Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Dennis Thomas¹, Vanessa M McDonald^{1

2}, Sean Stevens¹, Erin S Harvey^{1

2}, Melissa Baraket^{3

4}, Philip Bardin⁵, Jeffrey J Bowden⁶, Simon Bowler⁷, Jimmy Chien^{8

9}, Li Ping Chung¹⁰, Andrew Gillman¹¹, Mark Hew^{11

12}, Sandra Hodge^{13

14}, Alan James^{15

16}, Christine Jenkins^{17

18}, Constance H Katelaris^{19

20}, Gregory P Katsoulotos^{21

22

23

24}, David Langton^{25

26}, Joy Lee²⁷, Guy Marks^{3

21}, Matthew Peters¹⁷, Naghmeh Radhakrishna²⁸, Paul N Reynolds¹⁴, Janet Rimmer^{21

24}, Pathmanathan Sivakumaran²⁹, John W Upham^{30

31}, Peter Wark^{1

2}, Ian A Yang^{31

32}, Peter G Gibson^{1

2}

Affiliations

¹ Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia.
² Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
³ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
⁵ Lung and Sleep Medicine, Monash University and Medical Centre and Hudson Institute, Clayton, Victoria, Australia.
⁶ Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia.
⁷ Department of Respiratory Medicine, Mater Hospital, Brisbane, Queensland, Australia.
⁸ Department of Sleep and Respiratory Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
⁹ School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹¹ Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia.
¹² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹³ Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia.
¹⁴ Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia.
¹⁵ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹⁶ Medcial School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁷ Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia.
¹⁸ Concord Clinical School, University of Sydney, Concord, New South Wales, Australia.
¹⁹ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
²⁰ Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
²¹ Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.
²² The University of Notre Dame, Sydney, Western Australia, Australia.
²³ St George Specialist Centre, Kogarah, New South Wales, Australia.
²⁴ St Vincent's Clinic, Darlinghurst, New South Wales, Australia.
²⁵ Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
²⁶ Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia.
²⁷ Austin Health, Melbourne, Victoria, Australia.
²⁸ Respiratory Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
²⁹ Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
³⁰ Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
³¹ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
³² Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.

PMID: 37632144
DOI: 10.1111/all.15867

Observational Study

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Dennis Thomas et al. Allergy. 2024 Feb.

. 2024 Feb;79(2):384-392.

doi: 10.1111/all.15867. Epub 2023 Aug 25.

Authors

Affiliations

¹ Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia.
² Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
³ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
⁵ Lung and Sleep Medicine, Monash University and Medical Centre and Hudson Institute, Clayton, Victoria, Australia.
⁶ Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia.
⁷ Department of Respiratory Medicine, Mater Hospital, Brisbane, Queensland, Australia.
⁸ Department of Sleep and Respiratory Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
⁹ School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹¹ Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia.
¹² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹³ Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia.
¹⁴ Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia.
¹⁵ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹⁶ Medcial School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁷ Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia.
¹⁸ Concord Clinical School, University of Sydney, Concord, New South Wales, Australia.
¹⁹ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
²⁰ Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
²¹ Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.
²² The University of Notre Dame, Sydney, Western Australia, Australia.
²³ St George Specialist Centre, Kogarah, New South Wales, Australia.
²⁴ St Vincent's Clinic, Darlinghurst, New South Wales, Australia.
²⁵ Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
²⁶ Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia.
²⁷ Austin Health, Melbourne, Victoria, Australia.
²⁸ Respiratory Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
²⁹ Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
³⁰ Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
³¹ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
³² Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.

PMID: 37632144
DOI: 10.1111/all.15867

Abstract

Background: Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission.

Methods: This observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real-world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5-item Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post-bronchodilator FEV1 ≥80%) or stabilization (post-bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut-offs of ACQ-5/FEV1 scores. The predictors of clinical remission were identified.

Results: 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission.

Conclusion: Biologic treatment with mepolizumab or omalizumab for severe asthma-induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.

Keywords: asthma; mepolizumab; omalizumab; remission.

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References

REFERENCES

1. The Global Asthma Report 2018. Global Asthma Network; 2018.
1. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2022 www.ginasthma.org
1. Thomas D, McDonald VM, Pavord ID, Gibson PG. Asthma remission-what is it and how can it be achieved? Eur Respir J. 2022;60(5):2102583.
1. Upham JW, James AL. Remission of asthma: the next therapeutic frontier? Pharmacol Ther. 2011;130(1):38-45.
1. Menzies-Gow A, Szefler SJ, Busse WW. The relationship of asthma biologics to remission for asthma. J Allergy Clin Immunol Pract. 2021;9(3):1090-1098.

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Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Affiliations

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous