Sputum Type 2 Markers Could Predict Remission in Severe Asthma Treated With Anti-IL-5

Moermans, Catherine; Brion, C.; Bock, Geertruida H. de; Graff, Sophie; Gerday, Sara; Nekoee, Haleh; Poulet, Christophe; Bricmont, Noémie; Henket, Monique; Paulus, Virginie; Guissard, Françoise; Louis, Renaud; Schleich, Florence

doi:10.1016/j.chest.2023.01.037

Cited by 29 publications

(14 citation statements)

References 19 publications

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“…Three of the seven studies that report on biologic-induced asthma remission were small, including less than 55 participants. [7][8][9] The studies used a wide range of definitions including various exacerbation/ symptom/OCS criteria, biomarkers and cut-offs. The exacerbation definition (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…A handful of recent studies ( N = 7) have explored the remission rate induced by various biologics 8–12,16 . These studies evaluated several biologics concurrently ( N = 4), 7,9,12,16 or a single agent such as mepolizumab‐induced remission 11 and benralizumab‐induced remission 8 .…”

Section: Discussionmentioning

confidence: 99%

“…In response, researchers are racing to publish remission data on biologics. A few recent small studies, 7–9 a secondary analysis of a clinical trial dataset 10 and two recent observational studies 11,12 have evaluated the efficacy of various biologics in achieving remission. All these studies used different definitions and various biomarker cut‐off points to identify remission.…”

Section: Introductionmentioning

confidence: 99%

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Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Thomas,

McDonald,

Stevens

et al. 2023

Allergy

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BackgroundAsthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission.MethodsThis observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real‐world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5‐item Asthma Control Questionnaire (ACQ‐5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post‐bronchodilator FEV1 ≥80%) or stabilization (post‐bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut‐offs of ACQ‐5/FEV1 scores. The predictors of clinical remission were identified.Results29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission.ConclusionBiologic treatment with mepolizumab or omalizumab for severe asthma‐induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Thomas,

McDonald,

Stevens

et al. 2023

Allergy

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“…After 1 year of treatment, 23.9% (140/586) of SIROCCO/CALIMA patients had no exacerbations, no OCS use, a pre-bronchodilator (BD) forced expiratory volume in 1 s (FEV 1 ) increase of at least 100 mL and an Asthma Control Questionnaire (ACQ)-6 score lower than 1.5. A very recent observational study evaluated predictors of remission with mepoilzumab [ 79 ] defined as patients who combined 1 year after therapy: no chronic treatment with oral corticosteroids, no exacerbation, asthma control, FEV 1 >80% or an improvement of FEV 1 >10% and a blood eosinophil count <300 mm −3 . Patients reaching remission were characterised at baseline by increased levels of sputum eosinophils, sputum eotaxin-1, sputum TSLP, sputum IL-5, sputum eosinophil peroxydase and sputum IgE while blood eosinophils were not able to discriminate between patients in remission after 1 year of treatment.…”

Section: Severe Asthmamentioning

confidence: 99%

Cytokine-targeted therapies for asthma and COPD

et al. 2023

Self Cite

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Asthma affects over 300 million people worldwide and its prevalence is increasing. COPD is the third leading cause of death globally. Asthma and COPD are complex inflammatory diseases of the airways in which impaired host defences lead to increased susceptibility to pathogens, pollutants and allergens. There is a constant interplay between host and the environment. Environmental exposures can alter the lung microbiome and influence the development of sensitisation by disrupting normal immunoregulation. The underlying airway inflammation in severe asthma is heterogeneous, with upregulation of type 2 cytokines in most cases but increased neutrophilic inflammation and activated T-helper 17 mediated immunity in others. COPD may also comprise several different phentoypes that are driven by different molecular mechanisms or endotypes. This disease heterogeneity is affected by comorbidities, treatments and environmental exposures. Recent intervention trials have shed light on the pathways beyond type 2 inflammation that can lead to beneficial outcomesversuspotentially deleterious effects. We have made a great deal of progress over the last 10 years in terms of immunology and the pathophysiology of asthma and this has led to the development of novel treatments and major improvements in severe asthma outcomes. In COPD, however, no targeted treatments have demonstrated great improvements. This article reviews the mechanism of action and efficacy of the available biologics in asthma and COPD.

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“…Biomarkers facilitate improved characterization of patients, risk determination, more effective and economical treatment, the development of novel targeted treatments and the prediction of outcomes and remission [65]. Asthma is broadly divided into type-2 high and type-2 low disease based on blood eosinophil levels and/or FeNO [11].…”

Section: Biomarker-based Managementmentioning

confidence: 99%

Pulmonology for the rhinologist

Campbell,

Auyeung,

Katsoulotos

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The upper and lower airways are inter-related despite serving different functions and can no longer be considered separately. Rhinologists are becoming increasingly aware of the role the lower airway plays in optimizing outcomes for their patients. This review highlights recent developments in pulmonology that impact rhinologic conditions. Recent findings The unified airway concept now supports the multidisciplinary management of respiratory and rhinologic pathologies. Biomarkers, biologics and the concept of treatable traits have permitted the development of personalized and precise treatment of the entire respiratory tract. The concept of corticosteroid stewardship, the introduction of steroid sparing agents for the treatment of respiratory diseases and the development of biomarkers, now forces us to be more considerate and precise with oral corticosteroid (OCS) prescribing and to consider reduction regimens. Finally, current research on climate change and vaping will allow us to better educate and prepare our patients to improve adherence and avoid exacerbations to maintain optimal global respiratory health. Summary The inter-relatedness of the upper and lower airway has encouraged a multidisciplinary focus in respiratory medicine. More research is required to improve the precision respiratory medicine model, particularly in the realm of biomarkers and endotyping. These developments must also consider the impact of climate change, pollution and toxins for us to provide optimum care for our patients.

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Sputum Type 2 Markers Could Predict Remission in Severe Asthma Treated With Anti-IL-5

Cited by 29 publications

References 19 publications

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Cytokine-targeted therapies for asthma and COPD

Pulmonology for the rhinologist

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