Eosinophils in bronchial biopsy predict functional response to biological therapy in severe asthma

AbstractAround 5–10% of the total asthmatic population suffer from severe or uncontrolled asthma, which is associated with increased mortality and hospitalization, increased health care burden and worse quality of life. In the last few years, new drugs have been launched and several asthma phenotypes according to definite biomarkers have been identified. In particular, therapy with biologics has revolutionized the management and the treatment of severe asthma, showing high therapeutic efficacy associated with significant clinical benefits. To date, four types of biologics are licensed for severe asthma, i.e. omalizumab (anti-immunoglobulin E) antibody, mepolizumab and reslizumab (anti-interleukin [IL]-5antibody), benralizumab (anti-IL-5 receptor a antibody) and dupilumab (anti-IL-4 receptor alpha antibody). The aim of this article was to review the biologic therapies currently available for the treatment of severe asthma, in order to help physicians to choose the most suitable biologic agent for their asthmatic patients.

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New therapy options for patients with eosinophilic type of severe bronchial asthma

Medical Council ◽

10.21518/2079-701x-2019-21-111-116 ◽

2020 ◽

pp. 111-116

Author(s):

G. L. Ignatova ◽

V. N. Antonov ◽

E. V. Blinova ◽

I. V. Grebneva ◽

E. V. Sheklanova

Keyword(s):

Decision Making ◽

Severe Asthma ◽

Bronchial Asthma ◽

Clinical Studies ◽

Clinical Characteristics ◽

Biological Therapy ◽

Efficacy And Safety ◽

Therapy Options ◽

New Therapy ◽

Chelyabinsk Region

The article provides data on the epidemiology of severe asthma. It defines the phenotype and endotype of bronchial asthma and classifies BA according to phenotype/endotype. The features of the eosinophilic phenotype of severe bronchial asthma are considered. Clinical characteristics of the patient corresponding to the prescription of benralizumab are presented. The algorithm of decision making by a doctor-therapist about patients’ referral to a pulmonologist for consideration of the biological therapy issue is given. The results of the main clinical studies to assess the efficacy and safety of benralizumab in patients with severe eosinophilic bronchial asthma: SIROCCO, CALIMA, ZONDA, BORA are described. The experience of using various biological preparations for the treatment of severe asthma in Chelyabinsk and the Chelyabinsk Region has also been summarized.

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Chronic respiratory failure in severe asthma – Questions answered after biological therapy, a clinical case

Revista Portuguesa de Imunoalergologia ◽

10.32932/rpia.2021.09.066 ◽

2021 ◽

Vol 29 (3) ◽

pp. 209-213

Author(s):

Joana Branco ◽

◽

Filipa Todo Bom ◽

Sofia Furtado ◽

◽

...

Keyword(s):

Respiratory Failure ◽

Severe Asthma ◽

Systemic Corticosteroid ◽

Biological Therapy ◽

History Of ◽

Traditional Therapies ◽

Treatment Alternatives ◽

Type 2 Inflammation ◽

Systemic Corticosteroid Therapy

Severe asthma is defined as either refractory to traditional therapies or controlled only with therapies that have intolerable side effects. Biological agents are known to offer treatment alternatives to patients with type 2 inflammation severe asthma. We describe the case of a woman with a long history of type 2 inflammation severe asthma, with uncontrolled symptoms and need of systemic corticosteroid therapy as prevailing features, and with respiratory failure that differentiated her from other patients with severe asthma.

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Biological therapy in severe asthma: A gem or a jam

Egyptian Journal of Bronchology ◽

10.4103/1687-8426.176658 ◽

2016 ◽

Vol 10 (1) ◽

pp. 1

Author(s):

Hesham Raafat

Keyword(s):

Severe Asthma ◽

Biological Therapy

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A comparison of biologicals in the treatment of adults with severe asthma – real-life experiences

Asthma Research and Practice ◽

10.1186/s40733-020-00055-9 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Emma Kotisalmi ◽

Auli Hakulinen ◽

Mika Mäkelä ◽

Sanna Toppila-Salmi ◽

Paula Kauppi

Keyword(s):

Respiratory Tract ◽

Severe Asthma ◽

Biological Therapy ◽

Oral Corticosteroid ◽

Real Life ◽

Wilcoxon Test ◽

Upper Respiratory Tract ◽

Oral Corticosteroids ◽

Upper Respiratory ◽

Per Oral

Abstract Background Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies. Methods We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test. Results Of 64 patients, 40 used continuous per oral corticosteroid therapy prior to biological therapy. The mean daily dose of per oral corticosteroid was reduced in those with anti-IL5/IL5R therapy (− 3.0 mg, p = 0.02). The number of annual per oral corticosteroid courses decreased in both the anti-IL5/IL5R (− 2.8 courses, p < 0.05) and anti-IgE groups (− 1.3 courses, p < 0.05). The number of annual antibiotic courses (− 0.7 courses, p = 0.04) and total number of exacerbation events (− 4.4 events/year, p < 0.05) were reduced in the anti-IL5/IL5R group. In the 55 asthma patients analysed for upper respiratory tract findings, the results suggested a reduction in need for chronic rhinosinusitis surgery during biological therapy. Conclusions Results with biological therapies in this real-life clinical setting are comparable to those reported in clinical trials. Biological therapy reduces exacerbations and per oral corticosteroid use. Trial registration NCT04158050, retrospectively registered 6.11.2019.

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Availability and reimbursement of biological products for severe asthma in Bulgaria

SAGE Open Medicine ◽

10.1177/2050312120951067 ◽

2020 ◽

Vol 8 ◽

pp. 205031212095106

Author(s):

Petya Milushewa ◽

Miglena Doneva ◽

Guenka Petrova

Keyword(s):

Health Insurance ◽

Severe Asthma ◽

National Health Insurance ◽

National Health ◽

Biological Therapy ◽

Insurance Fund ◽

Health Insurance Fund ◽

National Health Insurance Fund ◽

Biological Products ◽

The Cost

Objectives: This study aims to analyze the reimbursement and cost of biological therapy for severe asthma in Bulgaria during 2014–2019 from the perspective of the National Health Insurance Fund. Methods: It is a retrospective, Marco-costing, top-down study of the expenditures for biological products for severe asthma. The changes in the cost paid by the National Health Insurance Fund per year, per product, and per patient during 2015–2020 were systematized and calculated. The utilization of biologicals was analyzed by calculating the defined daily dose/1000inh/day. Three databases were searched—the European Medicines Agency for the date of marketing authorization of biological products, National Council of Prices and Reimbursement for the date of their respective inclusion in the positive drug list, and National Health Insurance Fund about the number of patients with asthma, reimbursed sum for all asthma patients, and number of packages sold of biological products. Results: At the end of 2019, five international non-proprietary names of biologicals with indication for severe asthma had received European marketing authorization, and three of them were included in the Bulgarian positive drug list—omalizumab, mepolizumab, and benralizumab with a 75% reimbursement. Upon their introduction into the positive drug list, the reimbursed expenditures for asthma therapy started to increase from 27 million in 2014 to 33 million BGN in 2019 (€13.5–€16.5 million). The cost of therapy with biologicals rose from 16% to 24% of all anti-asthmatic medicines budget. The National Health Insurance Fund database reported that between 47,000 and 52,000 of patients with asthma, 466 are on biological therapy. The yearly cost of one asthma patient ranges between 512 and 615 BGN (€258–€307), and the yearly per-patient cost of severe asthma is 16,666 BGN (appr. €8333). Total utilization in defined daily dose/1000inh/day increases from 0.0199 to 0.0383 from 2015 to 2019. Conclusion: The access to biological therapy through the reimbursement system has improved during the last 3 years. The cost of therapy is posing a high burden on the National Health Insurance Fund and on the patients and is expected to increase due to the small number of patients on biological therapy currently in comparison to all reimbursed asthmatics.

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