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Scelo G, Tran TN, Le TT, Faregås M, Dorscheid D, Busby J, Al-Ahmad M, Al-Lehebi R, Altraja A, Beastall A, Bergeron C, Bjermer L, Bjerrum AS, Cano-Rosales DJ, Canonica GW, Carter V, Charriot J, Christoff GC, Cosio BG, Denton E, Fernandez-Sanchez MJ, Fonseca JA, Gibson PG, Goh C, Heaney LG, Heffler E, Hew M, Iwanaga T, Katial R, Koh MS, Kuna P, Larenas-Linnemann D, Lehtimäki L, Mahboub B, Martin N, Matsumoto H, Menzies-Gow AN, Papadopoulos NG, Patel P, Perez-De-Llano L, Peters M, Pfeffer PE, Popov TA, Porsbjerg CM, Rhee CK, Sadatsafavi M, Taillé C, Torres-Duque CA, Tsai MJ, Ulrik CS, Upham JW, von Bülow A, Wang E, Wechsler ME, Price DB. Exploring definitions and predictors of response to biologics for severe asthma. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00530-0. [PMID: 38768896 DOI: 10.1016/j.jaip.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Biologic effectiveness is often assessed as 'response', a term which eludes consistent definition. Identifying those most likely to respond in real-life has proven challenging. OBJECTIVE To explore definitions of biologic responders in adults with severe asthma and investigate patient characteristics associated with biologic response. METHODS This was a longitudinal cohort study using data from 21 countries, which shared data with the International Severe Asthma Registry. Changes in 4 asthma outcome domains were assessed in the 1-year period pre- and post-biologic-initiation in patients with predefined level of pre-biologic impairment. Responder cut-offs were: ≥50% reduction in exacerbation rate, ≥50% reduction in long-term oral corticosteroid [LTOCS] daily dose, ≥1 category improvement in asthma control, and ≥100mL improvement in FEV1. Responders were defined using single- and multiple-domains. The association between pre-biologic characteristics and post-biologic-initiation response were examined by multivariable analysis. RESULTS 2,210 patients were included. Responder rate ranged from 80.7% (n=566/701) for exacerbation-response to 10.6% (n=9/85) for 4-domain-response. Many responders still exhibited significant impairment post-biologic-initiation: 46.7% (n=206/441) of asthma control-responders with uncontrolled asthma pre-biologic still had incompletely-controlled disease post-biologic-initiation. Predictors of response were outcome-dependent. Lung function-responders were more likely to have higher pre-biologic FeNO (OR:1.20 for every 25ppb increase), and shorter asthma duration (OR:0.81, for every 10-year increase in duration). Higher BEC and presence of T2-related comorbidities were positively associated with higher odds of meeting LTOCS-, control- and lung function-responder criteria. CONCLUSION Our findings underscore the multi-modal nature of 'response', show that many responders experience residual symptoms post-biologic-initiation, and that predictors of response vary according to outcome assessed.
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Affiliation(s)
- Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Tham T Le
- BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Malin Faregås
- BioPharmaceuticals Medical, AstraZeneca - Gothenburg (Sweden); BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Delbert Dorscheid
- Center for Heart Lung Innovation, University of British Columbia, (Canada)
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University - Belfast (UK)
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University; Al-Rashed Allergy Center, Ministry of Health - Kuwait (Kuwait)
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City; Alfaisal University - Riyadh (Saudi Arabia); College of Medicine, Alfaisal University, Riyadh, (Saudi Arabia)
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, (Estonia)
| | | | - Celine Bergeron
- Centre for Lung Health, Vancouver General Hospital and University of British Columbia, Vancouver (Canada)
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, (Sweden)
| | - Anne S Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, (Denmark)
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano (Italy); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan (Italy)
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, (France)
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca (Spain)
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, (Australia); Department of Medicine, Central Clinical School, Monash University, (Australia)
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, (Colombia); Faculty of Medicine, Pontificia Universidad Javeriana, Bogota (Colombia)
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto - Porto (Portugal)
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital - Newcastle (Australia)
| | - Celine Goh
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University - Belfast (UK)
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano (Italy); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan (Italy)
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health; Public Health and Preventive Medicine, Monash University - Melbourne (Australia)
| | | | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, (USA)
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital - Singapore (Singapore)
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz - Lodz (Poland)
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, (Finland); Faculty of Medicine and Health Technology, Tampere University, Tampere, (Finland)
| | - Bassam Mahboub
- Rashid hospital, Dubai Health Authority (DHA) - Dubai (Utd.Arab Emir.)
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca - Cambridge (UK)
| | - Hisako Matsumoto
- Department of Respiratory Medicine & Allergology, Kindai University Faculty of Medicine, (Japan)
| | | | - Nikolaos G Papadopoulos
- Centre for Respiratory Medicine & Allergy, Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, (UK); Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens (Greece)
| | - Pujan Patel
- Respiratory Medicine, Royal Brompton Hospital, London, (UK)
| | - Luis Perez-De-Llano
- Pneumology Service. Lucus Augusti University Hospital. EOXI Lugo, Monforte, Cervo (Spain)
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney (Australia)
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London (UK)
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia (Bulgaria)
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, Department of Respiratory Medicine and Infections Diseases, Research Unit - Copenhagen (Denmark)
| | - Chin K Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea - Seoul (South Korea)
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia - Vancouver (Canada)
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université Paris Cité, Paris, (France)
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana - Bogotá (Colombia)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, (Taiwan); Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, (Taiwan)
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, (Denmark)
| | - John W Upham
- Frazer Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, (Australia)
| | - Anna von Bülow
- Respiratory Research Unit - Hvidovre, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg hospital, Copenhagen, (Denmark)
| | - Eileen Wang
- National Jewish Health and University of Colorado School of Medicine - Denver and Aurora (USA)
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver (USA)
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK); Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen (UK).
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Perez-de-Llano L, Scelo G, Tran TN, Le TT, Fagerås M, Cosio BG, Peters M, Pfeffer PE, Al-Ahmad M, Al-Lehebi RO, Altraja A, Bergeron C, Bjermer LH, Bjerrum AS, Bulathsinhala L, Busby J, Cano Rosales DJ, Canonica GW, Carter VA, Charriot J, Christoff GC, Denton EJ, Dorscheid DR, Fernandez Sanchez MJ, Fonseca JA, Gibson PG, Goh CYY, Heaney LG, Heffler E, Hew M, Iwanaga T, Katial R, Koh MS, Kuna P, Larenas-Linnemann DES, Lehtimäki L, Mahboub B, Martin N, Matsumoto H, Menzies-Gow AN, Papadopoulos NG, Popov TA, Porsbjerg CM, Patel P, Rhee CK, Sadatsafavi M, Taillé C, Torres-Duque CA, Tsai MJ, Ulrik CS, Upham JW, von Bülow A, Wang E, Wechsler ME, Price DB. Exploring Definitions and Predictors of Severe Asthma Clinical Remission Post-Biologic in Adults. Am J Respir Crit Care Med 2024. [PMID: 38701495 DOI: 10.1164/rccm.202311-2192oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood. OBJECTIVES To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it. METHODS This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis. MEASUREMENTS AND MAIN RESULTS 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation. CONCLUSIONS One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Trung N Tran
- AstraZeneca, Gaithersburg, Maryland, United States
| | - Tham T Le
- AstraZeneca R&D Gaithersburg, 468090, Gaithersburg, Maryland, United States
| | | | - Borja G Cosio
- Hospital Universitari Son Espases, 375118, IdISBa and Respiratory Medicine, Palma de Mallorca, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Matthew Peters
- Concord Hospital, Department of Thoracic Medicine, Sydney, Australia
| | - Paul E Pfeffer
- Queen Mary University of London, 4617, William Harvey Research Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Mona Al-Ahmad
- Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, College of Medicine, Kuwait , Kuwait
| | - Riyad O Al-Lehebi
- King Fahad Medical City, 37849, Department of Pulmonology,, Riyadh, Saudi Arabia
- Alfaisal University, 101686, Riyadh, Saudi Arabia
| | - Alan Altraja
- University of Tartu and Lung Clinic, Tartu University Hospital, Department of Pulmonology, Tartu, Estonia
| | - Celine Bergeron
- Vancouver General Hospital, 8167, Vancouver, British Columbia, Canada
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Leif H Bjermer
- Skåne University Hospital Labmedicin Skane, 405121, Respiratory Medicine and Allergology, Lund, Skåne, Sweden
| | - Anne S Bjerrum
- Aarhus Universitetshospital, 11297, Department of Respiratory Medicine, Aarhus, Denmark
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
- Optimum Patient Care UK, 601419, Cambridge, England, United Kingdom of Great Britain and Northern Ireland
| | - John Busby
- Queen's University Belfast, Centre of Experimental Medicine, Belfast, United Kingdom of Great Britain and Northern Ireland
| | | | - Giorgio W Canonica
- IRCCS Humanitas Research Hospital, 9268, Personalized Medicine, Asthma and Allergy, Rozzano, Lombardia, Italy
- Humanitas University, 437807, Department of Biomedical Sciences, Milan, Italy
| | - Victoria A Carter
- Optimum Patient Care, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | | | | | - Maria J Fernandez Sanchez
- Hospital Universitario San Ignacio, 173049, Pulmonary Unit, Bogota, Colombia
- Pontificia Universidad Javeriana, 27964, Faculty of Medicine, Bogota, Colombia
| | - João A Fonseca
- Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
- CUF Porto, Allergy Department, Senhora da Hora, Portugal
| | - Peter G Gibson
- University of Newcastle, 5982, Callaghan, New South Wales, Australia
| | - Celine Y Y Goh
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
| | - Liam G Heaney
- Belfast City Hospital, Regional Respiratory Centre, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Enrico Heffler
- Universita degli Studi di Catania, 9298, Clinical and Experimental Medicie, Catania, Italy
| | - Mark Hew
- Alfred Hospital, 5390, Allergy, Asthma & Clinical Immunology, Melbourne, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, 22457, School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Takashi Iwanaga
- Kindai University Hospital, 326473, Osakasayama, Osaka, Japan
| | - Rohit Katial
- AstraZeneca US, 33366, BioPharmaceuticals Medical, Gaithersburg, Maryland, United States
| | - Mariko S Koh
- Singapore General Hospital, 37581, Department of Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Piotr Kuna
- Medical University of Lodz, 37808, Division of Internal Medicine Asthma and Allergy, Lodz, Lodzkie, Poland
| | | | - Lauri Lehtimäki
- University of Tampere, 7840, Immunopharmacology reserach group, Tampere, Pirkanmaa, Finland
| | | | - Neil Martin
- AstraZeneca R&D Cambridge, 468087, Respiratory and Immunology, BioPharmaceuticals Medical, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
- University of Leicester, 4488, Leicester, Leicestershire, United Kingdom of Great Britain and Northern Ireland
| | - Hisako Matsumoto
- Kindai University Faculty of Medicine, Department of Respiratory Medicine & Allergology, Osakasayama, Osaka, Japan
| | - Andrew N Menzies-Gow
- AstraZeneca UK Limited, 4978, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Royal Brompton and Harefield Hospitals, 4964, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos G Papadopoulos
- University of Athens, Allergy Dpt, 2nd Pediatric Clinic, Athens, Greece
- University of Manchester, Centre for Paediatrics and Child Health, Institute of Human Development, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Todor A Popov
- Medical University Sofia, Clinic of Allergy & Asthma, Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, 53166, Department of Respiratory Medicine, Copenhagen NV, Denmark
- University of Copenhagen, 4321, Institute of Clinical Medicine, Kobenhavn, Denmark
| | - Pujan Patel
- Royal Brompton Hospital, 156726, London, United Kingdom of Great Britain and Northern Ireland
| | - Chin K Rhee
- Catholic university of Korea, Internal medicine, Seoul, Korea (the Republic of)
| | - Mohsen Sadatsafavi
- University of British Columbia, Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - Camille Taillé
- Inserm, Pathophysiology and Epidemiology of respiratory diseases. Epidemiology team, Paris, France
- Assistance Publique-Hôpitaux de Paris,, Paris, France
| | - Carlos A Torres-Duque
- Fundación Neumológica Colombiana, Research Department, Bogotá, Colombia
- Universidad de La Sabana, 27989, Chia, Colombia
| | - Ming-Ju Tsai
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
| | - Charlotte S Ulrik
- Hvidovre Hospital, 53137, Respiratory Medicine, Hvidovre, Denmark
- University of Copenhagen, Institute of Clinical Medicine, Denmark
| | - John W Upham
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Anna von Bülow
- Copenhagen University Hospital Bispebjerg, Department of Respiratory Medicine, Copenhagen, Denmark
| | - Eileen Wang
- National Jewish Health, 2930, Division of Allergy and Clinical Immunology, Department of Medicine, Denver, Colorado, United States
| | - Michael E Wechsler
- National Jewish Health, Department of Medicine, Denver, Colorado, United States
| | - David B Price
- University of Aberdeen, Academic Primary Care, Aberdeen, Scotland, United Kingdom of Great Britain and Northern Ireland;
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Casale TB, Fiocchi A, Greenhawt M. A practical guide for implementing omalizumab therapy for food allergy. J Allergy Clin Immunol 2024:S0091-6749(24)00334-8. [PMID: 38599291 DOI: 10.1016/j.jaci.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
The recent approval of omalizumab for the treatment of IgE-mediated food allergy is an important step forward for the millions of food allergy patients in the United States. Through the depletion of circulating IgE and the subsequent reduction of FcεR1 on key effector cells, patients increase their tolerance to food allergens. However, omalizumab does not permit patients to eat foods that they are allergic to with impunity. Rather, it protects them from most accidental exposures. In addition, omalizumab does not cure food allergy and has not demonstrated true immunomodulation. Thus, omalizumab might be a lifelong therapy for some patients. Furthermore, there are many important questions and issues surrounding the appropriate administration of omalizumab to treat food allergy, which we discuss. Managing treatment of patients with disease that falls outside the dosing range, assessing treatment response or nonresponse, addressing its appropriateness for patients older than 55, and determining whether immunotherapy plus omalizumab provides any advantage over omalizumab alone all need to be examined. Identifying appropriate patients for this therapy is critical given the cost of biologics. Indeed, not all food allergy patients are good candidates for this therapy. Also, when and how to stop omalizumab therapy in patients who may have outgrown their food allergy needs to be elucidated. Thus, although this therapy provides a good option for patients with food allergies, much information is needed to determine how best to use this therapy. Despite many unanswered questions and issues, we provide clinicians with some practical guidance on implementing this therapy in their patients.
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Affiliation(s)
- Thomas B Casale
- Department of Internal Medicine, Division of Allergy and Immunolgy, University of South Florida Morsani College of Medicine, Tampa, Fla.
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Mazurek-Durlak Z, Mularczyk K, Kwinta P, Lis G, Cichocka-Jarosz E. Omalizumab in the treatment of Morbihan syndrome in an adolescent girl - case report and literature review. Allergol Immunopathol (Madr) 2024; 52:23-31. [PMID: 38459887 DOI: 10.15586/aei.v52i2.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/15/2023] [Indexed: 03/11/2024]
Abstract
Morbihan syndrome (MS) is characterized by solid facial edema, usually related to rosacea or acne vulgaris. The facial edema deforms the patient's features, can impair peripheral vision, and affects quality of life. Its pathophysiology remains unclear. The disease usually has a slow and chronic course. MS most commonly affects middle-aged Caucasian men with rosacea and is rare in people below 20 years of age. MS is a diagnosis of exclusion. There is no standard treatment for MS, though systemic isotretinoin and antihistamines are mainly used. We present the case of an adolescent girl with MS nonresponding to 19 months of isotretinoin treatment with add-on antihistamines. Therapy with monthly administration of omalizumab (anti-IgE) for 6 months was an effective therapeutic option, improving the quality of life. Our case is the second description of omalizumab use in Morbihan syndrome, the first in an adolescent.
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Affiliation(s)
- Zofia Mazurek-Durlak
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland;
| | - Katarzyna Mularczyk
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Przemko Kwinta
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Grzegorz Lis
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Ewa Cichocka-Jarosz
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
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Kidwai S, Barbiero P, Meijerman I, Tonda A, Perez‐Pardo P, Lio ´ P, van der Maitland‐Zee AH, Oberski DL, Kraneveld AD, Lopez‐Rincon A. A robust mRNA signature obtained via recursive ensemble feature selection predicts the responsiveness of omalizumab in moderate-to-severe asthma. Clin Transl Allergy 2023; 13:e12306. [PMID: 38006387 PMCID: PMC10655633 DOI: 10.1002/clt2.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Not being well controlled by therapy with inhaled corticosteroids and long-acting β2 agonist bronchodilators is a major concern for severe-asthma patients. The current treatment option for these patients is the use of biologicals such as anti-IgE treatment, omalizumab, as an add-on therapy. Despite the accepted use of omalizumab, patients do not always benefit from it. Therefore, there is a need to identify reliable biomarkers as predictors of omalizumab response. METHODS Two novel computational algorithms, machine-learning based Recursive Ensemble Feature Selection (REFS) and rule-based algorithm Logic Explainable Networks (LEN), were used on open accessible mRNA expression data from moderate-to-severe asthma patients to identify genes as predictors of omalizumab response. RESULTS With REFS, the number of features was reduced from 28,402 genes to 5 genes while obtaining a cross-validated accuracy of 0.975. The 5 responsiveness predictive genes encode the following proteins: Coiled-coil domain- containing protein 113 (CCDC113), Solute Carrier Family 26 Member 8 (SLC26A), Protein Phosphatase 1 Regulatory Subunit 3D (PPP1R3D), C-Type lectin Domain Family 4 member C (CLEC4C) and LOC100131780 (not annotated). The LEN algorithm found 4 identical genes with REFS: CCDC113, SLC26A8 PPP1R3D and LOC100131780. Literature research showed that the 4 identified responsiveness predicting genes are associated with mucosal immunity, cell metabolism, and airway remodeling. CONCLUSION AND CLINICAL RELEVANCE Both computational methods show 4 identical genes as predictors of omalizumab response in moderate-to-severe asthma patients. The obtained high accuracy indicates that our approach has potential in clinical settings. Future studies in relevant cohort data should validate our computational approach.
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Affiliation(s)
- Sarah Kidwai
- Division of PharmacologyUtrecht Institute for Pharmaceutical ScienceFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | - Pietro Barbiero
- Department of Computer Science and TechnologyUniversity of CambridgeCambridgeUK
| | - Irma Meijerman
- Division of PharmacologyUtrecht Institute for Pharmaceutical ScienceFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | | | - Paula Perez‐Pardo
- Division of PharmacologyUtrecht Institute for Pharmaceutical ScienceFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | - Pietro Lio ´
- Department of Computer Science and TechnologyUniversity of CambridgeCambridgeUK
| | | | - Daniel L. Oberski
- Department of Data ScienceUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Aletta D. Kraneveld
- Division of PharmacologyUtrecht Institute for Pharmaceutical ScienceFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | - Alejandro Lopez‐Rincon
- Division of PharmacologyUtrecht Institute for Pharmaceutical ScienceFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
- Department of Data ScienceUniversity Medical Center UtrechtUtrechtThe Netherlands
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Belikova M, Säfholm J, Al-Ameri M, Orre AC, Dahlén SE, Adner M. Combined exposure to the alarmins TSLP, IL-33 and IL-25 enhances mast cell-dependent contractions of human bronchi. Clin Exp Allergy 2023; 53:1062-1066. [PMID: 37377053 DOI: 10.1111/cea.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/13/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Maria Belikova
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | - Jesper Säfholm
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | - Mamdoh Al-Ameri
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Charlotte Orre
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sven-Erik Dahlén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Adner
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
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7
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Ji Y, Calonder C, Kirsilä T, Burciu A, Tisu M, Joubert Y, Laurent N, Hua E, Patekar M, Drollmann A, Woessner R. Comprehensive Assessment of Pharmacokinetics, Pharmacodynamics, and Tolerability of Ligelizumab in Healthy Volunteers and Patients with Chronic Spontaneous Urticaria to Optimize Its Subcutaneous Delivery System. Pharmaceutics 2023; 15:2266. [PMID: 37765235 PMCID: PMC10535857 DOI: 10.3390/pharmaceutics15092266] [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] [Received: 07/10/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Ligelizumab is a highly potent, humanized IgG1, anti-IgE monoclonal antibody. To explore its optimal subcutaneous delivery, the pharmacokinetics (PK), pharmacodynamics (PD), and tolerability of ligelizumab from two Phase 1 studies in healthy volunteers (HVs) and four Phase 2 and 3 studies in patients with chronic spontaneous urticaria (CSU) were assessed. Using different injection volumes or durations of a liquid-in-vial (LIVI) formulation or different formulations (LIVI vs. prefilled syringe (PFS)), single-dose ligelizumab showed comparable PK exposure in HVs. Steady-state exposure of ligelizumab was also comparable between LIVI and PFS following multiple dosing in CSU patients. The total IgE level (a PD marker) and tolerability were similar between the two formulations in both HVs and patients. Furthermore, the PK, total IgE, and tolerability were comparable for PFS administered either by patients or healthcare providers (HCPs). Collective evidence demonstrated that the injection duration or volume, formulation, or administrator had no apparent impact on the PK, PD, and tolerability of ligelizumab, supporting no clinically relevant difference between LIVI and PFS, and that PFS can be administered by patients or HCPs. This report provides a comprehensive assessment based on data of multiple clinical endpoints from both HVs and patients to inform formulation development and commercial use of a monoclonal antibody.
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Affiliation(s)
- Yan Ji
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, USA
| | - Claudio Calonder
- Novartis Institutes for Biomedical Research, CH-4056 Basel, Switzerland
| | | | - Alis Burciu
- Novartis Pharma AG, CH-4056 Basel, Switzerland
| | - Matjaz Tisu
- Novartis Pharma AG, CH-4056 Basel, Switzerland
| | | | - Nathalie Laurent
- Novartis Institutes for Biomedical Research, CH-4056 Basel, Switzerland
| | - Eva Hua
- China Novartis Institutes for Biomedical Research Co., Ltd., Shanghai 201203, China
| | | | - Anton Drollmann
- Novartis Institutes for Biomedical Research, CH-4056 Basel, Switzerland
| | - Ralph Woessner
- Novartis Institutes for Biomedical Research, CH-4056 Basel, Switzerland
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8
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Pedersen NH, Sørensen JA, Ghazanfar MN, Zhang DG, Vestergaard C, Thomsen SF. Biomarkers for Monitoring Treatment Response of Omalizumab in Patients with Chronic Urticaria. Int J Mol Sci 2023; 24:11328. [PMID: 37511088 PMCID: PMC10379579 DOI: 10.3390/ijms241411328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic urticaria (CU) is a debilitating skin disease affecting around 1% of the population. CU can be subdivided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Different pathophysiological mechanisms have been proposed to play a role in the development of CU, and these are also being investigated as potential biomarkers in the diagnosis and management of the disease. As of now the only assessment tools available for treatment response are patient reported outcomes (PROs). Although these tools are both validated and widely used, they leave a desire for more objective measurements. A biomarker is a broad subcategory of observations that can be used as an accurate, reproducible, and objective indicator of clinically relevant outcomes. This could be normal biological or pathogenic processes, or a response to an intervention or exposure, e.g., treatment response. Herein we provide an overview of biomarkers for CU, with a focus on prognostic biomarkers for treatment response to omalizumab, thereby potentially aiding physicians in personalizing treatments.
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Affiliation(s)
- Nadja Højgaard Pedersen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Jennifer Astrup Sørensen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Misbah Noshela Ghazanfar
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Ditte Georgina Zhang
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
| | - Christian Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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9
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Staubach P, Alvaro-Lozano M, Sekerel BE, Maurer M, Ben-Shoshan M, Porter M, Hua E, Ji Y, Burciu A, Savelieva M, Severin T, Drollmann A, Bienczak A. Ligelizumab in adolescents with chronic spontaneous urticaria: Results of a dedicated phase 2b randomized clinical trial supported with pharmacometric analysis. Pediatr Allergy Immunol 2023; 34:e13982. [PMID: 37492920 DOI: 10.1111/pai.13982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU), a long-lasting disease in children, impacts their quality of life. We report the results of a phase 2b dose-finding trial of ligelizumab (NCT03437278) and a high-affinity humanized monoclonal anti-IgE antibody, in adolescents with CSU, supported by modeling and simulation analyses, mitigating challenges in pediatric drug development. METHODS This multicenter, double-blind, placebo-controlled trial, randomized H1-antihistamine-refractory adolescent CSU patients (12-18 years) 2:1:1 to ligelizumab 24 mg, 120 mg, or placebo every 4 weeks for 24 weeks. Patients on placebo transitioned to ligelizumab 120 mg at week 12. Integrating data from the previous adult and present adolescent trial of ligelizumab, a nonlinear mixed-effects modeling described the longitudinal changes in ligelizumab pharmacokinetics, and its effect on weekly Urticaria Activity Score (UAS7). RESULTS Baseline UAS7 (mean ± SD) was 30.5 ± 7.3 (n = 24), 29.3 ± 7.7 (n = 13), and 32.5 ± 9.0 (n = 12) for patients (median age, 15 years) on ligelizumab 24 mg, 120 mg, and placebo, respectively. Change from baseline in UAS7 at week 12 with ligelizumab 24 mg, 120 mg, and placebo was -15.7 ± 10.9, -18.4 ± 12.3, and -13.0 ± 13.0, respectively. Ligelizumab was well-tolerated. The modeling analysis showed that body weight, but not age, affected ligelizumab's apparent clearance. No significant differences between adolescents and adults were detected on the model-estimated maximum effect and potency. CONCLUSIONS Ligelizumab exhibited efficacy and safety in adolescent CSU patients, consistent with that in adults. The PK and potency of ligelizumab were not impacted by age, and the same dose of ligelizumab can be used for treating adolescents and adults with CSU. Our study shows how modeling and simulation can complement pediatric drug development.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Montserrat Alvaro-Lozano
- Department of Pediatric Allergology and Clinical Immunology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Bulent Enis Sekerel
- Faculty of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe University, Ankara, Turkey
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Paediatrics, Montreal Children's Hospital McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Eva Hua
- Shanghai Novartis Trading Ltd., Shanghai, China
| | - Yan Ji
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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10
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Olewicz-Gawlik A, Kowala-Piaskowska A. Self-reactive IgE and anti-IgE therapy in autoimmune diseases. Front Pharmacol 2023; 14:1112917. [PMID: 36755957 PMCID: PMC9899859 DOI: 10.3389/fphar.2023.1112917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
Growing evidence indicates the pathogenic role of autoreactive IgE in autoimmune diseases. Incidence of autoimmune and allergic diseases in the industrialized countries is consistently icreasing, thus leading to concerted efforts to comprehend the regulation of IgE-mediated mechanisms. The first reports of a presence of IgE autoantibodies in patients with autoimmune diseases have been published a long time ago, and it is now recognized that self-reactive IgE can mediate inflammatory response in bullous pemhigoid, systemic lupus erythematosus, chronic urticaria, and atopic dermatitis. The advances in understanding the pathomechanisms of these disorders brought to a successful use of anti-IgE strategies in their management. The present review discusses the current state of knowledge on the IgE-mediated autoimmunity and anti-IgE treatment, and pave the way for further exploration of the subject.
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Affiliation(s)
- Anna Olewicz-Gawlik
- Department of Immunology, Poznan University of Medical Sciences, Poznan, Poland,Department of Infectious Diseases, Hepatology and Acquired Immunodeficiencies, Poznan University of Medical Sciences, Poznan, Poland,*Correspondence: Anna Olewicz-Gawlik,
| | - Arleta Kowala-Piaskowska
- Department of Infectious Diseases, Hepatology and Acquired Immunodeficiencies, Poznan University of Medical Sciences, Poznan, Poland
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11
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Yang B, Yu H, Jia M, Yao W, Diao R, Li B, Wang Y, Li T, Ge L, Wang H. Successful treatment of dupilumab in Kimura disease independent of IgE: A case report with literature review. Front Immunol 2022; 13:1084879. [PMID: 36591252 PMCID: PMC9794988 DOI: 10.3389/fimmu.2022.1084879] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Kimura disease (KD) is a rare and benign chronic inflammatory disease of unknown cause. It is characterized by subcutaneous granuloma of soft tissues in the head and neck region, increased eosinophil count, and elevated serum IgE. Currently, no definitive treatments are recommended. A 57-year-old Chinese man was diagnosed with KD after 7 years of slow subcutaneous masses growth. The patient underwent treatment of oral glucocorticoids for 1 year, but the masses recurred as the dosage was tapered down. Subsequent anti-IgE therapy of omalizumab administered subcutaneously at 450 mg/day at a 4-week interval did not show improvement. The size of masses and serum IgE and circulating eosinophils did not decrease significantly after 19 cycles of continuous treatment. Ultimately, switched strategy of dupilumab was applied at an initial dose of 600 mg, followed by 300 mg every 2 weeks for 4 months. This treatment demonstrated dramatical effects with reduced masses in each area and fast dropdown of eosinophil counts, while the high level of serum IgE remained without changes. Recently, different biologics including anti-IgE, anti-IL-5, and anti-IL-4/IL-13 have been applied to treat KD with satisfied results and help to explore the pathogenesis of this rare disease. To our knowledge, this is the first report that demonstrates the effects of two different biologics in the same patient and reveals the impressive clinical efficacy of dupilumab to treat KD independent of IgE. Therefore, further investigation of the underlying mechanism and the development of diagnosis and treatment of KD is valuable.
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Affiliation(s)
- Boyun Yang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hanxiao Yu
- Clinical Research Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Minyue Jia
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wo Yao
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ran Diao
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bohui Li
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yongfang Wang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ting Li
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liuya Ge
- Outpatient Care Department, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huiying Wang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Huiying Wang,
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12
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Palomares O, Elewaut D, Irving PM, Jaumont X, Tassinari P. Regulatory T cells and immunoglobulin E: A new therapeutic link for autoimmunity? Allergy 2022; 77:3293-3308. [PMID: 35852798 DOI: 10.1111/all.15449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 01/28/2023]
Abstract
Autoimmune diseases have a prevalence of approximately 7 to 9% and are classified as either organ-specific diseases, including type I diabetes, multiple sclerosis, inflammatory bowel disease and myasthenia gravis, or systemic diseases, including systemic lupus erythematosus, rheumatoid arthritis and Sjögren's syndrome. While many advancements have been made in understanding of the mechanisms of autoimmune disease, including the nature of self-tolerance and its breakdown, there remain unmet needs in terms of effective and highly targeted treatments. T regulatory cells (Tregs) are key mediators of peripheral tolerance and are implicated in many autoimmune diseases, either as a result of reduced numbers or altered function. Tregs may be broadly divided into those generated in the thymus (tTregs) and those generated in the periphery (pTregs). Tregs target many different immune cell subsets and tissues to suppress excessive inflammation and to support tissue repair and homeostasis: there is a fine balance between Treg cell stability and the plasticity that is required to adjust Tregs' regulatory purposes to particular immune responses. The central role of immunoglobulin E (IgE) in allergic disease is well recognized, and it is becoming increasingly apparent that this immunoglobulin also has a wider role encompassing other diseases including autoimmune disease. Anti-IgE treatment restores the capacity of plasmacytoid dendritic cells (pDCs) impaired by IgE- high-affinity IgE receptor (FcεR1) cross-linking to induce Tregs in vitro in atopic patients. The finding that anti-IgE therapy restores Treg cell homeostasis, and that this mechanism is associated with clinical improvement in asthma and chronic spontaneous urticaria suggests that anti-IgE therapy may also have a potential role in the treatment of autoimmune diseases in which Tregs are involved.
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Affiliation(s)
| | - Dirk Elewaut
- Department of Rheumatology, VIB Center for Inflammation Research, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Peter M Irving
- Guy's and St Thomas' Hospital Foundation Trust, London, UK
- King's College London, London, UK
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13
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Taniguchi M, Heffler E, Olze H, White A, Côrte-Real J, Olsson P, Lazarewicz S. The Role of Omalizumab in NSAID-Exacerbated Respiratory Disease: A Narrative Review. J Allergy Clin Immunol Pract 2022; 10:2570-2578. [PMID: 35764285 DOI: 10.1016/j.jaip.2022.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is a condition characterized by the triad of chronic rhinosinusitis with nasal polyps, bronchial asthma, and hypersensitivity to nonsteroidal anti-inflammatory drugs. This article explores the current knowledge on the various pathological mechanism(s) of N-ERD-such as arachidonic acid metabolism, cysteinyl leukotrienes, prostaglandins, platelets, IgE, mast cells, eosinophils, basophils, and innate immune system-and the role of omalizumab in its management. The authors dive deep into the role of IgE in N-ERD and its potential as a therapeutic target. IgE plays a significant role in mediating allergic reactions, is intricately linked with mast cells, interacts with multiple immunopathological pathways involved in N-ERD, and tends to be elevated in patients with N-ERD. Multiple real-world studies, observational studies, and case series, as well as 2 phase III trials, have demonstrated the effectiveness of omalizumab in the management of N-ERD. For a disease with such a well-documented history, the pathophysiology of N-ERD and the most effective ways to manage it remain a mystery. With this background, the authors ask-is IgE a missing piece of the N-ERD puzzle, thus explaining the efficacy of omalizumab in the treatment of the disease?
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Affiliation(s)
- Masami Taniguchi
- Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan; Center for Clinical Research, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Heidi Olze
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Charité Universitätsmedizin, Berlin, Germany
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14
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Poto R, Quinti I, Marone G, Taglialatela M, de Paulis A, Casolaro V, Varricchi G. IgG Autoantibodies Against IgE from Atopic Dermatitis Can Induce the Release of Cytokines and Proinflammatory Mediators from Basophils and Mast Cells. Front Immunol 2022; 13:880412. [PMID: 35711458 PMCID: PMC9192953 DOI: 10.3389/fimmu.2022.880412] [Citation(s) in RCA: 12] [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: 02/21/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
IgE-mediated release of proinflammatory mediators and cytokines from basophils and mast cells is a central event in allergic disorders. Several groups of investigators have demonstrated the presence of autoantibodies against IgE and/or FcεRI in patients with chronic spontaneous urticaria. By contrast, the prevalence and functional activity of anti-IgE autoantibodies in atopic dermatitis (AD) are largely unknown. We evaluated the ability of IgG anti-IgE from patients with AD to induce the in vitro IgE-dependent activation of human basophils and skin and lung mast cells. Different preparations of IgG anti-IgE purified from patients with AD and rabbit IgG anti-IgE were compared for their triggering effects on the in vitro release of histamine and type 2 cytokines (IL-4, IL-13) from basophils and of histamine and lipid mediators (prostaglandin D2 and cysteinyl leukotriene C4) from human skin and lung mast cells. One preparation of human IgG anti-IgE out of six patients with AD induced histamine release from basophils, skin and lung mast cells. This preparation of human IgG anti-IgE induced the secretion of cytokines and eicosanoids from basophils and mast cells, respectively. Human monoclonal IgE was a competitive antagonist of both human and rabbit IgG anti-IgE. Human anti-IgE was more potent than rabbit anti-IgE for IL-4 and IL-13 production by basophils and histamine, prostaglandin D2 and leukotriene C4 release from mast cells. Functional anti-IgE autoantibodies rarely occur in patients with AD. When present, they induce the release of proinflammatory mediators and cytokines from basophils and mast cells, thereby possibly contributing to sustained IgE-dependent inflammation in at least a subset of patients with this disorder.
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Affiliation(s)
- Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
| | | | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
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15
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Ayats-Vidal R, Riera-Rubió S, Valdesoiro-Navarrete L, García-González M, Larramona-Carrera H, Cruz OA, Bosque-García M. Long-term outcome of omalizumab-assisted desensitisation to cow's milk and eggs in patients refractory to conventional oral immunotherapy: real-life study. Allergol Immunopathol (Madr) 2022; 50:1-7. [PMID: 35527650 DOI: 10.15586/aei.v50i3.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising approach to cow's milk and egg allergies, but reactions are frequent and some patients cannot be desensitized. OBJECTIVE To evaluate long-term OIT outcomes with omalizumab (OMZ) in paediatric patients with severe egg and/or milk allergies. METHODS This retrospective real-life study analysed findings in children with Immunoglobulin E-mediated allergy to cow's milk and/or hen eggs refractory to conventional OIT, who underwent OIT with OMZ in our department between 1 January 2010 and 31 December 2015. RESULTS In all, 41 patients were included (median age: 7 years; interquartile range [IQR]: 5.5-9.5); 26/41 (63.4%) underwent OIT for milk, 8/41 (19.5%) for egg and 7/41 (17.1%) for both. The median time between initiation of OMZ and OIT was 27 weeks (IQR: 22-33). Forty (97.56%) patients reached the maintenance phase (200 mL of cow's milk and 30 mL of raw egg or 1 cooked egg) in a median time of 27 weeks (IQR: 18-37). The median total time with OMZ was 117 weeks (IQR: 88-144). During the OMZ period, 2.44% (1/41) of patients presented anaphylaxis. After discontinuation of OMZ, 29.3% (12/41) presented anaphylaxis, 50% of them had a poor adherence to daily ingestion. One patient (2.44%) was diagnosed with eosinophilic esophagitis after 2 years of discontinuation of OMZ. Currently, after a median time of 9 years (IQR: 7-10) since the initiation of OMZ, 75.6% (31/41) are desensitized (27/31 without OMZ). CONCLUSIONS Omalizumab allows desensitisation of children with severe allergies to cow's milk and/or egg without developing severe reactions while receiving this treatment. However, discontinuation of OMZ leads to severe allergic reactions, and hence must be monitored carefully.
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Abstract
INTRODUCTION Across the globe, chronic urticaria (CU), i.e. chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU), is common, long-persisting and difficult to manage. Still, at least one-fifth is not sufficiently controlled by guideline-recommended treatment with H1-antihistamines and add-on therapy with the anti-IgE monoclonal antibody omalizumab. AREAS COVERED Using PubMed, ClinicalTrials.gov, Congress websites, and websites of the manufacturers, this review explored the pipeline, namely anti-IgE-, anti-cytokine-, anti-receptor biologics, and small molecules, in clinical development for CU. EXPERT OPINION The CU pipeline is promising. While three omalizumab biosimilars are investigated, the assumed early approval of ligelizumab will expand the effective and safe anti-IgE approach observed with omalizumab. For other anti-IgEs like UB-221, the development is behind. Data are too limited so far to clearly define the role of anti-cytokine and anti-cytokine receptor biologics such as dupilumab, tezepelumab, mepolizumab, benralizumab, and CDX-0159, of which only dupilumab is actually investigated in phase 3. Among three selective oral BTK inhibitors, remibrutinib, rilzabrutinib, and fenebrutinib, the development of remibrutinib is most advanced (phase 3). As the pipeline addresses different targets, study results will give deeper insights into the pathomechanisms of CU. Hopefully, in the next future additional approved and also more targeted approaches will be available.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
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17
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Sirufo MM, Bassino EM, De Pietro F, Ginaldi L, De Martinis M. Sex differences in the efficacy of omalizumab in the treatment of chronic spontaneous urticaria. Int J Immunopathol Pharmacol 2022; 35:20587384211065870. [PMID: 35170369 PMCID: PMC8855371 DOI: 10.1177/20587384211065870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Omalizumab is shown to be effective in the treatment of chronic spontaneous
urticaria (CSU), a disease with high personal and social impact. Sex
differences in CSU are recognized with women more frequently affected.
Scarce is the knowledge about response to omalizumab between sex groups. We
sought to identify any differences based on the sex of patients receiving
omalizumab. Methods We evaluated data of patients diagnosed with CSU refractory to high-dose
second-generation H1 antihistamines and treated with 300 mg omalizumab every
4 weeks for 6 months and then at relapse. Results Discussion: All patients, regardless of sex, age, or any other factor,
achieved the clinical remission of the disease after the first 3 doses with
a reduction of the disease activity indices and impact on the quality of
life. Recurrences predominate in men, two months after the suspension of the
drug. Respect to sex and recurrence we did not find any correlation with
age, body mass index, peripheral eosinophil counts, total IgE levels,
D-dimer, plasma prothrombine level or C-reactive protein. We found no sex
differences in tolerability and safety. CSU in girls may persist longer and
have worse prognosis, but no one has so far noted sex differences in
response to omalizumab. Conclusions Although there are no certainties on the mechanism of action of omalizumab in
CSU, the noticeable difference in response between males and females lead us
to suppose a role of the hormonal balance both on the pathogenesis of the
CSU and on the efficacy of OmAb.
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Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergology and Clinical Immunology Unit, Teramo, Italy
| | - Enrica Maria Bassino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergology and Clinical Immunology Unit, Teramo, Italy
| | - Francesca De Pietro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergology and Clinical Immunology Unit, Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergology and Clinical Immunology Unit, Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergology and Clinical Immunology Unit, Teramo, Italy
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18
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Huang WC, Fu PK, Chan MC, Chin CS, Huang WN, Lai KL, Wang JL, Hung WT, Wu YD, Hsieh CW, Wu MF, Chen YH, Hsu JY. Predictors of a Minimal Clinically Important Difference Following Omalizumab Treatment in Adult Patients With Severe Allergic Asthma. Front Med (Lausanne) 2022; 8:762318. [PMID: 35047521 PMCID: PMC8761618 DOI: 10.3389/fmed.2021.762318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Several factors have been found to be predictors of a good response following omalizumab treatment in patients with severe allergic asthma (SAA). However, it remains unclear whether clinical characteristics can predict a minimal clinically important difference (MCID) following omalizumab treatment in this population. Therefore, the aim of this study was to investigate the features associated with an MCID following omalizumab treatment in adult patients with SAA. Of the 124 participants enrolled in this retrospective, cross-sectional study, 94, 103, 20 and 53 achieved the MCID following treatment with omalizumab and were considered to be responders of exacerbation reduction (no exacerbation during the 1-year follow-up period or ≧50% reduction in exacerbations from baseline), oral corticosteroid (OCS) sparing (no use of OCS to control asthma during the study period or a reduction of the monthly OCS maintenance dose to <50% of baseline), lung function (an increase of ≧230 ml in the forced expiratory volume in 1 s from baseline) and asthma control (an increase of ≧3 points in the asthma control test score from baseline), respectively. Normal weight [<25 vs. ≧30 kg/m2, odds ratio (OR) = 3.86, p = 0.024] was predictive of a responder of reduction in exacerbations following omalizumab treatment while subjects with a blood eosinophil level of <300 cells/μL (<300 vs. ≧300 cells/μL, OR = 5.81, p = 0.001) were more likely to exhibit an MCID in OCS sparing. No factor was found to be a predictor of lung function or asthma control. When choosing treatment for adult patients with SAA, our findings may help to select those who may benefit the most from omalizumab treatment.
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Affiliation(s)
- Wei-Chang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Master Program for Health Administration, Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Human Science and Social Innovation, Hungkuang University, Taichung, Taiwan.,Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Ming-Cheng Chan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Shih Chin
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Nan Huang
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiun-Long Wang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Agricultural Biotechnology Research Center, National Chung Hsing University, Taichung, Taiwan.,Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Ting Hung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Da Wu
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Wei Hsieh
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Feng Wu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang Ming Chia Tung University, Taipei, Taiwan
| | - Jeng-Yuan Hsu
- Division of Clinical Research, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Physical Therapy, Chung-Shan Medical University, Taichung, Taiwan
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19
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Fenu G, La Tessa A, Calogero C, Lombardi E. Severe pediatric asthma therapy: Omalizumab-A systematic review and meta-analysis of efficacy and safety profile. Front Pediatr 2022; 10:1033511. [PMID: 36937051 PMCID: PMC10020639 DOI: 10.3389/fped.2022.1033511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/30/2022] [Indexed: 03/06/2023] Open
Abstract
Background Omalizumab is the first biological therapy used to treat moderate-to-severe asthma and certainly the one with the highest number of publications. Methods A systematic review and meta-analysis were performed to examine two critical outcomes of omalizumab therapy, asthma exacerbation rate, the reduction of the use of inhaled corticosteroids (ICS), and the improvement of the lung function as a secondary outcome using the following keywords in the MEDLINE database: "anti-IgE, severe asthma, children, and randomized controlled trial." We specifically selected papers that included moderate-to-severe asthma patients and collected data on children and adolescents. Results Four RCT studies (total number of patients = 1,239) were included in the analysis. The reported data on exacerbations showed an overall improvement in the exacerbation rate with a decreased use of inhaled steroids and some other minimal clinically important difference (MCID). Conclusions Our systematic review confirms the known findings that omalizumab therapy decreases asthma exacerbation rate and reduces background therapy inhaled steroid dose. Therefore, add-on therapy with omalizumab shows a good efficacy and safety profile, thus proving to be a useful additional therapeutic option. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023396785.
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Affiliation(s)
- Grazia Fenu
- Pediatric Pulmonary Unit, “Anna Meyer,” IRCCS Pediatric University-Hospital, Florence, Italy
- Correspondence: Grazia Fenu
| | | | - Claudia Calogero
- Pediatric Pulmonary Unit, “Anna Meyer,” IRCCS Pediatric University-Hospital, Florence, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, “Anna Meyer,” IRCCS Pediatric University-Hospital, Florence, Italy
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20
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Mir-Ihara P, Narváez-Fernández E, Domínguez-Ortega J, Entrala A, Barranco P, Luna-Porta JA, Romero D, Villamañán E, Losantos-García I, Quirce S. Safety of biological therapy in elderly patients with severe asthma. J Asthma 2021; 59:2218-2222. [PMID: 34889165 DOI: 10.1080/02770903.2021.2010747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the safety of biological therapy for severe T2 asthma (omalizumab, mepolizumab, benralizumab and reslizumab) under real-life conditions in elderly patients older than 70 years. METHODS Retrospective data collection including clinical characteristics, comorbidities, treatment, disease control and adverse events (AE) of all patients with severe asthma on biological therapy older than 70 years seen in the Severe Asthma Unit of our hospital. RESULTS Of 147 patients with severe asthma being treated with biologics, 21 patients older than 70 years were included. The median age of these patients was 76.3 years (range 71-86) and the majority were women (n = 18, 85.7%). There were 9 patients (42.9%) who experienced an AE related to biological treatment. Four (44.4%) were in treatment with omalizumab, two (22.2%) with mepolizumab, two patients (22.2%) with reslizumab and one (11.1%) with benralizumab. The median FEV1 (%) was 66%. These patients had a considerably higher body mass index (BMI). No significant differences were found for any other variable. Most of the AE reported were considered mild with the exception of one case of systemic AE (anaphylaxis) associated with omalizumab. CONCLUSION This study indicates that the prescription of biological therapy in elderly patients with severe asthma seems to be safe. More evidence is needed in this particular population.
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Affiliation(s)
| | | | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - Ana Entrala
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - Pilar Barranco
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - Juan-Alberto Luna-Porta
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
| | - David Romero
- Department of Pulmonology, La Paz University Hospital, Madrid, Spain
| | - Elena Villamañán
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain
| | | | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, Hospital La Paz Institute for Health Research, Madrid, Spain.,CIBERES, CIBER of Respiratory Diseases, Madrid, Spain
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21
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Berghea EC, Balgradean M, Pavelescu C, Cirstoveanu CG, Toma CL, Ionescu MD, Bumbacea RS. Clinical Experience with Anti-IgE Monoclonal Antibody (Omalizumab) in Pediatric Severe Allergic Asthma-A Romanian Perspective. Children (Basel) 2021; 8:1141. [PMID: 34943337 DOI: 10.3390/children8121141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
Background: Asthma is the most common chronic disease affecting children, with a negative impact on their quality of life. Asthma is often associated with comorbid allergic diseases, and its severity may be modulated by immunoglobulin E (IgE)-mediated allergen sensitization. Omalizumab is a humanized monoclonal anti-IgE antibody, the first biological therapy approved to treat patients aged ≥6 years with severe allergic asthma. The primary objective of our study was to investigate the efficacy and safety of Omalizumab in Romanian children with severe allergic asthma. Methods: In this observational real-life study, 12 children and adolescents aged 6 to 18 years (mean 12.4 years) with severe allergic asthma received Omalizumab as an add-on treatment. Asthma control, exacerbations, lung function, and adverse events were evaluated at baseline and after the first year of treatment. Results: We observed general improvement in total asthma symptom scores and reduction in the rate of exacerbation of severe asthma. Omalizumab treatment was associated with improvement in the measures of lung function, and no serious adverse reactions were reported. FEV1 improved significantly after one year of treatment with Omalizumab [ΔFEV1 (% pred.) = 18.3], and [similarly, ΔMEF50 (%) = 25.8]. The mean severe exacerbation rate of asthma decreased from 4.1 ± 2.8 to 1.15 ± 0.78 (p < 0.0001) during the year of treatment with Omalizumab. Conclusions: This study showed that Omalizumab can be an effective and safe therapeutic option for Romanian children and adolescents with severe allergic asthma, providing clinically relevant information on asthma control and exacerbation rate in children and adolescents. The results demonstrated the positive effect of Omalizumab in young patients with asthma, starting from the first year of treatment.
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22
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Sardina DS, Valenti G, Papia F, Uasuf CG. Exploring Machine Learning Techniques to Predict the Response to Omalizumab in Chronic Spontaneous Urticaria. Diagnostics (Basel) 2021; 11:2150. [PMID: 34829497 DOI: 10.3390/diagnostics11112150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Omalizumab is the best treatment for patients with chronic spontaneous urticaria (CSU). Machine learning (ML) approaches can be used to predict response to therapy and the effectiveness of a treatment. No studies are available on the use of ML techniques to predict the response to Omalizumab in CSU. Methods: Data from 132 CSU outpatients were analyzed. Urticaria Activity Score over 7 days (UAS7) and treatment efficacy were assessed. Clinical and demographic characteristics were used for training and validating ML models to predict the response to treatment. Two methodologies were used to label the data based on the response to treatment (UAS7 ≥ 6): (A) at 1, 3 and 5 months; (B) classifying the patients as early responders (ER), late responders (LR) or non-responders (NR) (ER: UAS 7 ≥ 6 at first month, LR: UAS 7 ≥ 6 at third month, NR: if none of the previous conditions occurred). Results: ER were predominantly characterized by hypertension, while LR mainly suffered from asthma and hypothyroidism. A slight positive correlation (R2 = 0.21) was found between total IgE levels and UAS7 at 1 month. Variable Importance Analysis (VIA) reported D-dimer and C-reactive proteins as the key blood tests for the performance of learning techniques. Using methodology (A), SVM (specificity of 0.81) and k-NN (sensitivity of 0.8) are the best models to predict LR at the third month. Conclusion: k-NN plus the SVM model could be used to identify the response to treatment. D-dimer and C-reactive proteins have greater predictive power in training ML models.
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23
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Saito H. [BASIC CONCEPT ABOUT PRIMARY PREVENTION OF ALLERGIC DISEASE]. Arerugi 2021; 70:1191-1195. [PMID: 34759083 DOI: 10.15036/arerugi.70.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hirohisa Saito
- National Research Institute for Child Health & Development
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24
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Chen F, Guo Y, Zhou K, Deng D, Yue W, Yang W, Zhang B, Li Y, Liang J, Li M, Yao Z. The clinical efficacy and safety of anti-IgE therapy in recessive dystrophic epidermolysis bullosa. Clin Genet 2021; 101:110-115. [PMID: 34494659 DOI: 10.1111/cge.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/10/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022]
Abstract
The treatment of recessive dystrophic epidermolysis bullosa (RDEB) remains challenging. Elevated IgE levels have previously been reported in several RDEB patients. In this prospective, single-centre, open intervention study, elevated IgE levels were seen in 11 out of 12 patients with intense pruritus, and the patients with elevated IgE levels received anti-IgE therapy every 4 weeks for at least three cycles. Compared with the baseline, 10 patients with RDEB had good clinical outcomes with enhanced wound healing, a reduction in Birmingham (epidermolysis bullosa) EB severity score by 15%, a reduction in affected body surface area by 23.3%, amelioration of skin inflammation, and an increase in type VII collagen deposition by 13.1-fold. All the patients had a good tolerance to anti-IgE therapy. Furthermore, patients with higher IgE levels tended to have higher disease severity and more favorable clinical outcomes. Our report also suggested the potential role of IgE in the pathogenesis of inflammatory conditions associated with RDEB. (ChiCTR1900021437).
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Affiliation(s)
- Fuying Chen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifeng Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kaili Zhou
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Deng
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wanbo Yue
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiqin Yang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Beibei Zhang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianying Liang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
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25
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Ibáñez-Sandín MD, Escudero C, Candón Morillo R, Lasa EM, Marchán-Martín E, Sánchez-García S, Terrados S, González Díaz C, Juste S, Martorell A, Gázquez García V, Ramírez Jiménez A, Abellán Á, Martos Calahorro MD, Tabar AI, Bartra J, García Rodríguez R, Gómez Galán C, Martín-Muñoz MF, Meseguer Arce J, Miralles JC, Montoro de Francisco AM, Poza Guedes P, Rodríguez Del Río P. Oral immunotherapy in severe cow's milk allergic patients treated with omalizumab: Real life survey from a Spanish registry. Pediatr Allergy Immunol 2021; 32:1287-1295. [PMID: 33835593 DOI: 10.1111/pai.13517] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral immunotherapy is a frequent treatment for the management of food allergies, but adverse events (AE) are common. This study assessed the outcome of cow's milk oral immunotherapy (MOIT) in severe cow`s milk-allergic patients treated with omalizumab in a real-life setting. METHODS OmaBASE was a national, multicenter, open, and observational registry that collected clinical, immunologic, and treatment from patients with food allergy receiving omalizumab. RESULTS Data derived from 58 patients aged 10.3 years (IQR 6.3-13.2) and median milk-specific IgE 100 kUA /L at the start of omalizumab treatment. Most had experienced anaphylaxis by accidental exposures (70.7%) and had asthma (81.0%). Omalizumab in monotherapy induced tolerance to ≥6000 mg of cow's milk protein (CMP) to 34.8% of patients tested by oral food challenge. Omalizumab combined with MOIT conferred desensitization to ≥6000 mg of CMP to 83.0% of patients. Omalizumab withdrawal triggered more AE (P = .013) and anaphylaxis (P = .001) than no discontinuation. Anaphylaxis was observed in 36.4% of patients who discontinued omalizumab, and more in those with sudden (50.0%) rather than progressive (12.5%) discontinuation. At database closure, 40.5% of patients who had completed follow-up tolerated CMP without omalizumab (7.2% 1500-4500 mg; 33.3% ≥6000 mg). CONCLUSION Milk oral immunotherapy initiated under omalizumab allows the desensitization of subjects with severe cow's milk allergy even after omalizumab discontinuation. However, discontinuation of omalizumab can lead to severe AE and should be carefully monitored.
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Affiliation(s)
- María Dolores Ibáñez-Sandín
- Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain
| | - Carmelo Escudero
- Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain
| | - Rocío Candón Morillo
- Department of Allergy, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Eva M Lasa
- Pediatric Allergy Unit, Hospital Universitario Donostia, San Sebastián, Spain
| | - Eva Marchán-Martín
- Department of Allergy, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Silvia Sánchez-García
- Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain
| | - Soledad Terrados
- Department of Allergy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos González Díaz
- Pediatric Allergy Unit, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Sonsoles Juste
- Department of Allergy, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Vanessa Gázquez García
- Department of Allergy, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Antonio Ramírez Jiménez
- Food Safety Unit, Department of Allergy, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ángel Abellán
- Department of Allergy, Hospital Universitario Los Arcos del Mar Menor, Murcia, Spain
| | | | - Ana I Tabar
- Department of Allergy, Hospital Complex of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to drugs and Allergy (ARADYAL) Research Network, Pamplona, Spain
| | - Joan Bartra
- Department of Allergy, Hospital Clinic, IDIBAPS, Universitat de Barcelona and ARAdyAL, Barcelona, Spain
| | - Rosa García Rodríguez
- Department of Allergy, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Catalina Gómez Galán
- Department of Allergy, Althaia, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | - José Meseguer Arce
- Department of Allergy, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan C Miralles
- Department of Allergy, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | - Paloma Poza Guedes
- Department of Allergy, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Pablo Rodríguez Del Río
- Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain
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26
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Bachert C, Maurer M, Palomares O, Busse WW. What is the contribution of IgE to nasal polyposis? J Allergy Clin Immunol 2021; 147:1997-2008. [PMID: 33757720 DOI: 10.1016/j.jaci.2021.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Taking a novel approach, this narrative review collates knowledge about nasal polyposis and the biological functions of IgE in several diseases (allergic rhinitis, allergic asthma, nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease, and chronic spontaneous urticaria) to consider which IgE-mediated mechanisms are relevant to nasal polyposis pathology. A type 2 eosinophil-dominated inflammatory signature is typical in nasal polyp tissue of European patients with nasal polyposis, with a shift toward this endotype observed in Asian populations in recent years. Elevated polyclonal IgE is present in the nasal tissue of patients with and without allergy. It is derived from many different B-cell clones and, importantly, is functional (proinflammatory). Staphylococcus aureus enterotoxins are thought to act as superantigens, inducing production of polyclonal IgE via B-cell and T-cell activation, and triggering release of inflammatory mediators. In some patients, exposure to antigens/triggers leads to production of high levels of antigen-specific IgE, which mediates cross-linking of the high-affinity IgE receptor on various cells, causing release of inflammatory mediators. The efficacy of omalizumab confirms IgE as an important inflammatory mediator in nasal polyposis. By blocking IgE, omalizumab targets the T2 inflammation in nasal polyposis, reduces nasal polyp score and improves symptoms.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Worm M, Francuzik W, Dölle-Bierke S, Alexiou A. Use of biologics in food allergy management. Allergol Select 2021; 5:103-7. [PMID: 33634220 DOI: 10.5414/ALX02141E] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 11/18/2022] Open
Abstract
Food allergies are a common medical problem, with children being the most affected patient group. The standard of care of food allergy consists of the acute treatment in case of a reaction and food avoidance in the long term, which influences the quality of life of patients. In this article, current developments for the causal treatment of food allergy including specific immunotherapy and biologics will be discussed. Epicutaneous and oral immunotherapy are currently in clinical development for the treatment of food allergy, and the results demonstrate good tolerability and efficacy with an increase in the oral threshold level. Biologics and, in particular, anti-IgE are currently investigated for their therapeutic use in food allergies. The results are promising, suggesting efficacy and tolerability.
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Pfaar O, Gehrt F, Li H, Rudhart SA, Nastev A, Stuck BA, Hoch S. Anti-IgE: A treatment option in allergic rhinitis? Allergol Select 2021; 5:119-27. [PMID: 33644635 DOI: 10.5414/ALX02205E] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Allergic rhinitis (AR) is the most common IgE-mediated allergic disease. Multiple clinical trials have demonstrated promising results on the AR treatment with biologics, in particular with the use of omalizumab – an anti-IgE antibody. Omalizumab has also been established in the routine management of allergic asthma and chronic idiopathic urticaria. However, currently there is no approved license for the use of biologics in AR in Germany. Materials and methods: A systematic literature review has been completed including randomized controlled trials, meta-analyses, and reviews on the treatment of AR with omalizumab. Results: The systematic review demonstrates strong evidence supporting the use of omalizumab in the treatment of AR with regard to symptom control, safety profile, and management of comorbidities. Conclusion: Omalizumab is a good and safe option in the treatment of AR in terms of symptom control and the management of pre-existing comorbidities. Further clinical trials with other biologics in the management of AR are needed and are expected to follow soon.
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Kucharczyk A, Więsik-Szewczyk E, Poznańska A, Jahnz-Różyk K. Clinical Determinants of Successful Omalizumab Therapy in Severe Allergic Asthma Patients: 4-Year-Long, Real-Life Observation. J Asthma Allergy 2020; 13:659-668. [PMID: 33363390 PMCID: PMC7754267 DOI: 10.2147/jaa.s282203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Omalizumab is a high-cost therapy recommended for the treatment of severe allergic asthma. Objective To find clinical parameters that are related to the sustained response to omalizumab. Patients and Methods This retrospective, real-life, 4-year follow-up was provided in Poland between March 2013 and May 2019. The success of omalizumab was assessed based on composed subjective and objective criteria. Simple/multiple regression analyses were performed to search for predictors of the response to omalizumab. Results A total of 989 severe allergic asthma patients were referred for omalizumab therapy, of whom 854 patients were considered eligible for treatment. At weeks 16 and 52, omalizumab was successful in 84% and 91% of patients, respectively. Treatment effectiveness was maintained up to the 4-year follow-up. Four predictors of the response to omalizumab were found at week 16 and two at week 52. The results at week 16 may be used as predictors of success at week 52 based on the model including baseline FEV1% and change in ACQ-7 and miniAQLQ score at week 16: the area under the ROC curve equals 0.746 [95% CI: 0.672–0.820]. Conclusion Omalizumab therapy is very effective, with this efficacy sustained after 4 years of treatment. Success of the therapy can be predicted from the baseline FEV1% and clinical improvement (based on ACQ-7 and miniAQLQ scores) at week 16.
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Affiliation(s)
- Aleksandra Kucharczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
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Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB, Lee SE, Levy JM, Lin SY, Lio PA, Peters AT, Platt MP, White AA. Targeted Molecular Therapies in Allergy and Rhinology. Otolaryngol Head Neck Surg 2020; 164:S1-S21. [PMID: 33138725 DOI: 10.1177/0194599820965233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). This paper summarizes the diagnosis and management of these conditions and critically reviews the clinical trial data that has led to regulatory approval of biologic agents for these conditions.
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Affiliation(s)
| | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Stella E Lee
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sandra Y Lin
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Peter A Lio
- Northwestern Medicine, Chicago, Illinois, USA
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Abstract
About 20 years after the identification of immunoglobulin E (IgE) and its key role in allergic hypersensitivity reactions against normally harmless substances, scientists have started inventing strategies to block its pathophysiological activity in 1986. The initial concept of specific IgE targeting through the use of anti-IgE antibodies has gained a lot of momentum and within a few years independent research groups have reported successful generation of first murine monoclonal anti-IgE antibodies. Subsequent generation of optimized chimeric and humanized versions of these antibodies has paved the way for the development of therapeutic anti-IgE biologicals as we know them today. With omalizumab, there is currently still only one therapeutic anti-IgE antibody approved for the treatment of allergic conditions. Since its application is limited to the treatment of moderate-to-severe persistent asthma and chronic spontaneous urticaria, major efforts have been undertaken to develop alternative anti-IgE biologicals that could potentially be used in a broader spectrum of allergic diseases. Several new drug candidates have been generated and are currently assessed in pre-clinical studies or clinical trials. In this review, we highlight the molecular properties of past and present anti-IgE biologicals and suggest concepts that might improve treatment efficacy of future drug candidates.
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Affiliation(s)
- Pascal Guntern
- Graduate School of Cellular and Biomedical Sciences University of Bern Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
- Department of Rheumatology, Immunology and Allergology University Hospital Bern Bern Switzerland
| | - Alexander Eggel
- Department of BioMedical Research University of Bern Bern Switzerland
- Department of Rheumatology, Immunology and Allergology University Hospital Bern Bern Switzerland
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Upchurch K, Wiest M, Cardenas J, Skinner J, Nattami D, Lanier B, Millard M, Joo H, Turner J, Oh S. Whole blood transcriptional variations between responders and non-responders in asthma patients receiving omalizumab. Clin Exp Allergy 2020; 50:1017-1034. [PMID: 32472607 DOI: 10.1111/cea.13671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/10/2020] [Accepted: 05/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Anti-IgE (omalizumab) has been used for the treatment of moderate-to-severe asthma that is not controlled by inhaled steroids. Despite its success, it does not always provide patients with significant clinical benefits. OBJECTIVE To investigate the transcriptional variations between omalizumab responders and non-responders and to study the mechanisms of action of omalizumab. METHODS The whole blood transcriptomes of moderate-to-severe adult asthma patients (N = 45:34 responders and 11 non-responders) were analysed over the course of omalizumab treatment. Non-asthmatic healthy controls (N = 17) were used as controls. RESULTS Transcriptome variations between responders and non-responders were identified using the genes significant (FDR < 0.05) in at least one comparison of each patient response status and time point compared with control subjects. Using gene ontology and network analysis, eight clusters of genes were identified. Longitudinal analyses of individual clusters revealed that responders could maintain changes induced with omalizumab treatment and become more similar to the control subjects, while non-responders tend to remain more similar to their pre-treatment baseline. Further analysis of an inflammatory gene cluster revealed that genes associated with neutrophil/eosinophil activities were up-regulated in non-responders and, more importantly, omalizumab did not significantly alter their expression levels. The application of modular analysis supported our findings and further revealed variations between responders and non-responders. CONCLUSION AND CLINICAL RELEVANCE This study provides not only transcriptional variations between omalizumab responders and non-responders, but also molecular insights for controlling asthma by omalizumab.
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Affiliation(s)
| | - Matthew Wiest
- Baylor University, Institute for Biomedical Studies, Waco, TX, USA
- Department of Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jacob Cardenas
- Baylor Institute for Immunology Research, Dallas, TX, USA
| | - Jason Skinner
- Baylor Institute for Immunology Research, Dallas, TX, USA
| | - Durgha Nattami
- Baylor Institute for Immunology Research, Dallas, TX, USA
| | - Bobby Lanier
- North Texas Institute for Clinical Trials, Ft Worth, TX, USA
| | - Mark Millard
- Martha Foster Lung Care Center, Baylor University Medical Center, Dallas, TX, USA
| | - HyeMee Joo
- Baylor University, Institute for Biomedical Studies, Waco, TX, USA
- Department of Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jacob Turner
- Department of Mathematics and Statistics, Stephen F. Austin State University, Nacogdoches, TX, USA
| | - SangKon Oh
- Baylor University, Institute for Biomedical Studies, Waco, TX, USA
- Department of Immunology, Mayo Clinic, Scottsdale, AZ, USA
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Ghazanfar MN, Holm JG, Thomsen SF. Omalizumab for cholinergic urticaria: 6 months prospective study and systematic review of the literature. Dermatol Ther 2020; 33:e14010. [PMID: 32654349 DOI: 10.1111/dth.14010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
To examine the effectiveness of omalizumab on disease activity and quality of life in patients with cholinergic urticaria (CholU). Further, a systematic review of the literature was performed to identify all studies of use of omalizumab in CholU. A total of 23 patients (63.9%) were refractory to updosed non-sedating antihistamines and initiated omalizumab in the observation period. Among these, an improvement of 10.8 UAS7 points (4.6-17.0), P = .002, was seen at 6 months follow up. DLQI and disease bother score VAS also improved significantly from before initiating treatment with omalizumab to follow-up; 7.0 points (3.6-10.3), P < .001 and 3.1 points (1.5-4.8), P = .001, respectively. The overall mean drug survival time for omalizumab (discontinued due to any cause) was 30.6 months (22.2-39.0). A total of five patients (21.7%) reported suspected side effects (headache, muscle pain, fatigue and injection site reactions) during treatment with omalizumab until 6 months follow-up. The systematic literature review identified 58 additional antihistamine refractory patients with CholU treated with omalizumab. The available studies reported that omalizumab is effective in patients with CholU and improves their disease-related quality of life. Omalizumab is safe, reduces disease activity and improves disease-related quality of life in patients with CholU.
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Affiliation(s)
| | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Maun HR, Jackman JK, Choy DF, Loyet KM, Staton TL, Jia G, Dressen A, Hackney JA, Bremer M, Walters BT, Vij R, Chen X, Trivedi NN, Morando A, Lipari MT, Franke Y, Wu X, Zhang J, Liu J, Wu P, Chang D, Orozco LD, Christensen E, Wong M, Corpuz R, Hang JQ, Lutman J, Sukumaran S, Wu Y, Ubhayakar S, Liang X, Schwartz LB, Babina M, Woodruff PG, Fahy JV, Ahuja R, Caughey GH, Kusi A, Dennis MS, Eigenbrot C, Kirchhofer D, Austin CD, Wu LC, Koerber JT, Lee WP, Yaspan BL, Alatsis KR, Arron JR, Lazarus RA, Yi T. An Allosteric Anti-tryptase Antibody for the Treatment of Mast Cell-Mediated Severe Asthma. Cell 2020; 179:417-431.e19. [PMID: 31585081 DOI: 10.1016/j.cell.2019.09.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/09/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022]
Abstract
Severe asthma patients with low type 2 inflammation derive less clinical benefit from therapies targeting type 2 cytokines and represent an unmet need. We show that mast cell tryptase is elevated in severe asthma patients independent of type 2 biomarker status. Active β-tryptase allele count correlates with blood tryptase levels, and asthma patients carrying more active alleles benefit less from anti-IgE treatment. We generated a noncompetitive inhibitory antibody against human β-tryptase, which dissociates active tetramers into inactive monomers. A 2.15 Å crystal structure of a β-tryptase/antibody complex coupled with biochemical studies reveal the molecular basis for allosteric destabilization of small and large interfaces required for tetramerization. This anti-tryptase antibody potently blocks tryptase enzymatic activity in a humanized mouse model, reducing IgE-mediated systemic anaphylaxis, and inhibits airway tryptase in Ascaris-sensitized cynomolgus monkeys with favorable pharmacokinetics. These data provide a foundation for developing anti-tryptase as a clinical therapy for severe asthma.
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Affiliation(s)
- Henry R Maun
- Department of Early Discovery Biochemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Janet K Jackman
- Department of Immunology Discovery, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - David F Choy
- Department of Biomarker Discovery OMNI, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Kelly M Loyet
- Department of Biochemical and Cellular Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Tracy L Staton
- Department of OMNI Biomarker Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Guiquan Jia
- Department of Biomarker Discovery OMNI, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Amy Dressen
- Department of Human Genetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jason A Hackney
- Department of Bioinformatics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Meire Bremer
- Department of OMNI Biomarker Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Benjamin T Walters
- Department of Biochemical and Cellular Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Rajesh Vij
- Department of Antibody Engineering, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Xiaocheng Chen
- Department of Antibody Engineering, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Neil N Trivedi
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Ashley Morando
- Department of Biochemical and Cellular Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Michael T Lipari
- Department of Early Discovery Biochemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Yvonne Franke
- Depratment of Biomolecular Resources, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Xiumin Wu
- Department of Translational Immunology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Juan Zhang
- Department of Translational Immunology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - John Liu
- Department of Translational Immunology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Ping Wu
- Department of Structural Biology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Diana Chang
- Department of Human Genetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Luz D Orozco
- Department of Bioinformatics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Erin Christensen
- Department of Protein Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Manda Wong
- Department of Structural Biology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Racquel Corpuz
- Department of Structural Biology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Julie Q Hang
- Department of Protein Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jeff Lutman
- Department of Preclinical and Translational Pharmacokinetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Siddharth Sukumaran
- Department of Preclinical and Translational Pharmacokinetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Yan Wu
- Department of Antibody Engineering, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Savita Ubhayakar
- Department of Drug Metabolism and Pharmacokinetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Xiaorong Liang
- Department of Drug Metabolism and Pharmacokinetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Lawrence B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Magda Babina
- Department of Dermatology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - John V Fahy
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Rahul Ahuja
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - George H Caughey
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Aija Kusi
- Department of Safety Assessment, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Mark S Dennis
- Department of Antibody Engineering, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Charles Eigenbrot
- Department of Structural Biology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Daniel Kirchhofer
- Department of Early Discovery Biochemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Cary D Austin
- Department of Pathology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Lawren C Wu
- Department of Immunology Discovery, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - James T Koerber
- Department of Antibody Engineering, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Wyne P Lee
- Department of Translational Immunology, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Brian L Yaspan
- Department of Human Genetics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Kathila R Alatsis
- Department of Safety Assessment, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Joseph R Arron
- Department of Immunology Discovery, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Robert A Lazarus
- Department of Early Discovery Biochemistry, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Tangsheng Yi
- Department of Immunology Discovery, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
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Muehling LM, Heymann PW, Wright PW, Eccles JD, Agrawal R, Carper HT, Murphy DD, Workman LJ, Word CR, Ratcliffe SJ, Capaldo BJ, Platts-Mills TAE, Turner RB, Kwok WW, Woodfolk JA. Human T H1 and T H2 cells targeting rhinovirus and allergen coordinately promote allergic asthma. J Allergy Clin Immunol 2020; 146:555-570. [PMID: 32320734 DOI: 10.1016/j.jaci.2020.03.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Allergic asthmatic subjects are uniquely susceptible to acute wheezing episodes provoked by rhinovirus. However, the underlying immune mechanisms and interaction between rhinovirus and allergy remain enigmatic, and current paradigms are controversial. OBJECTIVE We sought to perform a comprehensive analysis of type 1 and type 2 innate and adaptive responses in allergic asthmatic subjects infected with rhinovirus. METHODS Circulating virus-specific TH1 cells and allergen-specific TH2 cells were precisely monitored before and after rhinovirus challenge in allergic asthmatic subjects (total IgE, 133-4692 IU/mL; n = 28) and healthy nonallergic controls (n = 12) using peptide/MHCII tetramers. T cells were sampled for up to 11 weeks to capture steady-state and postinfection phases. T-cell responses were analyzed in parallel with 18 cytokines in the nose, upper and lower airway symptoms, and lung function. The influence of in vivo IgE blockade was also examined. RESULTS In uninfected asthmatic subjects, higher numbers of circulating virus-specific PD-1+ TH1 cells, but not allergen-specific TH2 cells, were linked to worse lung function. Rhinovirus infection induced an amplified antiviral TH1 response in asthmatic subjects versus controls, with synchronized allergen-specific TH2 expansion, and production of type 1 and 2 cytokines in the nose. In contrast, TH2 responses were absent in infected asthmatic subjects who had normal lung function, and in those receiving anti-IgE. Across all subjects, early induction of a minimal set of nasal cytokines that discriminated high responders (G-CSF, IFN-γ, TNF-α) correlated with both egress of circulating virus-specific TH1 cells and worse symptoms. CONCLUSIONS Rhinovirus induces robust TH1 responses in allergic asthmatic subjects that may promote disease, even after the infection resolves.
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Affiliation(s)
- Lyndsey M Muehling
- Department of Medicine, University of Virginia School of Medicine, Charlottesville; Department of Microbiology, University of Virginia School of Medicine, Charlottesville
| | - Peter W Heymann
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Paul W Wright
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Jacob D Eccles
- Department of Medicine, University of Virginia School of Medicine, Charlottesville; Department of Microbiology, University of Virginia School of Medicine, Charlottesville
| | - Rachana Agrawal
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Holliday T Carper
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Deborah D Murphy
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Lisa J Workman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Carolyn R Word
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Sarah J Ratcliffe
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Brian J Capaldo
- Department of Microbiology, University of Virginia School of Medicine, Charlottesville
| | | | - Ronald B Turner
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | | | - Judith A Woodfolk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville; Department of Microbiology, University of Virginia School of Medicine, Charlottesville.
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Licari A, Manti S, Chiappini E, Ciprandi G, Marseglia GL. Severe asthma in children: Current goals and unmet needs. Pediatr Allergy Immunol 2020; 31 Suppl 24:40-42. [PMID: 32017220 DOI: 10.1111/pai.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
Severe asthma in children is considered a complex and heterogeneous disease. A multidisciplinary assessment is required to correctly identify and manage these children because they potentially need close monitoring and additional treatment with advanced targeted therapies. Recent research efforts focused on the identification of epidemiologic, clinical, and functional characteristics of the disease in the pediatric age. Novel findings on the molecular mechanisms underlying severe asthma have led to the recognition of different endotypes and related biomarkers able to predict the response to advanced biologic therapies. Progress in our knowledge of severe asthma has occurred with the introduction of biologic therapies. Future goals in asthma care include the identification of the links between phenotypes and endotypes, as well as the identification of novel predictive biomarkers. They will help to select candidates for innovative biologic therapies and ultimately improve outcomes in children with severe asthma.
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Affiliation(s)
- Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Sara Manti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elena Chiappini
- Infectious Disease Unit, Department of Science Health, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Heymann PW, Platts-Mills TAE, Woodfolk JA, Borish L, Murphy DD, Carper HT, Conaway MR, Steinke JW, Muehling L, Gerald Teague W, Kennedy JL, Irani AM, McGraw MD, Early SV, Wheatley LM, Adams AP, Turner RB. Understanding the asthmatic response to an experimental rhinovirus infection: Exploring the effects of blocking IgE. J Allergy Clin Immunol 2020; 146:545-554. [PMID: 32018030 DOI: 10.1016/j.jaci.2020.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rhinovirus frequently causes asthma exacerbations among children and young adults who are allergic. The interaction between allergen and rhinovirus-induced symptoms and inflammation over time is unclear. OBJECTIVE Our aim was to compare the response to an experimental inoculation with rhinovirus-16 in allergic asthmatics with the response in healthy controls and to evaluate the effects of administrating omalizumab before and during the infection. METHODS Two clinical trials were run in parallel. In one of these trials, the response to an experimental inoculation with rhinovirus-16 among asthmatics with high levels of total IgE was compared to the response in healthy controls. The other trial compared the effects of administering omalizumab versus placebo to asthmatics in a randomized, double-blind placebo-controlled investigation. The primary outcome for both trials compared lower respiratory tract symptoms (LRTSs) between study groups over the first 4 days of infection. RESULTS Frequent comparisons of symptoms, lung function, and blood eosinophil counts revealed differences that were more pronounced among allergic asthmatics than among controls by days 2 and 3 after virus inoculation. Additionally, an augmentation of upper respiratory tract symptom scores and LRTS scores occurred among the atopic asthmatics versus the controls during the resolution of symptoms (P < .01 for upper respiratory symptom tract scores and P < .001 for LRTS scores). The beneficial effects of administering omalizumab on reducing LRTSs and improving lung function were strongest over the first 4 days. CONCLUSIONS LRTSs and blood eosinophil counts were augmented and lung function was reduced among allergic asthmatics early after rhinovirus inoculation but increased late in the infection during symptom resolution. The effect of administering omalizumab on the response to rhinovirus was most pronounced during the early/innate phase of the infection.
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Affiliation(s)
- Peter W Heymann
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va.
| | | | - Judith A Woodfolk
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Larry Borish
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Deborah D Murphy
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Holliday T Carper
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Mark R Conaway
- Department of Public Health Sciences, University of Virginia, Charlottsville, Va
| | - John W Steinke
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Lyndsey Muehling
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - W Gerald Teague
- Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Joshua L Kennedy
- Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Anne-Marie Irani
- Division of Pediatric Allergy and Immunology, Virginia Commonwealth University, Richmond, Va
| | - Matthew D McGraw
- Division of Pediatric Pulmonology, University of Rochester, Rochester, NY
| | - Stephen V Early
- Division of Pediatric Otolaryngology, University of Virginia, Charlottsville, Va
| | - Lisa M Wheatley
- Allergy, Asthma and Airways Biology Branch, Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Amy P Adams
- Department of Pharmacy, University of Virginia, Charlottsville, Va
| | - Ronald B Turner
- Department of Pediatric Infectious Diseases, University of Virginia, Charlottsville, Va
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Rubini NPM, Ensina LFC, Silva EMK, Sano F, Solé D. Effectiveness and safety of Omalizumab in the treatment of chronic spontaneous urticaria: Systematic review and meta-analysis. Allergol Immunopathol (Madr) 2019; 47:515-22. [PMID: 31607407 DOI: 10.1016/j.aller.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) affects approximately 1% of the population, affecting both children and adults. Omalizumab (Oma) is a therapeutic option for patients with refractory forms of CSU. OBJECTIVES To determine the effectiveness and safety of Oma in the treatment of CSU. METHODS Systematic review (Cochrane Collaboration methodology) of randomized clinical trials comparing Oma to placebo in refractory CSU treatment. The search is based on MEDLINE; EMBASE, Central Cochrane Library, and LILACS. The outcomes evaluated were: control of the illness, adverse events, and quality of life. RESULTS Of the 848 identified studies 13 were selected for further review and six were included in the meta-analysis. For all outcomes, high-quality evidence has confirmed that Oma is effective in the treatment of CSU. The dosage of 300mg/month achieved better results; namely a significant reduction in pruritus, papules, and urticaria activity, as well as an increase in the number of patients with a controlled condition, improvement in the quality of life and no differences in adverse events compared to the placebo. CONCLUSIONS High-quality evidence demonstrates that Oma is effective and safe in the treatment of CSU refractory to therapy with H1 antihistamines.
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Lababidi HM, AlSowayigh OM, BinHowemel SF, AlReshaid KM, Alotaiq SA, Bahnassay AA. Refractory asthma phenotyping based on immunoglobulin E levels and eosinophilic counts: A real life study. Respir Med 2019; 158:55-8. [PMID: 31605922 DOI: 10.1016/j.rmed.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma is an inflammatory heterogeneous disease with variable severity. The serum IgE level and Eosinophilic count have been used as biomarkers to define treatment strategies with biological agents in severe refractory asthma. OBJECTIVE The aim of this study is to determine the concurrence of high eosinophil count and elevated serum IgE levels in patients with severe refractory asthma. METHODS A retrospective cross-sectional real-life study was conducted on patients attending adult refractory asthma outpatient clinic between 2015 and 2018. Serum total IgE level and blood EOS count on matched dates with spirometry and Asthma Control Test (ACT) scores were collected. All data were obtained while patients were not on biological agents. RESULTS A total of 142 patients with severe refractory asthma were included. The mean age was 43 years, mean eosinophilic count 564 cells/μL and mean serum IgE levels of 520 IU/ml. There was a significant correlation between serum IgE level and eosinophilic count. Serum IgE and eosinophilic count were concurrently elevated in 110 patients (78%). The patients were further categorized into four subgroups. Group A: IgE 30-100 IU/mL and EOS 150-300 cells/μL (7.3%), Group B: IgE >100 IU/mL and EOS 150-300 cells/μL (19.1%), Group C: IgE 30-100 IU/mL and EOS >300 cells/μL (14.5%) and Group D: IgE >100 IU/mL, EOS >300 cells/μL (59.1%). CONCLUSION The majority of severe refractory asthma patients exhibits both elevated serum IgE level and eosinophilic counts.
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Probst M, Gogolka A, Krüll M, Noga O. In search of clinically relevant parameters to monitor successful omalizumab therapy in allergic asthma. Allergol Select 2018; 2:49-55. [PMID: 31826042 DOI: 10.5414/ALX01377E] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/02/2010] [Indexed: 11/25/2022] Open
Abstract
Background: Omalizumab is approved as add-on therapy for the treatment of severe uncontrolled allergic asthma. Increase in quality of life and decrease of exacerbations and hospital admission, as well as immunmodulatory effects have been described with omalizumab therapy. However, to date there are few parameters to monitor success and to evaluate the individual advantage of this therapy for the patient. Furthermore, no reliable parameter to predict response to treatment exists so far. The aim of this study was to define an easily applicable parameter for response to treatment with omalizumab. Method: 43 patients with allergic asthma were treated with omalizumab at a dose of at least 0,016 mg/kg/IgE every 4 weeks. Before, and 12 weeks after initiation of therapy, bodyplethysmography including airway resistance was performed. Efficacy of treatment was judged by the attending physician on the basis of a five point chart. Furthermore, a differential blood count was performed before, and 12 weeks after initiation of treatment. Total and specific IgE against all relevant antigens were determined before start of therapy. Results: Airway resistance in patients with response to treatment with omalizumab (responders) was significantly decreased in comparison to patients without clinical benefit (non-responder). The number of eosinophil granulocytes in the peripheral blood was decreased in both groups without significant difference. Response to therapy was associated with younger age and lower levels of specific IgE against the allergen with the highest sIgE-level (seasonal and perennial), but not with the sIgE level of the perennial allergens in general. Conclusion: Measurement of airway resistance might be an additional parameter for monitoring response to therapy with omalizumab. High specific IgE levels, for both perennial and concomitant seasonal allergens as well as increasing age, seem to predict less favorable treatment outcomes.
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Johnston A, Smith C, Zheng C, Aaron SD, Kelly SE, Skidmore B, Wells GA. Influence of prolonged treatment with omalizumab on the development of solid epithelial cancer in patients with atopic asthma and chronic idiopathic urticaria: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:1291-1305. [PMID: 31295369 DOI: 10.1111/cea.13457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/14/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We investigated whether prolonged treatment with omalizumab influences development or progression of solid epithelial cancer in patients with atopic asthma or chronic idiopathic urticaria. DESIGN Systematic review and meta-analysis of intervention and observational studies. Randomized controlled trials were assessed for risk of bias using the Cochrane Risk of Bias tool, comparative observational studies were assessed using the Newcastle-Ottawa Scale, and non-comparative observational studies were assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. DATA SOURCES We searched MEDLINE, EMBASE, Cochrane Library and grey literature for eligible studies to November 2017. All searches were updated in January 2019. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Randomized, quasi-randomized, controlled clinical trials and observational studies were included if they involved patients ≥ 12 years with moderate-to-severe persistent asthma or chronic idiopathic urticaria treated with omalizumab for ≥ 40 weeks. Eligible comparators included standard of care, placebo, cromoglycate or no treatment. RESULTS One hundred and sixty seven unique studies were eligible for inclusion; however, only twelve (7.2%, n = 11 758) reported any outcome of interest, none of which involved patients with urticaria. 195 cancer events were reported. We found no statistically significant increase in the odds of study-emergent solid epithelial cancer in patients randomized to long-term treatment with omalizumab compared to standard of care (Peto OR: 0.65, 95% CI: 0.11, 3.74, I2 = 41%). Less than one per cent of participants of non-comparative observational studies (n = 2350) were diagnosed with a solid epithelial tumour (meta-proportion: 0.86% [95% CI: 0.24, 1.86%, I2 = 56%]). In the only comparative observational study reporting on cancer, the proportion of study-emergent solid epithelial tumour events was nearly identical in both study groups (omalizumab: 2.3%, standard of care: 2.2%). CONCLUSIONS There is insufficient evidence to determine whether long-term treatment with omalizumab influences development or progression of solid epithelial cancer in these patient populations. PROSPERO registration # CRD 42018082211.
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Affiliation(s)
- Amy Johnston
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christine Smith
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Carine Zheng
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shawn D Aaron
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, ON, Canada
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Abstract
Urticaria (hives) is a highly prevalent skin disorder that can occur with or without associated angioedema. Chronic spontaneous urticaria (CSU) is a condition which persists for more than 6 weeks in duration and occurs in the absence of an identifiable provoking factor. CSU results from pathogenic activation of mast cells and basophils, which gives rise to the release of proinflammatory mediators that support the generation of urticaria. Several theories have been put forth regarding the pathogenesis of CSU with much evidence pointing toward a potential autoimmune etiology in up to 50% of patients with this condition. In this review, we highlight the evidence surrounding the autoimmune pathogenesis of chronic urticaria including recent data which suggests that CSU may involve contributions from both immunoglobin G (IgG)-specific and immunoglobulin E (IgE)-specific autoantibodies against a vast array of antigens that can span beyond those found on the surface of mast cells and basophils.
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Affiliation(s)
- Sonali J Bracken
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Soman Abraham
- Department of Pathology, Duke University Medical Center, Durham, NC, United States.,Department of Immunology, Duke University Medical Center, Durham, NC, United States
| | - Amanda S MacLeod
- Department of Immunology, Duke University Medical Center, Durham, NC, United States.,Department of Dermatology, Duke University Medical Center, Durham, NC, United States
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Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis is a complex inflammatory disorder, which is often recalcitrant to medical and surgical management. Recently, biologic agents have been studied as an adjunct treatment for this patient population. OBJECTIVE The purpose of this study is to examine the role of biologic agents for chronic rhinosinusitis patients by reviewing literature and clinical trials. METHODS A comprehensive review of literature and clinical trials-both recently completed and ongoing-was undertaken to examine up-to-date evidence of current biologic therapy and its role in chronic rhinosinusitis patients-including anti-IgE, anti-IL-4, anti-IL-5, anti-IL-13, and GATA-3 DNAzyme. RESULTS Specific biologic agents discussed include omalizumab, reslizumab, mepolizumab, benralizumab, dupilumab, and Hgd40/SB010. Risks, side effects, and administration information are also reviewed. An algorithm for the use of biologics in patients with chronic rhinosinusitis with nasal polyposis is proposed. CONCLUSION These treatments have promising results and may prove to be an important adjunct for patients with recalcitrant sinus disease.
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Affiliation(s)
- Alison G Kartush
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jane K Schumacher
- 2 Department of Internal Medicine. Affiliate clinician: Loyola University Medical Center, Maywood, Illinois
| | - Rachna Shah
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Monica O Patadia
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
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Asero R. Efficacy of omalizumab 150 mg/month as a maintenance dose in patients with severe chronic spontaneous urticaria showing a prompt and complete response to the drug. Allergy 2018; 73:2242-2244. [PMID: 29989179 DOI: 10.1111/all.13549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano MI Italy
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Huang YC, Weng CM, Lee MJ, Lin SM, Wang CH, Kuo HP. Endotypes of severe allergic asthma patients who clinically benefit from anti-IgE therapy. Clin Exp Allergy 2018; 49:44-53. [PMID: 30107059 DOI: 10.1111/cea.13248] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Omalizumab, a recombinant monoclonal anti-IgE antibody, was developed for the treatment of severe allergic asthma. Not all these patients respond to omalizumab. OBJECTIVE This study aimed to evaluate whether the proinflammatory cytokine profiles in the severe allergic asthma patients were different between who responded and nonresponded to omalizumab therapy. METHODS A prospective study was conducted to examine type 2 cytokines and epithelium-derived cytokines in the bronchial tissues by immunohistochemistry, Western blot and PCR analysis among patients with severe allergic asthma before and after omalizumab therapy. RESULTS Fourteen of 23 patients with unstable severe allergic asthma improved their asthma control after 4 months of omalizumab treatment (Responders), while nine failed to improve (Non-Responders). Most of Responders were type 2-high endotype (12/14) with upregulated expression of IL-33, IL-25 and TSLP in their bronchial tissues, while most of Non-Responders were type 2-low endotype (8/9). Repeated bronchoscopic biopsy was done in nine responders after omalizumab treatment and showed a decline in IL-13, IL-33, IL-25 and TSLP expression in the bronchial tissues. Among 14 Responders who continued omalizuamb treatments to a total 12 months, six patients achieved a well control of asthma (ACT ≥ 23), while eight patients required additional treatment for asthma symptoms and had more rhinosinusitis comorbidities and a mixed eosinophilic and neutrophilic inflammation in their bronchial tissues. CONCLUSION Most of the severe allergic asthma patients who benefited from omalizumab treatment were IL-33, IL-25 and TSLP aggravated type 2-high endotype. Rhinosinusitis or with a mixed eosinophilic and neutrophilic airway inflammation should be evaluated in patients who partially responded to omalizumab treatment.
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Affiliation(s)
- Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Ming Weng
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Jung Lee
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Han-Pin Kuo
- College of Medicine, Taipei Medical University, Taipei, Taiwan
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Steiß JO, Schmidt A, Lindemann H, Rudloff S, Staatz A, Strohner P, Becher G, Nährlich L, Zimmer KP. Monitoring of omalizumab therapy in children and adolescents. Allergol Select 2018; 2:32-38. [PMID: 31826035 PMCID: PMC6881852 DOI: 10.5414/alx01337e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/09/2010] [Accepted: 07/28/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Omalizumab is a successfully implemented supplementary therapy for improving asthma control in children aged 6 years and older with severe persistent allergic asthma. The dosage of omalizumab depends on body weight and IgE level, yet no parameter has been established to guide dosage changes during therapy. Clinical studies in patients with allergic asthma or allergic rhinitis revealed a clinically relevant improvement by using omalizumab leading to concentrations of free serum IgE reported to be lower than 50 ng/ml. Therefore, only the question concerning the concentrations of free IgE used in a therapy with omalizumab is regarded of clinical importance, while total IgE (free and omalizumab-bound IgE) increases during treatment. PATIENTS AND METHODS Ten patients, 8 to 17 years of age, received therapy with omalizumab due to severe allergic asthma. In addition, the patients had pronounced rhinoconjunctivitis, food allergy, insect sting allergy, and/or neurodermitis. The total IgE in the serum was measured in the patients 3 - 6 months before each omalizumab injection as a potential progress parameter (Sandwich-Immunoassay ADVIA Centaur). RESULTS Six months after beginning of the therapy with omalizumab, a significant decrease of the total IgE concentration was found, in comparison to the baseline values (p < 0.003). In all patients the tolerability of omalizumab was very good: there was a reduction in the frequency of the asthma exacerbations and rescue medications. All patients reported a clearly improved quality of life. CONCLUSIONS A general increase in IgE was not observed in any of the children we treated with omalizumab. Apart from the development of routine assays to determine free serum IgE levels, the significance of the total serum IgE as a suitable control of an omalizumab therapy should be further investigated in controlled studies with regard to sensitivity and specificity. In order to only administer the lowest necessary dose of omalizumab especially in children and adolescents, the establishment of laboratory parameters (free IgE and/or total IgE) to adequately monitor the therapy is urgently needed. Patients undergoing an omalizumab therapy require medical supervision at close intervals.
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Affiliation(s)
- J O Steiß
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
| | - A Schmidt
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
| | - H Lindemann
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
| | - S Rudloff
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
| | | | | | | | - L Nährlich
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
| | - K P Zimmer
- Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen
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Pitrez PM, de Souza RG, Roncada C, Heinzmann-Filho JP, Santos G, Pinto LA, Jones MH, Stein RT. Impact of omalizumab in children from a middle-income country with severe therapy-resistant asthma: A real-life study. Pediatr Pulmonol 2017; 52:1408-1413. [PMID: 29027379 DOI: 10.1002/ppul.23845] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/01/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Severe asthma in children is a global health problem. Severe therapy-resistant asthma (STRA) in children is a major clinical challenge due to persistent symptoms despite high doses of corticosteroids and results in high public health costs. Omalizumab (anti-IgE monoclonal antibody) has been described as an effective add-on therapy in these patients. The characteristics of children with STRA from low- and middle-income countries have scarcely been reported, and no real-life study has been published on the effects of omalizumab in this group of patients. The aim of our study is to report the first clinical real-life experiences with omalizumab in Brazilian children with STRA. METHODS Children (6-18 years old) from a referral center who were diagnosed with STRA were included in this retrospective study based on our clinical databases. The included children had undergone at least 6 months of omalizumab treatment and fulfilled the following initial criteria: 1) >6 years old; 2) a positive skin-prick test for at least one aeroallergen; and 3) a serum total IgE level between 30 and 1500 IU/mL. Clinical and lung function variables were analyzed before and after treatment. RESULTS Fourteen children (mean age: 11.9 years; percentage female: 72%) were included in this study. Omalizumab treatment significantly increased control of the disease according to a standardized questionnaire administered at every visit (P < 0.0001), ceased hospitalizations in 70% (P = 0.02) of patients, and allowed 8/9 (89%) patients to be weaned off oral steroids (P = 0.004). CONCLUSIONS In this retrospective report, the use of omalizumab in Brazilian children with STRA significantly improved disease control, decreased hospitalizations, and allowed suspension of continuous oral corticosteroids.
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Affiliation(s)
- Paulo M Pitrez
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo G de Souza
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristian Roncada
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joao P Heinzmann-Filho
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovana Santos
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo A Pinto
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus H Jones
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato T Stein
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Lin C, Lee IT, Sampath V, Dinakar C, DeKruyff RH, Schneider LC, Nadeau KC. Combining anti-IgE with oral immunotherapy. Pediatr Allergy Immunol 2017; 28:619-627. [PMID: 28782296 DOI: 10.1111/pai.12767] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/24/2022]
Abstract
Food allergy is a significant medical problem that affects up to 8% of children in developed countries. At present, there are no curative therapies available in routine practice and management of food allergy involves strict allergen avoidance, education, and prompt treatment upon accidental exposure. Oral immunotherapy (OIT) is an efficacious experimental approach to food allergy and has been shown to provide a substantial benefit in terms of allergen desensitization. However, OIT is associated with high rates of allergic reactions, and the period of protection offered by OIT appears to be limited and highly variable. Recurrence of allergen sensitivity after a period of treatment discontinuation is commonly observed. With the aim of overcoming these limitations of OIT, several trials have studied omalizumab (anti-IgE monoclonal antibody) as an adjuvant treatment for patients undergoing OIT. Results from these trials have shown that the addition of omalizumab to OIT leads to a significant decrease in the frequency and severity of reactions, which allows for an increase in the threshold of tolerance to food allergens. This review provides a summary of the current literature and addresses some of the key questions that remain regarding the use of omalizumab in conjunction with OIT.
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Affiliation(s)
- Chunrong Lin
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ivan T Lee
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chitra Dinakar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Rosemarie H DeKruyff
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Kari Christine Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
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49
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Licari A, Castagnoli R, Denicolò C, Rossini L, Seminara M, Sacchi L, Testa G, De Amici M, Marseglia GL. Omalizumab in Children with Severe Allergic Asthma: The Italian Real-Life Experience. Curr Respir Med Rev 2017; 13:36-42. [PMID: 29213221 PMCID: PMC5684803 DOI: 10.2174/1573398x13666170426094536] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 11/26/2022]
Abstract
Background: Anti-IgE treatment represents a major breakthrough in the therapeutic management of severe allergic asthma. To date, omalizumab is the only biological drug currently licensed as add-on therapy in children aged > 6 years with moderate-to-severe and severe allergic asthma uncontrolled after treatment with high dose of inhaled corticosteroids plus long-acting inhaled beta2-agonist. The clinical efficacy and safety of omalizumab treatment in the pediatric population has been extensively documented in specific trials and consistently expanded from real-life studies. Our aim is to describe the impact of omalizumab on asthma management, by reporting the results of the first Italian multicenter observational study conducted in children and adolescents with severe allergic asthma. Methods: The study was a 1-year real-life multicenter survey conducted in 13 pediatric allergy and pulmonology tertiary centers in Italy. All patients with confirmed severe allergic asthma from whom Omalizumab add-on treatment was initiated between 2007 and 2015 were included in the study. Results: Forty-seven patients with severe allergic asthma were included in the study. A significant reduction in the number of asthma exacerbations was observed during treatment with omalizumab, when compared with the previous year (1.03 vs 7.2 after 6 months (p<0.001) and 0.8 after 12 months (p<0.001), respectively). Hospital admissions were reduced by 96%. At 12 months, forced expiratory volume in 1 s improved and a corticosteroid sparing effect was observed. No serious adverse events were reported during the follow-up period of 12 months. Conclusion: The results of the first Italian multicenter observational study confirmed that omalizumab is an effective and safe add-on therapy in uncontrolled severe allergic asthma in children.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Chiara Denicolò
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Linda Rossini
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Manuela Seminara
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Sacchi
- Laboratory for Biomedical Informatics "Mario Stefanelli" Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giorgia Testa
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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50
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Stretz E, Oppel EM, Räwer HC, Chatelain R, Mastnik S, Przybilla B, Ruëff F. Overcoming severe adverse reactions to venom immunotherapy using anti-IgE antibodies in combination with a high maintenance dose. Clin Exp Allergy 2017; 47:1631-1639. [PMID: 28802075 DOI: 10.1111/cea.12997] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND An omalizumab treatment and a high maintenance venom dose may both help to prevent recurrent systemic allergic reactions (SAR) to venom immunotherapy (VIT). The effectiveness of this combination therapy, however, is unclear. OBJECTIVE We wanted to explore the possibility whether a temporary treatment with the anti-IgE antibody omalizumab combined with a VIT using an elevated maintenance dose of >100 μg venom may establish a permanent tolerance of maintenance VIT. METHODS For this retrospective case series, we scoured our institutional data base for patients who had had an insect venom allergy, and in whom it had not been possible to continue VIT because of repeated unstoppable SAR during maintenance VIT. Patients were divided into those who had received the combination therapy (omalizumab group) and those who had not received omalizumab because its costs could not be covered (controls). Guided by the total IgE level and by body weight, omalizumab had been given subcutaneously 5, 3 and 1 weeks before VIT had been restarted. Three to 6 months after an elevated maintenance dose (200-300 μg venom) had been reached, omalizumab had been stopped. RESULTS Between 2006 and 2011, 15 patients had qualified for an off-label use of omalizumab: 10 patients had received the combination therapy, and 5 patients had remained without such a therapy. The combination therapy leads to a durable tolerance of VIT in all patients even after omalizumab had been discontinued (median of follow-up time 5.8 years, IQR 2.7-8.6 years). Sting challenge tests were tolerated by all of the re-stung omalizumab patients (n = 8). In all controls, VIT had to be stopped permanently due to repeated SARs (P < .001 vs omalizumab group). CONCLUSIONS AND CLINICAL RELEVANCE Combining a temporary omalizumab therapy with an elevated maintenance dose seems a promising approach to achieve a tolerance of treatment in patients with a recurrent SAR to VIT.
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Affiliation(s)
- E Stretz
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - E M Oppel
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - H-C Räwer
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - R Chatelain
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - S Mastnik
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - B Przybilla
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - F Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
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