Breathing for Two: A Case of Severe Eosinophilic Asthma During Pregnancy Treated With Benralizumab

Saco, Tara; Tabatabaian, Farnaz

doi:10.1016/j.anai.2018.09.300

Cited by 10 publications

(4 citation statements)

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“…One case report regarding use of benralizumab for severe eosinophilic asthma notes 'limited fetal complications' without additional information on fetal outcome [100]. In the case report of benralizumab use for HES during pregnancy, suppression of eosinophils in the fetus from birth to 7 months without any adverse effects was noted [99].…”

Section: Discussionmentioning

confidence: 99%

Asthma in pregnancy: a review of recent literature

Colas,

Namazy

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Asthma remains the most common respiratory disease in pregnancy. Identifying risk factors for asthma exacerbations during pregnancy is critical, as uncontrolled asthma can have detrimental effects for both mother and baby. In this review, we discuss recent literature exploring risk factors, fetal and maternal effects, and treatment options for asthma during pregnancy. Recent findings Recent literature suggests that optimizing asthma during pregnancy improves outcomes for both mother and baby, as well as later in childhood. Current research affirms that the benefit of asthma medication use outweighs any potential risks related to the medications themselves. Limited information is available regarding the use of newer therapies such as biologics during pregnancy. Summary Identifying risk factors for asthma exacerbations during pregnancy is critical to prevent adverse outcomes for both mother and baby. Recent evidence continues to affirm the safety of asthma medication use; more studies are needed regarding the use of new therapies during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Asthma in pregnancy: a review of recent literature

Colas,

Namazy

2024

Current Opinion in Pulmonary Medicine

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“…Generally, studies have not found evidence to support significant immunosuppression by TNFα inhibitors since there is no observed increase in infection rates in exposed infants, regardless of whether exposure occurred early or late in pregnancy [22 ▪▪ ,24]. Overall, the recommendation from rheumatologic societies is to continue TNFα inhibitors throughout pregnancy and transiently hold them during the third trimester, if the underlying disease is well controlled [22 ▪▪ ,25,29,30,38,39,40 ▪ ,41,42,43 ▪ ,44] (Table 2).…”

Section: Potential To the Fetus And Newborn Due To Biologics Usementioning

confidence: 99%

Safety of biologic agents for the management of rheumatic diseases during pregnancy

D’Gama,

Bermas

2024

Current Opinion in Rheumatology

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Purpose of review To discuss the current understanding regarding the use of biologic therapeutics in pregnancy. Recent findings Our understanding of the mechanisms underlying the potential fetal and infant exposure to biologics as well as a growing body of empirical evidence from real world use of biologics in pregnancy have demonstrated that biologics are generally compatible preconception and during pregnancy. Long-term effects of exposure to biologic agents in utero are not known, but will be uncovered in time. Biosimilars, which are becoming more popular, may not always share the same safety profiles as their originators. Summary Biologics have revolutionized the management of rheumatologic disease and ushered in a new era of clinical remission among patients. These agents, developed and introduced into clinical use at the beginning of the new millennium, are very potent, yet their efficacy in treating disease often in reproductive aged women, raises questions regarding their safety during pregnancy. These therapeutics can cause immunosuppression and can inhibit immunologic circuits that are not only involved in disease pathophysiology but hypothetically could impact the development of the fetal immune system. Reassuringly, biologics, typically antibodies or antibody-based proteins, are introduced to the fetus via the typical route of transplacental antibody transfer, and thus only begin to be transferred in appreciable amounts in the second trimester (after organogenesis). From theoretic and empirical standpoints, biologic use during pregnancy appears well tolerated for fetal development and to not substantially affect infant immune development.

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“…Such data is also needed to inform the safety of these agents in the context of pregnancy, given that there are only a few case reports of such use across the three agents to date. 253,254 Regarding biomarkers, post-hoc analyses of clinical trial data have suggested that baseline BEC may potentially be the most useful predictor of treatment response to these agents. 56,[255][256][257] This was also observed in real-world settings, 239,258 but not consistently.…”

Section: Omalizumabmentioning

confidence: 99%

Recent Insights into the Management of Inflammation in Asthma

Rupani¹,

Fong²,

Kyyaly³

et al. 2021

JIR

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The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.

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Breathing for Two: A Case of Severe Eosinophilic Asthma During Pregnancy Treated With Benralizumab

Cited by 10 publications

References 0 publications

Asthma in pregnancy: a review of recent literature

Asthma in pregnancy: a review of recent literature

Safety of biologic agents for the management of rheumatic diseases during pregnancy

Recent Insights into the Management of Inflammation in Asthma

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