Use of FeNO to predict anti-IL-5 and IL-5R biologics efficacy in a real-world cohort of adults with severe eosinophilic asthma

Menigoz, Charlotte; Dirou, S.; Chambellan, Arnaud; Hassoun, Dorian; Moui, Antoine; Magnan, A.; Blanc, F.–X.

doi:10.1080/02770903.2022.2136526

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…Higher FENO levels may be predictive of achieving asthma remission when we use Mepolizumab. This agrees with another real-life study where adults with severe eosinophilic asthma and who had a baseline FeNO ≥ 50 ppb experienced a greater decrease in exacerbations after 12 months of anti-IL-5 or IL-5R biologic than those with a FeNO < 50 ppb [14].…”

Section: Discussionsupporting

confidence: 91%

Clinical Asthma Remission Obtained with Biologics in Real Life: Patients’ Prevalence and Characteristics

Sposato

Bianchi

Rícci

et al. 2023

JPM

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Background: The prevalence of clinical asthma remission with biologics in severe asthma has not been well understood yet. We do not even know whether there might be characteristics that identify subjects prone to remission of the disease. Materials and Methods: Retrospectively, four groups of severe asthmatics already treated with Omalizumab, Mepolizumab, Benralizumab and Dupilumab (302, 55, 95 and 34 patients, respectively) for at least 12 months were considered. The number of individuals with clinical asthma remission was sought in each group. This was considered when patients, after a treatment of at least 1 year with one of the aforesaid biologics, showed the disappearance of asthma symptoms (ACT ≥ 20), zero exacerbations, suspension of oral corticosteroids and a FEV1% ≥ 80%. Baseline characteristics of patients with and without remission were also taken into account. Results: The prevalence of asthma remission after a mean of 37.8 ± 19.2, 13.5 ± 1.7, 15.4 ± 5.5 and 12 ± 0 months of Omalizumab, Mepolizumab, Benralizumab and Dupilumab treatments was 21.8%, 23.6%, 35.8% and 23.5%, respectively. For each biologic, different baseline characteristics, seem to be associated with failure to achieve clinical asthma remission. Older age, higher BMI, a later age of asthma onset, rhinitis/sinusitis/nasal polyposis, comorbidities and a greater asthma severity may be the characteristics of a suboptimal response to biologic treatments. Conclusion: All biologics have the potential to induce disease remission in severe asthmatics. For each biologic, there may be several markers that can identify the patients who will not achieve asthma remission. It would be important to detect them (by carrying out targeted studies) as they would allow us to select the best biologic that may induce clinical asthma remission on a larger number of patients.

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Section: Discussionsupporting

confidence: 91%

Clinical Asthma Remission Obtained with Biologics in Real Life: Patients’ Prevalence and Characteristics

Sposato

Bianchi

Rícci

et al. 2023

JPM

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“…However, neither blood eosinophil count nor FeNO level could be confirmed as predictive of a response to dupilumab as defined by the GETE. Patients with a high blood eosinophil count or a high FeNO level are more likely to respond to other biologics, as well as to dupilumab [ 26 , 27 , 28 , 29 , 30 , 31 ]. Therefore, it may be difficult to predict whether dupilumab is more likely to be effective based on these biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Switching to Dupilumab from Other Biologics without a Treatment Interval in Patients with Severe Asthma: A Multi-Center Retrospective Study

Higo

Ichikawa

Arakawa

et al. 2023

JCM

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Background: Dupilumab is a fully humanized monoclonal antibody that blocks interleukin-4 and interleukin-13 signals. Several large clinical trials have demonstrated the efficacy of dupilumab in patients with severe asthma. However, few studies have examined a switch to dupilumab from other biologics. Methods: This retrospective, multi-center observational study was conducted by the Okayama Respiratory Disease Study Group. Consecutive patients with severe asthma who were switched to dupilumab from other biologics without a treatment interval between May 2019 and September 2021 were enrolled. Patients with a treatment interval of more than twice the standard dosing interval for the previous biologic prior to dupilumab administration were excluded. Results: The median patient age of the 27 patients enrolled in this study was 57 years (IQR, 45–68 years). Eosinophilic chronic rhinosinusitis (ECRS)/chronic rhinosinusitis with nasal polyp (CRSwNP) was confirmed in 23 patients. Previous biologics consisted of omalizumab (n = 3), mepolizumab (n = 3), and benralizumab (n = 21). Dupilumab significantly improved FEV1 (median improvement: +145 mL) and the asthma control test score (median improvement: +2). The overall response rate in patients receiving dupilumab for asthma as determined using the Global Evaluations of Treatment Effectiveness (GETE) was 77.8%. There were no significant differences in the baseline characteristics of the GETE-improved group vs. the non-GETE-improved group. ECRS/CRSwNP improved in 20 of the 23 patients (87.0%). Overall, 8 of the 27 patients (29.6%) developed transient hypereosinophilia (>1500/μL), but all were asymptomatic and able to continue dupilumab therapy. Conclusions: Dupilumab was highly effective for the treatment of severe asthma and ECRS/CRSwNP, even in patients switched from other biologics without a treatment interval.

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“…Our results are partially in line with those reported by Meningoz et al in a retrospective real-world study investigating the efficacy of anti-IL5/5R treatment in patients with severe eosinophilic asthma. FeNO level changes were not associated with therapeutic response, as measured by ACT and FEV 1 [9]. Another real-life study on 99 patients treated with mepolizumab concluded that baseline FeNO https://publications.ersnet.org on on June 27, 2024 by guest Copyright Downloaded from value was not different in patients defined clinical "non-responders", "responders" or "superresponders" [10].…”

Section: Research Lettermentioning

confidence: 96%

Revealing the gap: fractional exhaled nitric oxide and clinical responsiveness to biological therapy in severe asthma – a retrospective study

Maniscalco,

Candia,

Visca

et al. 2024

ERJ Open Res

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Extract Patients with severe asthma often require treatment with a biological drug directed at pivotal immune regulators, including interleukin (IL)-4, IL-5, IL-13, immunoglobulin E (IgE) and, more recently, thymic stromal lymphopoietin [1]. In this regard, biomarkers of type 2-high inflammation, such as exhaled nitric oxide fraction ( F ENO ), have been progressively and successfully utilised for the endotyping of severe asthma patients [2] in order to improve their therapeutical management. However, there has been relatively little focus on monitoring the dynamics of these biomarkers after treatment initiation and on understanding the correlation between drug-induced changes and the observed clinical response [3].

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Use of FeNO to predict anti-IL-5 and IL-5R biologics efficacy in a real-world cohort of adults with severe eosinophilic asthma

Cited by 8 publications

References 42 publications

Clinical Asthma Remission Obtained with Biologics in Real Life: Patients’ Prevalence and Characteristics

Clinical Asthma Remission Obtained with Biologics in Real Life: Patients’ Prevalence and Characteristics

Switching to Dupilumab from Other Biologics without a Treatment Interval in Patients with Severe Asthma: A Multi-Center Retrospective Study

Revealing the gap: fractional exhaled nitric oxide and clinical responsiveness to biological therapy in severe asthma – a retrospective study

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