Depletion rate of blood eosinophils with mepolizumab, benralizumab and oral prednisolone in patients with severe asthma

2020 ◽  
Author(s):  
Angela Moran ◽  
Sanjay Ramakrishnan ◽  
Catherine Borg ◽  
Clare Connolly ◽  
Simon Couillard ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Oral Prednisolone ◽  
Depletion Rate ◽  
Blood Eosinophils

scholarly journals Characterisation of patients with severe asthma in the UK Severe Asthma Registry in the biologic era

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215168
Author(s):  
David J Jackson ◽  
John Busby ◽  
Paul E Pfeffer ◽  
Andrew Menzies-Gow ◽  
Thomas Brown ◽  
...  
Keyword(s):  
Asthma Control ◽  
Severe Asthma ◽  
Symptom Control ◽  
Unmet Need ◽  
High Dose ◽  
Blood Eosinophil ◽  
Biologic Therapies ◽  
Exacerbation Rate ◽  
The Uk ◽  
Blood Eosinophils

BackgroundThe UK Severe Asthma Registry (UKSAR) is the world’s largest national severe asthma registry collecting standardised data on referrals to UK specialist services. Novel biologic therapies have transformed the management of type 2(T2)-high severe asthma but have highlighted unmet need in patients with persisting symptoms despite suppression of T2-cytokine pathways with corticosteroids.MethodsDemographic, clinical and treatments characteristics for patients meeting European Respiratory Society / American Thoracic Society severe asthma criteria were examined for 2225 patients attending 15 specialist severe asthma centres. We assessed differences in biomarker low patients (fractional exhaled nitric oxide (FeNO) <25 ppb, blood eosinophils <150/μL) compared with a biomarker high population (FeNO ≥25 ppb, blood eosinophils ≥150/µL).ResultsAge (mean 49.6 (14.3) y), age of asthma onset (24.2 (19.1) y) and female predominance (62.4%) were consistent with prior severe asthma cohorts. Poor symptom control (Asthma Control Questionnaire-6: 2.9 (1.4)) with high exacerbation rate (4 (IQR: 2, 7)) were common despite high-dose treatment (51.7% on maintenance oral corticosteroids (mOCS)). 68.9% were prescribed biologic therapies including mepolizumab (50.3%), benralizumab (26.1%) and omalizumab (22.6%). T2-low patients had higher body mass index (32.1 vs 30.2, p<0.001), depression/anxiety prevalence (12.3% vs 7.6%, p=0.04) and mOCS use (57.9% vs 42.1%, p<0.001). Many T2-low asthmatics had evidence of a historically elevated blood eosinophil count (0.35 (0.13, 0.60)).ConclusionsThe UKSAR describes the characteristics of a large cohort of asthmatics referred to UK specialist severe asthma services. It offers the prospect of providing novel insights across a range of research areas and highlights substantial unmet need with poor asthma control, impaired lung function and high exacerbation rates. T2-high phenotypes predominate with significant differences apparent from T2-low patients. However, T2-low patients frequently have prior blood eosinophilia consistent with possible excessive corticosteroid exposure.

scholarly journals IgE, blood eosinophils and FeNO are not enough for choosing a monoclonal therapy among the approved options in patients with type 2 severe asthma

2021 ◽  
Vol 14 (3) ◽  
pp. 100520
Author(s):  
Jorge Sánchez ◽  
Edison Morales ◽  
Luis-Carlos Santamaria ◽  
Ana-Milena Acevedo ◽  
Ana Calle ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Blood Eosinophils

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

2017 ◽  
Author(s):  
Enrico Heffler ◽  
Giovanni Terranova ◽  
Carlo Chessari ◽  
Valentina Frazzetto ◽  
Giuseppe Picardi ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Point Of Care ◽  
Clinic Setting ◽  
Blood Eosinophils

scholarly journals The importance of being not significant: Blood eosinophils and clinical responses do not correlate in severe asthma patients treated with mepolizumab in real life

Allergy ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 1460-1463 ◽  
Author(s):  
Diego Bagnasco ◽  
Alessandro Massolo ◽  
Marco Bonavia ◽  
Luisa Brussino ◽  
Caterina Bucca ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Real Life ◽  
Asthma Patients ◽  
Clinical Responses ◽  
Blood Eosinophils

scholarly journals Biomarkers in the context of managing severe asthma

2019 ◽  
Vol 2 (1) ◽  
pp. 10-18
Author(s):  
Stanley J. Szefler
Keyword(s):  
Nitric Oxide ◽  
Severe Asthma ◽  
Clinical Application ◽  
Biologic Therapy ◽  
Asthma Management ◽  
Response To Treatment ◽  
Biologic Therapies ◽  
Uncontrolled Asthma ◽  
The Cost ◽  
Blood Eosinophils

Only recently have asthma strategies addressed biomarkers in asthma management, for example, as applied in the identification of severe asthmatics likely to respond to biologic therapy. Three biomarkers are readily available for clinical application in managing severe asthma including blood eosinophils, exhaled nitric oxide and serum IgE. While we have a limited number of biomarkers for clinical application, the available biomarkers have ushered in the era of personalized medicine for asthma. These three biomarkers are readily available for application in the clinic setting to select medications and to monitor response to treatment as well as medication adherence. These biomarkers can be used to modify the cost of uncontrolled asthma and also used to select those patients likely to respond to the available biologic therapies for severe asthma.

scholarly journals Serum Prednisolone Levels as a Marker of Oral Corticosteroid Adherence in Severe Asthma

2020 ◽  
Author(s):  
James Michael Ramsahai ◽  
Emily King ◽  
Robert Niven ◽  
Gael Tavernier ◽  
Peter Wark ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Prospective Observational Study ◽  
Oral Prednisolone ◽  
Sputum Eosinophil ◽  
Steroid Resistant ◽  
Sputum Eosinophilia ◽  
Advanced Therapies ◽  
Objective Marker ◽  
Eosinophil Counts

Abstract Background Severe asthma is a complex heterogeneous disease typically requiring advanced therapies. Underlying the treatment of all asthma, however, is the consistent recommendation across international guidelines to ensure that adherence to therapy is adequate. Currently, there is no consensus on an objective marker of adherence.Methods We performed a prospective observational study of 17 participants taking oral prednisolone using serum prednisolone levels as a marker of adherence, and sputum eosinophilia as a marker of control of type 2 airway inflammation. Based on these biomarkers, we classified participants into a non-adherent and an adherent cohort, and further stratified by the presence of ongoing sputum eosinophilia.Results We identified 3 non-adherent participants and 14 who were adherent, based on their serum prednisolone levels. Stratification using sputum eosinophil counts identified one participant as having ongoing sputum eosinophilia in the setting of non-adherence, while six were identified as steroid resistant with ongoing sputum eosinophilia despite adherence to oral prednisolone therapy.Conclusion Serum prednisolone can be used an objective marker of adherence in those patients with severe asthma taking daily oral prednisolone. In combination with sputum eosinophil counts, a steroid resistant cohort can be distinguished from one with ongoing inflammation in the setting of non-adherence. This information can then be used by clinicians to differentiate the optimal next steps for treatment in these specific populations.

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