Adherence to inhaled corticosteroids and clinical outcomes following a year of benralizumab therapy for severe eosinophilic asthma

d’Ancona, G; Kavanagh, Joanne; Dhariwal, Jaideep; Hearn, AP; Roxas, C; Fernandes, Mariana; Green, Linda; Thomson, Louise; Nanzer, AM; Kent, Brian D.

doi:10.1111/all.14737

Cited by 16 publications

(15 citation statements)

References 11 publications

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“…Decreased adherence to ICS can also play a role in a suboptimal response to biologic therapy. In a real-world analysis of 91 mOCS-dependent severe asthma patients treated with mepolizumab those who had poor adherence to ICS experienced significantly more exacerbations and less reduction in prednisolone dose than those with good adherence [ 102 ], although this was not the case with benralizumab [ 103 ], potentially due to its more complete eosinophil depletion.…”

Section: Choosing a Biologic In Severe Eosinophilic Asthmamentioning

confidence: 99%

A pragmatic guide to choosing biologic therapies in severe asthma

Kavanagh

Hearn

Jackson

2021

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There are now several monoclonal antibody (mAb) therapies (“biologics”) available to treat severe asthma. Omalizumab is an anti-IgE mAb and is licensed in severe allergic asthma. Current evidence suggests it may decrease exacerbations by augmenting deficient antiviral immune responses in asthma. Like all other biologics, clinical efficacy is greatest in those with elevated T2 biomarkers. Three biologics target the interleukin (IL)-5–eosinophil pathway, including mepolizumab and reslizumab that target IL-5 itself, and benralizumab that targets the IL-5 receptor (IL-5R-α). These drugs all reduce the exacerbation rate in those with raised blood eosinophil counts. Mepolizumab and benralizumab have also demonstrated steroid-sparing efficacy. Reslizumab is the only biologic that is given intravenously rather than by the subcutaneous route. Dupilumab targets the IL-4 receptor and like mepolizumab and benralizumab is effective at reducing exacerbation rate as well as oral corticosteroid requirements. It is also effective for the treatment of nasal polyposis and atopic dermatitis. Tezepelumab is an anti-TSLP (thymic stromal lymphopoietin) mAb that has recently completed phase 3 trials demonstrating significant reductions in exacerbation rate even at lower T2 biomarker thresholds.Many patients with severe asthma qualify for more than one biologic. To date, there are no head-to-head trials to aid physicians in this choice. However, post-hoc analyses have identified certain clinical characteristics that are associated with superior responses to some therapies. The presence of allergic and/or eosinophilic comorbidities, such as atopic dermatitis, nasal polyposis or eosinophilic granulomatosis with polyangiitis, that may additionally benefit by the choice of biologic should also be taken into consideration, as should patient preferences which may include dosing frequency. To date, all biologics have been shown to have excellent safety profiles.

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Section: Choosing a Biologic In Severe Eosinophilic Asthmamentioning

confidence: 99%

A pragmatic guide to choosing biologic therapies in severe asthma

Kavanagh

Hearn

Jackson

2021

Breathe

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“…Over the course of a 1-year study, patients with SEA who received mepolizumab and remained adherent to ICS experienced a reduction in exacerbations, whereas the exacerbation rate in patients with poor ICS adherence failed to improve [65]. In contrast, data from a similar study demonstrated that significant reductions in exacerbations with benralizumab were evident regardless of level of ICS adherence [66]. It is possible that this difference may reflect partial versus complete eosinophil depletion with these two therapies; however, further prospective studies are required to investigate this.…”

Section: Steroid-sparing Studiesmentioning

confidence: 98%

Eosinophils and eosinophilic immune dysfunction in health and disease

2022

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The functions ascribed to eosinophils have classically been limited to host defence against certain parasitic infections and potentially deleterious effects in the setting of specific diseases that are associated with elevated eosinophil counts in blood and/or tissue. The ability to induce eosinophil depletion either experimentally in animal models or through targeted therapies in humans has extended our understanding of the roles played by eosinophils in health and homeostasis as well as in disease pathogenesis. When associated with human disease aetiology, the eosinophil takes on a pathogenic rather than a protective role. This maladaptive response, called “eosinophilic immune dysfunction” herein, appears central to exacerbation pathogenesis and disease control in severe asthma and may be involved in the aetiology of other eosinophil-related conditions ranging from organ-system-limited diseases such as phenotypic subsets of chronic obstructive pulmonary disease and chronic rhinosinusitis with nasal polyposis to more broadly systemic diseases such as eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. In this review, we describe the evidence supporting eosinophilic functions related to health and homeostasis and explore the contribution of eosinophilic immune dysfunction to human disease.

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“…Somewhat surprisingly, common themes in adherence are that its improvement does not consistently result in a corresponding improvement in biomarkers, morbidity, mortality, quality of life, patient satisfaction, healthcare use, or costs [73,[75][76][77][78], that symptoms do not beget adherence [79] and the effectiveness of seemingly similar treatments may be affected differently by concomitant treatment adherence [80,81]. A 2017 Cochrane review aimed to assess the efficacy and safety of interventions intended to improve adherence to ICS therapy in asthma [75].…”

Section: Limitations Of Improvements In Adherencementioning

confidence: 99%

Improving adherence in chronic airways disease: are we doing it wrongly?

d’Ancona

Weinman

2021

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Non-adherence to medicines is a significant clinical and financial burden, but successful strategies to improve it, and thus bring about significant improvements in clinical outcome, remain elusive. Many barriers exist, including a lack of awareness amongst some healthcare professionals as to the extent and impact of non-adherence and a dearth of skills to address it successfully. Patients may not appreciate that they are non-adherent, feel they cannot disclose it or underestimate its impact on their health in the short and longer term. In describing the evidence-based frameworks that identify the causal factors behind medicines taking (or not taking) behaviours, we can start to personalise interventions to enable individuals to make informed decisions about their treatments and thus overcome real and perceived barriers to adherence.Educational aimsTo understand the underlying principles of why a patient may or may not take medicines as agreed.To choose targeted interventions to support better adherence.

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Adherence to inhaled corticosteroids and clinical outcomes following a year of benralizumab therapy for severe eosinophilic asthma

Cited by 16 publications

References 11 publications

A pragmatic guide to choosing biologic therapies in severe asthma

A pragmatic guide to choosing biologic therapies in severe asthma

Eosinophils and eosinophilic immune dysfunction in health and disease

Improving adherence in chronic airways disease: are we doing it wrongly?

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