Blood eosinophil count and FeNO to predict benralizumab effectiveness in real-life severe asthma patients

The aim of this study has been to evaluate the efficacy of the IL-5 receptor blocker benralizumab on chronic rhinosinusitis with nasal polyposis (CRSwNP), associated with severe eosinophilic allergic asthma. Ten patients with severe eosinophilic allergic asthma and CRSwNP were enrolled. Sino-nasal outcome test (SNOT-22), numerical rating scale (NRS), endoscopic nasal polyp score, Lund Mackey CT (computed tomography) score, and blood eosinophil count were measured at baseline and after 24 weeks of treatment with benralizumab. All the above clinical, endoscopic, imaging, and hematological parameters significantly improved after 24 weeks of treatment with benralizumab. In particular, SNOT-22 decreased from 61.10 ± 17.20 to 26.30 ± 19.74 ( P < 0.001), NRS decreased from 7.20 ± 1.55 to 3.40 ± 2.22 ( P < 0.001), the endoscopic polyp nasal score decreased from 4.20 ± 1.32 to 2.50 ± 1.78 ( P < 0.001), the Lund-Mackay CT score decreased from 16.60 ± 5.50 to 6.90 ± 5.99 ( P < 0.001), and blood eosinophil count decreased from 807.3 ± 271.1 cells/μL to 0 cells/μL ( P < 0.0001). These results strongly suggest that benralizumab exerted a very effective therapeutic action on CRSwNP associated with severe asthma, thus improving nasal symptoms and decreasing polyp size.

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Point-of-care blood eosinophil count in a severe asthma clinic setting

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2017.05.016 ◽

2017 ◽

Vol 119 (1) ◽

pp. 16-20 ◽

Cited By ~ 14

Author(s):

Enrico Heffler ◽

Giovanni Terranova ◽

Carlo Chessari ◽

Valentina Frazzetto ◽

Claudia Crimi ◽

...

Keyword(s):

Severe Asthma ◽

Eosinophil Count ◽

Point Of Care ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Clinic Setting

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Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study

European Respiratory Journal ◽

10.1183/13993003.02523-2017 ◽

2018 ◽

Vol 51 (5) ◽

pp. 1702523 ◽

Cited By ~ 69

Author(s):

Marc Humbert ◽

Camille Taillé ◽

Laurence Mala ◽

Vincent Le Gros ◽

Jocelyne Just ◽

...

Keyword(s):

Allergic Asthma ◽

Eosinophil Count ◽

Response Rate ◽

Real Life ◽

Blood Eosinophil ◽

Exacerbation Rate ◽

Blood Eosinophil Count ◽

Life Study ◽

Severe Allergic Asthma ◽

Blood Eosinophils

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab.This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL−1 in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL−1 (n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils <300 cells·µL−1 (n=346).This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL−1, and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.

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Saudi Arabian real-life experience with biologic therapy in severe asthma

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2021.807 ◽

2021 ◽

Vol 16 ◽

Author(s):

Safwat Eldaboussi ◽

Ahmed Qabil ◽

Ahmed Lotfi ◽

Amgad Awad ◽

Eman Abdel Salam ◽

...

Keyword(s):

Observational Study ◽

Asthma Control ◽

Severe Asthma ◽

Eosinophil Count ◽

Biologic Therapy ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Asthma Exacerbations ◽

Percent Improvement

Background: Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.Methods: This multicenter observational study enrolled a cohort of 97 patients from Mach 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV1 before and during biologic therapy.Results: Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV1 improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.Conclusions: Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.

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Prognostic and Predictive Value of Blood Eosinophil Count, Fractional Exhaled Nitric Oxide, and Their Combination in Severe Asthma: A Post Hoc Analysis

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201903-0599le ◽

2019 ◽

Vol 200 (10) ◽

pp. 1308-1312 ◽

Cited By ~ 20

Author(s):

Rahul Shrimanker ◽

Oliver Keene ◽

Gareth Hynes ◽

Sally Wenzel ◽

Steven Yancey ◽

...

Keyword(s):

Nitric Oxide ◽

Severe Asthma ◽

Predictive Value ◽

Eosinophil Count ◽

Exhaled Nitric Oxide ◽

Blood Eosinophil ◽

Fractional Exhaled Nitric Oxide ◽

Blood Eosinophil Count ◽

Post Hoc Analysis ◽

Post Hoc

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Prevalence of Asthma-COPD Overlap in COPD and Severe Asthma Cohorts

10.21203/rs.3.rs-851216/v1 ◽

2021 ◽

Author(s):

Hyonsoo Joo ◽

So-Young Park ◽

So Young Park ◽

Seo Young Park ◽

Sang-Heon Kim ◽

...

Keyword(s):

Severe Asthma ◽

Eosinophil Count ◽

Clinical Manifestations ◽

Forced Expiratory Volume ◽

Smoking History ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Obstructive Pulmonary Disease ◽

Blood Eosinophil Count ◽

Bronchodilator Response

Abstract Background: Asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with similar clinical manifestations, despite differences in pathophysiology. Asthma-COPD overlap (ACO) is a condition characterized by overlapping clinical features of both diseases. There have been few reports regarding the prevalence of ACO in COPD and severe asthma cohorts. ACO is heterogeneous; patients can be classified on the basis of phenotype differences. This study was performed to analyze the prevalence of ACO in COPD and severe asthma cohorts. In addition, this study compared baseline characteristics among ACO patients according to phenotype.Methods: Patients with COPD were prospectively enrolled into the Korean COPD subgroup study (KOCOSS) cohort. Patients with severe asthma were prospectively enrolled into the Korean Severe Asthma Registry (KoSAR). ACO was defined in accordance with the updated Spanish criteria. In the COPD cohort, ACO was defined as bronchodilator response (BDR) ≥ 15% and ≥ 400 mL from baseline or blood eosinophil count ≥ 300 cells/μL. In the severe asthma cohort, ACO was defined as age ≥ 35 years, smoking ≥ 10 pack-years, and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity < 0.7. Patients with ACO were divided into four groups according to smoking history (threshold: 20 pack-years) and blood eosinophil count (threshold: 300 cells/μL).Results: The prevalence of ACO significantly differed between the COPD and severe asthma cohorts (19.8% [365/1839] vs. 12.5% [104/832], respectively, P < 0.001). The numbers of patients in each group were as follows: Group A (smoking 10–20 pack-years and blood eosinophil count ≥ 300 cells/μL), 42 (9.1%); Group B (smoking 10–20 pack-years and eosinophil count < 300 cells/μL), 17 (3.7%); Group C (smoking ≥ 20 pack-years and eosinophil count ≥ 300 cells/μL), 341 (73.8%); and Group D (smoking ≥ 20 pack-years and eosinophil count < 300 cells/μL), 62 (13.4%). Age, sex, BDR, comorbidities, and medications significantly differed among the four groups.Conclusion: The prevalence of ACO differed between COPD and severe asthma cohorts. ACO patients can be classified into four phenotype groups, such that each phenotype exhibits distinct characteristics.

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Eosinophils Target Therapy for Severe Asthma: Critical Points

BioMed Research International ◽

10.1155/2018/7582057 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

L. Brussino ◽

E. Heffler ◽

C. Bucca ◽

S. Nicola ◽

G. Rolla

Keyword(s):

Severe Asthma ◽

Eosinophil Count ◽

Inhaled Corticosteroids ◽

Response To Treatment ◽

High Dose ◽

Blood Eosinophil ◽

Moderate Increase ◽

Eosinophilic Asthma ◽

Peripheral Blood Eosinophil ◽

Blood Eosinophil Count

Asthma is a chronic and heterogeneous disease, which is defined as severe disease whenever it requires treatment with a high dose of inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘‘uncontrolled’’ or if it remains ‘‘uncontrolled’’ despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma, which is characterized by sputum eosinophilia, associated with mild to moderate increase in blood eosinophil count, frequently adult-onset, and associated with chronic rhinosinusitis with nasal polyps in half of the cases. Eosinophilic asthma is driven by T2 inflammation, characterized, among the others, by interleukin-5 production. IL-5 plays a key role in the differentiation, survival, migration, and activation of eosinophils, and it has become an appealing therapeutic target for eosinophilic asthma. In recent years two monoclonal antibodies (mepolizumab and reslizumab) directed against IL-5 and one monoclonal antibody directed against the alpha-subunit of the IL-5 receptor (benralizumab) have been developed. All these IL-5 target drugs have been shown to reduce the number of exacerbation in patients with severe asthma selected on the basis of peripheral blood eosinophil count. There are still a number of unresolved issues related to the anti-IL5 strategy in eosinophilic asthma, which are here reviewed. These issues include the effects of such therapy on airway obstruction and asthmatic symptoms, the level of baseline eosinophils that predicts a response to treatment, the relationship between blood and airway eosinophilia, and, perhaps most importantly, how to elucidate the pathogenetic role played by eosinophils in the individual patient with severe eosinophilic asthma.

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