scholarly journals Effects of the first three doses of benralizumab on symptom control, lung function, blood eosinophils, oral corticosteroid intake, and nasal polyps in a patient with severe allergic asthma

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090696 ◽  
Author(s):  
Corrado Pelaia ◽  
Maria Teresa Busceti ◽  
Alessandro Vatrella ◽  
Marco Ciriolo ◽  
Eugenio Garofalo ◽  
...  
Keyword(s):  
Nasal Polyps ◽  
Oral Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Serum Levels ◽  
Forced Expiratory Volume ◽  
High Serum ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Blood Eosinophils

Severe allergic eosinophilic asthma can be characterized by inadequate control, despite the regular use of high dosages of inhaled corticosteroids/long-acting β2-adrenergic agonists combinations, and the very frequent utilization of oral corticosteroids. Therefore, under these circumstances, an add-on biological treatment with monoclonal antibodies directed against suitable molecular targets, involved in the pathobiology of type-2 airway inflammation, is very useful. Within such a context, our case report refers to a 46-year-old woman with severe allergic eosinophilic asthma and relapsing nasal polyps, not eligible to add-on biological therapy with omalizumab because of her very high serum levels of immunoglobulins E (IgE). She is currently under treatment with the humanized monoclonal antibody benralizumab (30 mg subcutaneous injection, administered every 4 weeks for the first three doses, and every 8 weeks thereafter), an eosinophil-depleting anti-interleukin-5-receptor biologic. Our patient experienced relevant clinical and functional improvements already after the first dose, and subsequently striking changes were recorded after the second and third doses, including remarkable increases in asthma control test scores and forced expiratory volume in 1 s values, associated with a complete depletion of blood eosinophils and the interruption of oral corticosteroid intake, as well as with the concomitant disappearance of nasal polyps after the second dose. In conclusion, this case study suggests that benralizumab can exert a very rapid and effective therapeutic action in patients with severe eosinophilic asthma and nasal polyposis.

scholarly journals Switch from Omalizumab to Benralizumab in Allergic Patients with Severe Eosinophilic Asthma: A Real-Life Experience from Southern Italy

Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1822
Author(s):  
Corrado Pelaia ◽  
Claudia Crimi ◽  
Santi Nolasco ◽  
Giovanna Elisiana Carpagnano ◽  
Raffaele Brancaccio ◽  
...  
Keyword(s):  
Life Experience ◽  
Symptom Control ◽  
Real Life ◽  
Forced Expiratory Volume ◽  
Blood Eosinophil ◽  
Asthma Control Test ◽  
Biologic Treatment ◽  
Eosinophilic Asthma ◽  
Exacerbation Rate ◽  
Severe Eosinophilic Asthma

Background. The wide availability of monoclonal antibodies for the add-on therapy of severe asthma currently allows for the personalization of biologic treatment by selecting the most appropriate drug for each patient. However, subjects with overlapping allergic and eosinophilic phenotypes can be often eligible to more than one biologic, so that the first pharmacologic choice can be quite challenging for clinicians. Within such a context, the aim of our real-life investigation was to verify whether allergic patients with severe eosinophilic asthma, not adequately controlled by an initial biologic treatment with omalizumab, could experience better therapeutic results from a pharmacologic shift to benralizumab. Patients and methods. Twenty allergic patients with severe eosinophilic asthma, unsuccessfully treated with omalizumab and then switched to benralizumab, were assessed for at least 1 year in order to detect eventual changes in disease exacerbations, symptom control, oral corticosteroid intake, lung function, and blood eosinophils. Results. In comparison to the previous omalizumab therapy, after 1 year of treatment with benralizumab our patients experienced significant improvements in asthma exacerbation rate (p < 0.01), rescue medication need (p < 0.001), asthma control test (ACT) score (p < 0.05), forced expiratory volume in the first second (FEV1) (p < 0.05), and blood eosinophil count (p < 0.0001). Furthermore, with respect to the end of omalizumab treatment, the score of sino-nasal outcome test-22 (SNOT-22) significantly decreased after therapy with benralizumab (p < 0.05). Conclusion. The results of this real-life study suggest that the pharmacologic shift from omalizumab to benralizumab can be a valuable therapeutic approach for allergic patients with severe eosinophilic asthma, not adequately controlled by anti-IgE treatment.

scholarly journals Switching from omalizumab to mepolizumab: real-life experience from Southern Italy

2020 ◽  
Vol 14 ◽  
pp. 175346662092923 ◽  
Author(s):  
Giovanna Elisiana Carpagnano ◽  
Corrado Pelaia ◽  
Maria D’Amato ◽  
Nunzio Crimi ◽  
Nicola Scichilone ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Severe Asthma ◽  
Southern Italy ◽  
Life Experience ◽  
Real Life ◽  
Forced Expiratory Volume ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Life Study ◽  
First Choice

Background: Current availability of several biologic treatments for severe asthma makes it possible to choose the most appropriate for each patient. Sometimes a good percentage of patients with severe asthma may be eligible for biologics that target either the allergic phenotype or the eosinophilic one, but not all respond to that selected as first choice. The aim of our real-life study was to assess whether, for patients with severe eosinophilic allergic asthma, not previously controlled by the anti-IgE omalizumab, the shift to another biologic targeting interleukin-5, such as mepolizumab, may represent a good therapeutic choice. Methods: A total of 41 consecutive patients with severe, persistent allergic, eosinophilic asthma, uncontrolled despite treatment with omalizumab, were enrolled in seven certified Clinical Respiratory Units of Southern Italy (Catania, Catanzaro, Foggia, Bari, Palermo, and two University Respiratory Units of Naples) and shifted to mepolizumab without a wash-out period. Data at baseline, after at least 12 months of therapy with omalizumab, and after at least 12 months of treatment with mepolizumab were collected. Results: After at least 12 months of therapy with mepolizumab, patients experienced a significant decrease in the number of exacerbations/year (5.8 ± 1.8 versus 0.7 ± 0.9, p < 0.0001), an increment of asthma control test score (12 ± 2.7 versus 21.9 ± 2.7, p < 0.0001), an increase in pre-bronchodilator forced expiratory volume in 1 s (1.56 ± 0.45 l versus 1.86 ± 0.52 l, p < 0.0001), and a reduction of blood eosinophils (584 ± 196 cells/µl versus 82 ± 56 cells/µl, p < 0.0001). The percentage of patients who were dependent on corticosteroids significantly decreased from 46% at baseline to 5% during treatment with mepolizumab. Conclusion: Results of our real-life multicentric experience confirms that the shift to mepolizumab could be a good therapeutic strategy in severe eosinophilic allergic asthma not previously controlled by omalizumab. The reviews of this paper are available via the supplemental material section.

scholarly journals Fluctuation-based clustering reveals phenotypes of patients with different asthma severity

2020 ◽  
Vol 6 (2) ◽  
pp. 00007-2019
Author(s):  
Anja Jochmann ◽  
Luca Artusio ◽  
Hoda Sharifian ◽  
Angela Jamalzadeh ◽  
Louise J. Fleming ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Asthma Severity ◽  
Forced Expiratory Volume ◽  
High Dose ◽  
Act Scores ◽  
Asthma Control Test ◽  
Daily Fluctuation ◽  
Difficult Asthma ◽  
Act Score ◽  
Cluster 2

Serial peak expiratory flow (PEF) measurements can identify phenotypes in severe adult asthma, enabling more targeted treatment. The feasibility of this approach in children has not been investigated.Overall, 105 children (67% male, median age 12.4 years) with a range of asthma severities were recruited and followed up over a median of 92 days. PEF was measured twice daily. Fluctuation-based clustering (FBC) was used to identify clusters based on PEF fluctuations. The patients’ clinical characteristics were compared between clusters.Three PEF clusters were identified in 44 children with sufficient measurements. Cluster 1 (27% of patients: n=12) had impaired spirometry (mean forced expiratory volume in 1 s (FEV1) 71% predicted), significantly higher exhaled nitric oxide (≥35 ppb) and uncontrolled asthma (asthma control test (ACT) score <20 of 25).Cluster 2 (45%: n=20) had normal spirometry, the highest proportion of difficult asthma and significantly more patients on a high dose of inhaled corticosteroids (≥800 µg budesonide).Cluster 3 (27%: n=12) had mean FEV1 92% predicted, the highest proportion of patients with no bronchodilator reversibility, a low ICS dose (≤400 µg budesonide), and controlled asthma (ACT scores ≥20 of 25).Three clinically relevant paediatric asthma clusters were identified using FBC analysis on PEF measurements, which could improve telemonitoring diagnostics. The method remains robust even when 80% of measurements were removed. Further research will determine clinical applicability.

scholarly journals Dynamics of inhaled corticosteroid use are associated with asthma attacks

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joy Lee ◽  
Jacqueline Huvanandana ◽  
Juliet M. Foster ◽  
Helen K. Reddel ◽  
Michael J. Abramson ◽  
...  
Keyword(s):  
Electronic Monitoring ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Area Under The Curve ◽  
Adherence Behavior ◽  
Baseline Status ◽  
Multivariable Analyses ◽  
Transitional Probabilities ◽  
Blood Eosinophils

AbstractInhaled corticosteroids (ICS) suppress eosinophilic airway inflammation in asthma, but patients may not adhere to prescribed use. Mean adherence—averaging total doses taken over prescribed—fails to capture many aspects of adherence. Patients with difficult-to-treat asthma underwent electronic monitoring of ICS, with data collected over 50 days. These were used to calculate entropy (H) a measure of irregular inhaler use over this period, defined in terms of transitional probabilities between different levels of adherence, further partitioned into increasing (Hinc) or decreasing (Hdec) adherence. Mean adherence, time between actuations (Gapmax), and cumulative time- and dose-based variability (area-under-the-curve) were measured. Associations between adherence metrics and 6-month asthma status and attacks were assessed. Only H and Hdec were associated with poor baseline status and 6-month outcomes: H and Hdec correlated negatively with baseline quality of life (H:Spearman rS = − 0·330, p = 0·019, Hdec:rS = − 0·385, p = 0·006) and symptom control (H:rS = − 0·288, p = 0·041, Hdec: rS = − 0·351, p = 0·012). H was associated with subsequent asthma attacks requiring hospitalisation (Wilcoxon Z-statistic = − 2.34, p = 0·019), and Hdec with subsequent asthma attacks of other severities. Significant associations were maintained in multivariable analyses, except when adjusted for blood eosinophils. Entropy analysis may provide insight into adherence behavior, and guide assessment and improvement of adherence in uncontrolled asthma.

scholarly journals Mepolizumab effectiveness in patients with severe eosinophilic asthma and co-presence of bronchiectasis: a real-world retrospective pilot study

2020 ◽  
Author(s):  
Claudia Crimi ◽  
Raffaele Campisi ◽  
Santi Nolasco ◽  
Giulia Cacopardo ◽  
Rossella Intravaia ◽  
...  
Keyword(s):  
Pilot Study ◽  
Lung Function ◽  
Real Life ◽  
Specific Effect ◽  
List Type ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Severe Eosinophilic Asthma ◽  
Asthma Symptoms ◽  
Blood Eosinophils

AbstractBackgroundThe association of bronchiectasis (BE) in patients with severe eosinophilic asthma (SEA) is quite frequent. Mepolizumab is a well-recognized treatment for SEA; we aim to evaluate its effectiveness in SEA patients with and without BE in real-life.MethodsWe performed a single-center retrospective pilot study, including patients with SEA treated with mepolizumab for one year. Asthma control test (ACT), lung function, annual exacerbations rate, oral corticosteroid dosage, FeNO, chronic mucous secretions, blood and sputum eosinophils were recorded at baseline and after 6 and 12 months.Resultswe included 32 patients (mean age: 52.3±10, 59% female). 50% showed co-presence of bronchiectasis, (SEA+BE). Significant improvements were found in ACT [(13.8±4.6 to 20.7±4.1, p=0.0009) and (13±4.8 to 20.7±4.6, p=0.0003)], annual exacerbations rate [from 7 (4-12) to 0 (0.00-0.75) and from 8 (4-12) to 0 (0-1), p<0.0001], and blood eosinophils count [748 cells/μL (400-1250) vs. 84 cells/μL (52.5-100), and from 691 cells/μL (405-798) vs. 60 cells/μL (41-105), p<0.0001] in SEA and SEA+BE group respectively, already after 6 months of treatment. A reduction in daily oral corticosteroids intake at 12 months was shown [from 15 mg (0-25) to 0 mg (0-0), p=0.003 and from 8.8 mg (0-25) to 0 mg (0-0) (p=0.01)] in both SEA and SEA+BE, respectively. Similar results were found, comparing SEA+BE patients based on the severity of bronchiectasis.ConclusionsMepolizumab effectively improves asthma symptoms control, reducing annual exacerbations and corticosteroid intake in all patients with SEA, even in the subgroup with coexisting bronchiectasis, independently of their severity.HighlightsMepolizumab is effective in the treatment of severe eosinophilic asthma (SEA) in clinical trials and real-life studies.Bronchiectasis is a frequent comorbidity in patients with severe eosinophilic asthma.Mepolizumab proved to be effective in improving asthma symptoms control, mucus hypersecretion, lung function, and reducing sputum and blood eosinophils, corticosteroids dependency and annual exacerbations both in severe eosinophilic asthma patients with or without co-presence of bronchiectasis.Mepolizumab showed to be effective in patients with asthma and co-presence of bronchiectasis, regardless of BE severity.Assessing the co-presence and severity of bronchiectasis may help clinicians select the right biologic for a prompt treatment-specific effect.

scholarly journals Is there an association between the value of forced expiratory volume in the 1st second, the Asthma Control Test and a Control Framework by Global Initiative for asthma in asthmatic children and adolescents treated with inhaled corticosteroids?

2019 ◽  
Vol 29 (3) ◽  
pp. 346-353
Author(s):  
Karla Delevedove Taglia-Ferre ◽  
Sandra Lisboa ◽  
Luanda Dias da S. Salviano ◽  
Ana Carolina Carioca da Costa ◽  
Shandra Lisboa Monteiro ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Asthma Control ◽  
Control Method ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Control Test ◽  
Asthma Control Test ◽  
Asthmatic Children ◽  
Global Initiative For Asthma ◽  
Global Initiative

Objective: Evaluate the presence of association between the classification of the level of asthma control, using the method proposed by the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT)/Childhood-ACT and the forced expiratory volume in the 1st second (FEV1), in asthmatic children and adolescents treated with inhaled corticosteroids, followed up at the National Institute of Women's, Children's and Adolescents' Health FernandesFigueira of the Oswaldo Cruz Foundation (IFF / FIOCRUZ). Method: A cross-sectional study was carried out with a review of the medical records of all children between 7 and 17 years of age followed up at the Asthma Outpatient Clinic and referred to the Respiratory Insertion Test (PFR) sector between March 2013 and September 2014. In the same day were applied the C-ACT/ACT questionnaires, an asthma control method proposed by the GINA and the FEV1 value in a spirometrictest. Results: From the total number of records evaluated (72), 16 children were excluded because they did not meet the required criteria for performing spirometry. The sample studied (56 children) was predominantly male (58.9%) and median age was 12 (7-17) years. It was observed an association between FEV1 and GINA values ??(p <0.01). Conclusion: The results found in this study indicate that FEV1 measurement is a useful component among the instruments for assessing clinical control of asthma by GINA.

Fluticasone versus Salmeterol/Low-Dose Fluticasone for Long-Term Asthma Control

2002 ◽  
Vol 36 (12) ◽  
pp. 1944-1949 ◽  
Author(s):  
Catherine A Heyneman ◽  
Rachel Crafts ◽  
Jerry Holland ◽  
Aaron D Arnold
Keyword(s):  
Fluticasone Propionate ◽  
Asthma Control ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Persistent Asthma ◽  
Forced Expiratory Volume ◽  
Combination Drug ◽  
Medium Dose

OBJECTIVE: To evaluate the relative clinical superiority of increasing the dose of fluticasone propionate versus the addition of salmeterol to low-dose fluticasone propionate for long-term asthma control. DATA SOURCES: Literature was identified by a MEDLINE search (1966–October 2002). Key search terms included asthma, inhalation, corticosteroid, β-adrenergic agonist, and combination drug therapy. DATA SYNTHESIS: Current guidelines for long-term control of asthma include treatment with either inhaled corticosteroids (medium dose) or inhaled corticosteroids (low to medium dose) in combination with a long-acting bronchodilator. Previous studies evaluating salmeterol or formoterol combination therapy with beclomethasone or budesonide have generally produced superior results compared with increasing the dose of the inhaled corticosteroid. Four recent controlled clinical trials have compared the clinical utility of fluticasone propionate monotherapy versus salmeterol/low-dose fluticasone propionate for long-term asthma control in patients with moderate to severe persistent asthma. Based on spirometry data, rescue albuterol use, and symptom scores, the addition of salmeterol to low-dose fluticasone propionate was superior to increasing the dose of fluticasone propionate. CONCLUSIONS: Based on improvements in forced expiratory volume in 1 second, peak expiratory flow, and symptom control, the addition of salmeterol to low-dose fluticasone propionate provides better control of asthma than increasing the dose of fluticasone propionate.

scholarly journals Clinical profile of patients with adult-onset eosinophilic asthma

2016 ◽  
Vol 2 (2) ◽  
pp. 00100-2015 ◽  
Author(s):  
Jantina C. de Groot ◽  
Huib Storm ◽  
Marijke Amelink ◽  
Selma B. de Nijs ◽  
Edwin Eichhorn ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Inhaled Corticosteroids ◽  
Early Recognition ◽  
Airflow Limitation ◽  
Blood Eosinophil ◽  
Adult Onset ◽  
Air Trapping ◽  
Eosinophilic Asthma ◽  
Computed Tomography Scanning ◽  
Blood Eosinophils

Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma.130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×109 L−1) were compared with 361 adult-onset asthma patients with low (<0.3×109 L−1) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters.Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had higher levels of total IgE without more sensitisation to common inhaled allergens. In addition, these patients had worse lung function, and more often showed fixed airflow limitation, air trapping, nasal polyposis and abnormalities on sinus computed tomography scanning. Chronic rhinosinusitis, air trapping and male sex were three independent factors associated with blood eosinophilia (adjusted OR 3.8 (95% CI 1.7–8.1), 3.0 (95% CI 1.1–8.1) and 2.4 (95% CI 1.3–4.4), respectively).Patients with adult-onset asthma with elevated blood eosinophils exhibit a distinct profile, which can readily be recognised in clinical practice.

Mepolizumab Effectiveness and Allergic Status in Real Life

2020 ◽  
pp. 1-8
Author(s):  
Bruno Sposato ◽  
Marco Scalese ◽  
Gianna Camiciottoli ◽  
Giovanna Elisiana Carpagnano ◽  
Corrado Pelaia ◽  
...  
Keyword(s):  
Oral Corticosteroid ◽  
Real Life ◽  
Blood Eosinophil ◽  
Test Results ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Prick Test ◽  
Significant Relationships ◽  
Therapeutic Choice ◽  
Β2 Agonists

<b><i>Background:</i></b> It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. <b><i>Objective:</i></b> We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. <b><i>Method:</i></b> We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; <i>n</i>: 97–72.4%), and nonallergic, with no prick test results and normal IgE levels &#x3c;100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; <i>n</i>: 37–27.6%). They had taken mepolizumab for at least 6 months. <b><i>Results:</i></b> After 10.9 ± 3.7 months, improvements in FEV<sub>1</sub>%, FEF<sub>25–75</sub>%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5–9]) than in SAEA (5 [2.5–8.5]; <i>p</i> = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV<sub>1</sub> &#x3e;80%, FEF<sub>25–75</sub> &#x3e;65%, exacerbations ≤2, BE &#x3c;300 cells/µL, and FENO &#x3c;25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV<sub>1</sub>% (β = −0.110; <i>p</i> = 0.266), FEF<sub>25–75</sub>% (β = −0.228; <i>p</i> = 0.06), BE counts (β = −0.012; <i>p</i> = 0.918), FENO (β = 0.234; <i>p</i> = 0.085), ACT (β = 0.046; <i>p</i> = 0.660), and exacerbations (β = −0.070; <i>p</i> = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV<sub>1</sub> &#x3e;80%: OR = 1.04 [95% CI: 0.43–2.55], <i>p</i> = 0.923; FEF<sub>25–75</sub> &#x3e;65%: OR = 0.41 [95% CI: 0.08–2.03], <i>p</i> = 0.272) were detected. Neither all other parameters, such as ACT &#x3e;20 (OR = 0.73 [95% CI: 0.32–1.63], <i>p</i> = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55–3.27], <i>p</i> = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40–3.39], <i>p</i> = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40–29.27], <i>p</i> = 0.258), were differently associated with 1 or the other phenotype. <b><i>Conclusion:</i></b> Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.

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