Hannah Wangberg1, Samantha R Spierling Bagsic2, Lilliana Osuna2, Andrew A White3. 1. Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif. 2. Scripps Health, Scripps Whittier Diabetes Institute, San Diego, Calif. 3. Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif. Electronic address: White.Andrew@scrippshealth.org.
Abstract
BACKGROUND: There are no head-to-head studies for patients with aspirin-exacerbated respiratory disease (AERD) comparing any of the 5 Food and Drug Administration-approved respiratory biologic therapies. OBJECTIVE: Explore outcomes in subjects with AERD using biologic therapies in a real-world clinic setting. METHODS: A retrospective pilot study was conducted for subjects with AERD who had been prescribed omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor alpha [anti-IL-5Rα]), or dupilumab (anti-IL-4 receptor alpha [anti-IL-4Rα]). Clinical outcomes pre- versus postinitiation of biologic therapy were explored including symptoms, 22-item sino-nasal outcome test scores, systemic corticosteroid and antibiotic prescriptions, and emergency room visits related to AERD. RESULTS: Of the 74 subjects, 58.1% (n = 43) had used 1 biologic, though many (41.9%, n = 31) trialed more than 1 biologic. Of the 50 subjects who had used anti-IL-4Rα therapy, 98% (49 of 50) still had this therapy prescribed at study completion compared with 48.6% (17 of 35) and 26.9% (7 of 26) of those who used anti-IgE and anti-IL-5 and anti-IL-5 receptor alpha (anti-IL-5/IL-5Rα) therapy, respectively. Among those on anti-IL-4Rα therapy, there was a significant reduction in median total 22-item sino-nasal outcome test scores (51 to 19, P = .0002), corticosteroid bursts (2 to 0, P < .0001), and median number of antibiotic courses for respiratory disease (1 to 0, P = .0469) prebiologic versus postbiologic initiation. No statistically significant difference in those outcomes was observed for individuals on anti-IgE or anti-IL-5/IL-5Rα therapy. CONCLUSIONS: Anti-IL-4Rα therapy led to significantly higher rates of clinical improvement in AERD when compared with anti-IL-5/IL-5Rα and anti-IgE biologic therapies. Prospective studies would help clarify best practices for the use of biologic therapies in AERD.
BACKGROUND: There are no head-to-head studies for patients with aspirin-exacerbated respiratory disease (AERD) comparing any of the 5 Food and Drug Administration-approved respiratory biologic therapies. OBJECTIVE: Explore outcomes in subjects with AERD using biologic therapies in a real-world clinic setting. METHODS: A retrospective pilot study was conducted for subjects with AERD who had been prescribed omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor alpha [anti-IL-5Rα]), or dupilumab (anti-IL-4 receptor alpha [anti-IL-4Rα]). Clinical outcomes pre- versus postinitiation of biologic therapy were explored including symptoms, 22-item sino-nasal outcome test scores, systemic corticosteroid and antibiotic prescriptions, and emergency room visits related to AERD. RESULTS: Of the 74 subjects, 58.1% (n = 43) had used 1 biologic, though many (41.9%, n = 31) trialed more than 1 biologic. Of the 50 subjects who had used anti-IL-4Rα therapy, 98% (49 of 50) still had this therapy prescribed at study completion compared with 48.6% (17 of 35) and 26.9% (7 of 26) of those who used anti-IgE and anti-IL-5 and anti-IL-5 receptor alpha (anti-IL-5/IL-5Rα) therapy, respectively. Among those on anti-IL-4Rα therapy, there was a significant reduction in median total 22-item sino-nasal outcome test scores (51 to 19, P = .0002), corticosteroid bursts (2 to 0, P < .0001), and median number of antibiotic courses for respiratory disease (1 to 0, P = .0469) prebiologic versus postbiologic initiation. No statistically significant difference in those outcomes was observed for individuals on anti-IgE or anti-IL-5/IL-5Rα therapy. CONCLUSIONS: Anti-IL-4Rα therapy led to significantly higher rates of clinical improvement in AERD when compared with anti-IL-5/IL-5Rα and anti-IgE biologic therapies. Prospective studies would help clarify best practices for the use of biologic therapies in AERD.
Authors: Philippe Gevaert; Nicholas Van Bruaene; Tom Cattaert; Kristel Van Steen; Thibaut Van Zele; Frederic Acke; Natalie De Ruyck; Katrien Blomme; Ana R Sousa; Richard P Marshall; Claus Bachert Journal: J Allergy Clin Immunol Date: 2011-09-28 Impact factor: 10.793
Authors: Claus Bachert; Peter W Hellings; Joaquim Mullol; Robert M Naclerio; Jingdong Chao; Nikhil Amin; Annette Grabher; Brian N Swanson; Jennifer D Hamilton; Sophie Guillonneau; Christine Taniou; Donghui Zhang; Gianluca Pirozzi; Neil M H Graham; Heribert Staudinger; Leda P Mannent; Asif Khan Journal: J Allergy Clin Immunol Pract Date: 2019-03-27
Authors: Tiffany Jean; Victoria Eng; Javed Sheikh; Michael S Kaplan; Bruce Goldberg; Su Jau Yang; Shefali Samant Journal: Allergy Asthma Proc Date: 2019-09-01 Impact factor: 2.587
Authors: Claus Bachert; Ana R Sousa; Valerie J Lund; Glenis K Scadding; Philippe Gevaert; Shuaib Nasser; Stephen R Durham; Marjolein E Cornet; Harsha H Kariyawasam; Jane Gilbert; Daren Austin; Aoife C Maxwell; Richard P Marshall; Wytske J Fokkens Journal: J Allergy Clin Immunol Date: 2017-07-04 Impact factor: 10.793
Authors: Joseph K Han; Claus Bachert; Wytske Fokkens; Martin Desrosiers; Martin Wagenmann; Stella E Lee; Steven G Smith; Neil Martin; Bhabita Mayer; Steven W Yancey; Ana R Sousa; Robert Chan; Claire Hopkins Journal: Lancet Respir Med Date: 2021-04-16 Impact factor: 30.700
Authors: C Caruso; S Colantuono; D Pugliese; C Di Mario; B Tolusso; E Gremese; G Papparella; F Castrì; A Gasbarrini; A Romano; A Armuzzi Journal: Allergy Asthma Clin Immunol Date: 2020-04-22 Impact factor: 3.406