel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Maspero JF, Katelaris CH, Busse WW, Castro M, Corren J, Chipps BE, Peters AT, Pavord ID, Ford LB, Sher L, Rabe KF, Rice MS, Rowe P, Lu Y, Harel S, Jagerschmidt A, Khan AH, Kamat S, Pirozzi G, Amin N, Ruddy M, Graham NMH, Mannent LP, Teper A. Dupilumab Efficacy in Uncontrolled, Moderate-to-Severe Asthma with Self-Reported Chronic Rhinosinusitis. J Allergy Clin Immunol Pract 2019; 8:527-539.e9. [PMID: 31351189 DOI: 10.1016/j.jaip.2019.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4 and IL-13 signaling, key drivers of type 2 inflammation. In the phase 3 study (NCT02414854), add-on dupilumab 200 mg/300 mg every 2 weeks, versus placebo, significantly reduced severe asthma exacerbations and improved pre-bronchodilator forced expiratory volume in 1 second (FEV1) and quality-of-life measures in patients with uncontrolled, moderate-to-severe asthma, with greater efficacy observed in those with a high baseline type 2 phenotype. OBJECTIVE To assess the efficacy and safety of dupilumab in patients with uncontrolled, moderate-to-severe asthma with or without self-reported comorbid chronic rhinosinusitis (CRS or non-CRS). METHODS Comorbid CRS was self-reported by patients using an e-diary. Annualized severe exacerbation rates, changes from baseline in pre- and post-bronchodilator FEV1, patient-reported outcomes, type 2 biomarkers, and safety were assessed. RESULTS CRS was self-reported by 382 of 1902 (20.1%) patients. Dupilumab 200 mg/300 mg reduced annualized severe exacerbation rates by 63%/61%, respectively, in patients with CRS, and by 42%/40% in patients without CRS (all P < .001 vs placebo). Dupilumab also improved lung function and patient-reported asthma control and quality of life, and suppressed type 2 biomarkers versus placebo in both subgroups. Clinical responses were rapid, with near-maximal responses observed at the earliest measured time points and sustained at week 52. Improvements observed in the CRS subgroup were similar to or numerically greater than those in the non-CRS subgroup. CONCLUSION Dupilumab showed efficacy and was generally well tolerated in patients with uncontrolled, moderate-to-severe asthma with or without CRS.
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Affiliation(s)
| | - Constance H Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Mario Castro
- Washington University School of Medicine, Saint Louis, Mo
| | | | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Anju T Peters
- Division of Allergy-Immunology and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, Calif
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany; Christian-Albrechts-University of Kiel, Member of the German Center for Lung Research (DZL), Kiel, Germany
| | | | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Sivan Harel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Busse WW, Maspero JF, Hanania NA, FitzGerald JM, Ford LB, Rice M, Lu Y, Rowe P, Staudinger H, Amin N, Ruddy M, Graham NM, Teper A. Dupilumab Improves Lung Function and Reduces Severe Exacerbation Rate in Patients With Uncontrolled, Moderate-to-Severe Asthma With or Without Comorbid Allergic Rhinitis: Results From the Phase 3 LIBERTY ASTHMA QUEST Study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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Corren J, Bousquet J, Busse WW, Maspero JF, Hanania NA, Ford LB, Rice M, Lu Y, Rowe P, Harel S, Staudinger H, Ruddy M, Graham NM, Amin N, Teper A. Dupilumab Suppresses Inflammatory Biomarkers in Asthma Patients With or Without Allergic Rhinitis: Post Hoc Analysis of the LIBERTY ASTHMA QUEST Study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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Bousquet J, Maspero JF, Chipps BE, Corren J, FitzGerald JM, Chen Z, Lu Y, Rowe P, Staudinger H, Ruddy M, Graham NM, Kamat S, Amin N, Teper A, Khan A. Dupilumab Consistently Improves Rhinoconjunctivitis-Specific Health-Related Quality of Life in Patients With Uncontrolled, Moderate-to-Severe Asthma and Comorbid Allergic Rhinitis: Results from the Phase 3 LIBERTY ASTHMA QUEST Study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Nipp RD, El-Jawahri A, Ruddy M, Fuh C, Temel B, D'Arpino SM, Cashavelly BJ, Jackson VA, Ryan DP, Hochberg EP, Greer JA, Temel JS. Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer. Ann Oncol 2019; 30:274-280. [PMID: 30395144 PMCID: PMC6386022 DOI: 10.1093/annonc/mdy488] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.
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Affiliation(s)
- R D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
| | - A El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - M Ruddy
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - C Fuh
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - B Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - S M D'Arpino
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - B J Cashavelly
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - V A Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - D P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - E P Hochberg
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - J A Greer
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - J S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
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Maspero JF, Corren J, Ford LB, Sher L, Chipps BE, Peters AT, Rice M, Rowe P, Lu Y, Harel S, Staudinger H, Amin N, Ruddy M, Graham NM, Teper A. Dupilumab Suppresses Type 2 Biomarkers in Asthma Patients With and Without Comorbid Chronic Rhinosinusitis With or Without Nasal Polyposis (CRS/NP): Post Hoc Analysis of LIBERTY ASTHMA QUEST. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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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Han JK, Bachert C, Desrosiers M, Laidlaw TM, Hopkins C, Fokkens WJ, Paggiaro P, Ho Cho S, Olze H, Greos LS, Zhang M, Fan C, Draikiwicz S, Amin N, Kamat S, Khan A, Pirozzi G, Graham NM, Ruddy M, Staudinger H, Mannent LP. Efficacy and Safety of Dupilumab in Patients with Chronic Rhinosinusitis with Nasal Polyps: Results from the Randomized Phase 3 Sinus-24 Study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.948] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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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Castro M, Corren J, Hanania N, Pavord I, Quirce S, Thangavelu K, Rice M, O'Riordan T, Maroni J, Rowe P, Lu Y, Amin N, Ruddy M, Akinlade B, Graham N, Teper A. DUPILUMAB EFFICACY IN UNCONTROLLED, MODERATE-TO-SEVERE ALLERGIC ASTHMA IN THE PHASE 3 LIBERTY ASTHMA QUEST STUDY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Beysen C, Ruddy M, Stoch A, Mixson L, Rosko K, Riiff T, Turner SM, Hellerstein MK, Murphy EJ. Dose-dependent quantitative effects of acute fructose administration on hepatic de novo lipogenesis in healthy humans. Am J Physiol Endocrinol Metab 2018; 315:E126-E132. [PMID: 29558206 DOI: 10.1152/ajpendo.00470.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fructose feeding increases hepatic de novo lipogenesis (DNL) and is associated with nonalcoholic fatty liver disease. Little is known, however, about individual variation in susceptibility to fructose stimulation of DNL. In this three-period crossover study, 17 healthy male subjects were enrolled to evaluate the within- and between-subject variability of acute fructose feeding on hepatic fractional DNL. During each assessment, [1-13C1]acetate was infused to measure DNL in the fasting state and during fructose feeding. Subjects randomly received a high dose of fructose (10 mg·kg fat-free mass-1·min-1) on two occasions and a low dose (5 mg·kg fat-free mass-1·min-1) on another. Fructose solutions were administered orally every 30 min for 9.5 h. Ten subjects completed all three study periods. DNL was assessed as the fractional contribution of newly synthesized palmitate into very-low-density lipoprotein triglycerides using mass isotopomer distribution analysis. Mean fasting DNL was 5.3 ± 2.8%, with significant within- and between-subject variability. DNL increased dose dependently during fructose feeding to 15 ± 2% for low- and 29 ± 2% for high-dose fructose. The DNL response to high-dose fructose was very reproducible within an individual ( r = 0.93, P < 0.001) and independent of fasting DNL. However, it was variable between individuals and significantly correlated to influx of unlabeled acetyl-CoA ( r = 0.7, P < 0.001). Unlike fasting DNL, fructose-stimulated DNL is a robust and reproducible measure of hepatic lipogenic activity for a given individual and may be a useful indicator of metabolic disease susceptibility and treatment response.
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Affiliation(s)
| | | | | | | | | | | | | | - Marc K Hellerstein
- KineMed, Emeryville, California
- Department of Nutritional Sciences, University of California Berkeley , Berkeley, California
| | - Elizabeth J Murphy
- KineMed, Emeryville, California
- Department of Medicine, University of California San Francisco, California
- Division of Endocrinology, Zuckerberg San Francisco General, San Francisco, California
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Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, Zhu H, Hamilton JD, Swanson BN, Khan A, Chao J, Staudinger H, Pirozzi G, Antoni C, Amin N, Ruddy M, Akinlade B, Graham NMH, Stahl N, Yancopoulos GD, Teper A. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. N Engl J Med 2018; 378:2475-2485. [PMID: 29782224 DOI: 10.1056/nejmoa1804093] [Citation(s) in RCA: 680] [Impact Index Per Article: 113.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dupilumab is a fully human anti-interleukin-4 receptor α monoclonal antibody that blocks both interleukin-4 and interleukin-13 signaling. Its effectiveness in reducing oral glucocorticoid use in patients with severe asthma while maintaining asthma control is unknown. METHODS We randomly assigned 210 patients with oral glucocorticoid-treated asthma to receive add-on dupilumab (at a dose of 300 mg) or placebo every 2 weeks for 24 weeks. After a glucocorticoid dose-adjustment period before randomization, glucocorticoid doses were adjusted in a downward trend from week 4 to week 20 and then maintained at a stable dose for 4 weeks. The primary end point was the percentage reduction in the glucocorticoid dose at week 24. Key secondary end points were the proportion of patients at week 24 with a reduction of at least 50% in the glucocorticoid dose and the proportion of patients with a reduction to a glucocorticoid dose of less than 5 mg per day. Severe exacerbation rates and the forced expiratory volume in 1 second (FEV1) before bronchodilator use were also assessed. RESULTS The percentage change in the glucocorticoid dose was -70.1% in the dupilumab group, as compared with -41.9% in the placebo group (P<0.001); 80% versus 50% of the patients had a dose reduction of at least 50%, 69% versus 33% had a dose reduction to less than 5 mg per day, and 48% versus 25% completely discontinued oral glucocorticoid use. Despite reductions in the glucocorticoid dose, in the overall population, dupilumab treatment resulted in a severe exacerbation rate that was 59% (95% confidence interval [CI], 37 to 74) lower than that in the placebo group and resulted in an FEV1 that was 0.22 liters (95% CI, 0.09 to 0.34) higher. Injection-site reactions were more common with dupilumab than with placebo (9% vs. 4%). Transient blood eosinophilia was observed in more patients in the dupilumab group than in the placebo group (14% vs. 1%). CONCLUSIONS In patients with glucocorticoid-dependent severe asthma, dupilumab treatment reduced oral glucocorticoid use while decreasing the rate of severe exacerbations and increasing the FEV1. Transient eosinophilia was observed in approximately 1 in 7 dupilumab-treated patients. (Funded by Sanofi and Regeneron Pharmaceuticals; LIBERTY ASTHMA VENTURE ClinicalTrials.gov number, NCT02528214 .).
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Affiliation(s)
- Klaus F Rabe
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Parameswaran Nair
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Guy Brusselle
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Jorge F Maspero
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Mario Castro
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Lawrence Sher
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Hongjie Zhu
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Jennifer D Hamilton
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Brian N Swanson
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Asif Khan
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Jingdong Chao
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Heribert Staudinger
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Gianluca Pirozzi
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Christian Antoni
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Nikhil Amin
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Marcella Ruddy
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Bolanle Akinlade
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Neil M H Graham
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Neil Stahl
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - George D Yancopoulos
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
| | - Ariel Teper
- From LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (P.N.); Ghent University Hospital, Ghent, Belgium (G.B.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Washington University School of Medicine, St. Louis (M.C.); Peninsula Research Associates, Rolling Hills Estates, CA (L.S.); Sanofi, Bridgewater, NJ (H.Z., B.N.S., H.S., G.P., C.A., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (J.D.H., J.C., N.A., M.R., B.A., N.M.H.G., N.S., G.D.Y.); and Sanofi, Chilly Mazarin, France (A.K.)
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50
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Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, Busse WW, Ford L, Sher L, FitzGerald JM, Katelaris C, Tohda Y, Zhang B, Staudinger H, Pirozzi G, Amin N, Ruddy M, Akinlade B, Khan A, Chao J, Martincova R, Graham NMH, Hamilton JD, Swanson BN, Stahl N, Yancopoulos GD, Teper A. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med 2018; 378:2486-2496. [PMID: 29782217 DOI: 10.1056/nejmoa1804092] [Citation(s) in RCA: 1084] [Impact Index Per Article: 180.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dupilumab is a fully human anti-interleukin-4 receptor α monoclonal antibody that blocks both interleukin-4 and interleukin-13 signaling. We assessed its efficacy and safety in patients with uncontrolled asthma. METHODS We randomly assigned 1902 patients 12 years of age or older with uncontrolled asthma in a 2:2:1:1 ratio to receive add-on subcutaneous dupilumab at a dose of 200 or 300 mg every 2 weeks or matched-volume placebos for 52 weeks. The primary end points were the annualized rate of severe asthma exacerbations and the absolute change from baseline to week 12 in the forced expiratory volume in 1 second (FEV1) before bronchodilator use in the overall trial population. Secondary end points included the exacerbation rate and FEV1 in patients with a blood eosinophil count of 300 or more per cubic millimeter. Asthma control and dupilumab safety were also assessed. RESULTS The annualized rate of severe asthma exacerbations was 0.46 (95% confidence interval [CI], 0.39 to 0.53) among patients assigned to 200 mg of dupilumab every 2 weeks and 0.87 (95% CI, 0.72 to 1.05) among those assigned to a matched placebo, for a 47.7% lower rate with dupilumab than with placebo (P<0.001); similar results were seen with the dupilumab dose of 300 mg every 2 weeks. At week 12, the FEV1 had increased by 0.32 liters in patients assigned to the lower dose of dupilumab (difference vs. matched placebo, 0.14 liters; P<0.001); similar results were seen with the higher dose. Among patients with a blood eosinophil count of 300 or more per cubic millimeter, the annualized rate of severe asthma exacerbations was 0.37 (95% CI, 0.29 to 0.48) among those receiving lower-dose dupilumab and 1.08 (95% CI, 0.85 to 1.38) among those receiving a matched placebo (65.8% lower rate with dupilumab than with placebo; 95% CI, 52.0 to 75.6); similar results were observed with the higher dose. Blood eosinophilia occurred after the start of the intervention in 52 patients (4.1%) who received dupilumab as compared with 4 patients (0.6%) who received placebo. CONCLUSIONS In this trial, patients who received dupilumab had significantly lower rates of severe asthma exacerbation than those who received placebo, as well as better lung function and asthma control. Greater benefits were seen in patients with higher baseline levels of eosinophils. Hypereosinophilia was observed in some patients. (Funded by Sanofi and Regeneron Pharmaceuticals; LIBERTY ASTHMA QUEST ClinicalTrials.gov number, NCT02414854 .).
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Affiliation(s)
- Mario Castro
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Jonathan Corren
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Ian D Pavord
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Jorge Maspero
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Sally Wenzel
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Klaus F Rabe
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - William W Busse
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Linda Ford
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Lawrence Sher
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - J Mark FitzGerald
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Constance Katelaris
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Yuji Tohda
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Bingzhi Zhang
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Heribert Staudinger
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Gianluca Pirozzi
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Nikhil Amin
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Marcella Ruddy
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Bolanle Akinlade
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Asif Khan
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Jingdong Chao
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Renata Martincova
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Neil M H Graham
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Jennifer D Hamilton
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Brian N Swanson
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Neil Stahl
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - George D Yancopoulos
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
| | - Ariel Teper
- From the Washington University School of Medicine, St. Louis (M.C.); David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J. Corren), and Peninsula Research Associates, Rolling Hills Estates (L.S.) - both in California; Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom (I.D.P.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.M.); the University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh (S.W.); LungenClinic Grosshansdorf, Grosshansdorf, and Christian Albrechts University Kiel, Kiel - both in Germany (K.F.R.); the Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison (W.W.B.); the Asthma and Allergy Center, Bellevue, NE (L.F.); the University of British Columbia, Vancouver, Canada (J.M.F.); Campbelltown Hospital and Western Sydney University, Sydney (C.K.); the Faculty of Medicine, Kindai University, Osakasayama, Japan (Y.T.); Sanofi, Bridgewater, NJ (B.Z., H.S., G.P., B.N.S., A.T.); Regeneron Pharmaceuticals, Tarrytown, NY (N.A., M.R., B.A., J. Chao, N.M.H.G., J.D.H., N.S., G.D.Y.); Sanofi, Chilly-Mazarin, France (A.K.); and Sanofi, Prague, Czech Republic (R.M.)
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