The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies.
Curr Med Res Opin. 2017 Jun 23;:1-26
Authors: Goldman M, Hirsch I, Zangrilli JG, Newbold P, Xu X
OBJECTIVE: Benralizumab, an anti-eosinophilic monoclonal antibody, in combination with high-dosage inhaled corticosteroids and long-acting β2-agonists (ICS/LABA) significantly reduced asthma exacerbations, improved lung function, and reduced symptoms for patients with severe, uncontrolled asthma with blood eosinophil counts ≥300 cells/µL in the Phase III SIROCCO and CALIMA studies. To understand the efficacy and safety of benralizumab for patients with eosinophil-driven disease with blood eosinophil counts lower than 300 cells/µL, we evaluated the effect of applying an eosinophil cutoff of ≥150 cells/µL.
METHODS: Adult patients with uncontrolled asthma despite high-dosage ICS/LABA ± additional asthma controller(s) received subcutaneous benralizumab 30 mg every 8 weeks (Q8W; first three doses every 4 weeks) or placebo for 48 (SIROCCO) or 56 (CALIMA) weeks. Efficacy measures including annual exacerbation rate, prebronchodilator FEV1, and total asthma symptom score were analyzed by baseline blood eosinophil counts ≥150 vs. <150 cells/µL.
RESULTS: Benralizumab reduced asthma exacerbation rates by 42% in SIROCCO (rate ratio: 0.58; 95% CI: 0.46-0.74; p<0.001; n = 325) and 36% in CALIMA (rate ratio: 0.64; 95% CI: 0.50-0.81; p<0.001; n = 300) vs. placebo (n = 306, 315) for patients with blood eosinophil counts ≥150 cells/µL. Benralizumab increased prebronchodilator FEV1 (both studies, p≤0.002) and improved total asthma symptom score in SIROCCO (p = 0.009) at end of treatment vs. placebo for patients with blood eosinophil counts ≥150 cells/µL. The overall adverse events frequency was similar between treatment groups and eosinophil count cohorts.
CONCLUSION: These results support the efficacy and safety of benralizumab for patients with severe asthma and blood eosinophil counts ≥150 cells/µL.
PMID: 28644104 [PubMed - as supplied by publisher]
Cytomegalovirus DNA is highly prevalent in the blood of patients with asthma and is associated with age and asthma traits.
Allergy. 2017 Jun 22;:
Authors: Kowalski ML, Wardzynska A, Studzinska M, Pawelczyk M, Lesnikowski ZJ, Paradowska E
CMV IgG antibodies have been associated with inflammageing and immunosenescence. We aimed to assess the presence of CMV DNA in the blood of adult and elderly patients with bronchial asthma to establish potential association of CMV DNAemia with asthma and asthma characteristics. Eighty-five elderly asthmatics, 74 younger asthma patients and 114 age-matched controls were recruited. The CMV DNA was detected using commercial artus assay in 10.7% of asthma patients, but was negative in all control individuals. The secondary assay identified CMV DNA in 41.5% of asthmatics and 13.3% of control subjects (p<0.001). Presence of CMV DNA was associated with increased risk of asthma and CMV DNA copy numbers correlated with some asthma traits, including respiratory parameters, and exhaled breath Nitric Oxide. We conclude, that CMV infection is associated with asthma and may contribute to the pathogenesis of asthmatic inflammation. This article is protected by copyright. All rights reserved.
PMID: 28643373 [PubMed - as supplied by publisher]
Exercise-Induced Bronchospasm and Allergy.
Front Pediatr. 2017;5:131
Authors: Caggiano S, Cutrera R, Di Marco A, Turchetta A
Sport is an essential part of childhood, with precious and acknowledged positive health effects but the impact of exercise-induced bronchoconstriction (EIB) significantly reduces participation in physical activity. It is important to recognize EIB, differentiating EIB with or without asthma if the transient narrowing of the airways after exercise is associated with asthmatic symptoms or not, in the way to select the most appropriate treatment among the many treatment options available today. Therapy is prescribed based on symptoms severity but diagnosis of EIB is established by changes in lung function provoked by exercise evaluating by direct and indirect tests. Sometimes, in younger children it is difficult to obtain the registration of difference between the preexercise forced expiratory volume in the first second (FEV1) value and the lowest FEV1 value recorded within 30 min after exercise, defined as the gold standard, but interrupter resistance, in association with spirometry, has been showed to be a valid alternative in preschool age. Atopy is the main risk factor, as demonstrated by epidemiologic data showing that among the estimated pediatric population with EIB up to 40% of them have allergic rhinitis and 30% of these patients may develop adult asthma, according with atopic march. Adopting the right treatment and prevention, selecting sports with no marked hyperventilation and excessive cooling of the airways, children with EIB can be able to take part in physical activity like all others.
PMID: 28642859 [PubMed - in process]
Association of Obstructive Sleep Apnea with Asthma: A Meta-Analysis.
Sci Rep. 2017 Jun 22;7(1):4088
Authors: Kong DL, Qin Z, Shen H, Jin HY, Wang W, Wang ZF
This study evaluates the relationship between obstructive sleep apnea (OSA) and asthma. Literature search was carried out in several electronic databases and random effects meta-analyses were performed to obtain pooled estimates of the prevalence of OSA, OSA risk and sleep disordered breathing (SDB) in asthma patients and pooled odds ratios of the prevalence between asthma and non-asthma patients. In adult asthma patients, the prevalence [95% confidence interval] of OSA, OSA risk, and SDB was 49.50 [36.39, 62.60] %, 27.50 [19.31, 35.69] %, and 19.65 [14.84, 24.46] % respectively. The odds of having OSA, OS risk and SDB by the asthma patients were 2.64 [1.76, 3.52], 3.73 [2.90, 4.57] and 1.73 [1.11, 2.36] times higher (p < 0.00001 for all) in asthma than in non-asthma patients, respectively. Adult asthma patients with OSA had significantly higher BMI in comparison with asthma patients without OSA. This study reveals that the prevalence of OSA in asthma patients is considerably higher; even higher than OSA risk and SDB. Sleep studies should be performed in asthma patients with symptoms suggestive of OSA/OSA risk/SDB.
PMID: 28642543 [PubMed - in process]
"Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort." Dominick E. Shaw, Ana R. Sousa, Stephen J. Fowler, Louise J. Fleming, Graham Roberts, Julie Corfield, Ioannis Pandis, Aruna T. Bansal, Elisabeth H. Bel, Charles Auffray, Chris H. Compton, Hans Bisgaard, Enrica Bucchioni, Massimo Caruso, Pascal Chanez, Barbro Dahlén, Sven-Erik Dahlen, Kerry Dyson, Urs Frey, Thomas Geiser, Maria Gerhardsson de Verdier, David Gibeon, Yi-ke Guo, Simone Hashimoto, Gunilla Hedlin, Elizabeth Jeyasingham, Pieter-Paul W. Hekking, Tim Higenbottam, Ildikó Horváth, Alan J. Knox, Norbert Krug, Veit J. Erpenbeck, Lars X. Larsson, Nikos Lazarinis, John G. Matthews, Roelinde Middelveld, Paolo Montuschi, Jacek Musial, David Myles, Laurie Pahus, Thomas Sandström, Wolfgang Seibold, Florian Singer, Karin Strandberg, Jorgen Vestbo, Nadja Vissing, Christophe von Garnier, Ian M. Adcock, Scott Wagers, Anthony Rowe, Peter Howarth, Ariane H. Wagener, Ratko Djukanovic, Peter J. Sterk and Kian Fan Chung on behalf of the U-BIOPRED Study Group. Eur Respir J 2015; 46: 1308-1321.
Eur Respir J. 2017 Jun;49(6):
PMID: 28642304 [PubMed - in process]