Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy

Eger, Katrien; Hashimoto, Simone; Braunstahl, Gert‐Jan; Brinke, Anneke ten; Patberg, Kornelis W.; Beukert, Annelies; Smeenk, Frank W.J.M.; Brugge, Simone van der Sar–van der; Weersink, Els J.M.; Bel, Elisabeth H.

doi:10.1016/j.rmed.2020.106287

Cited by 47 publications

(65 citation statements)

References 37 publications

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“…Six patients were on anti-IL5 therapy and three of them were admitted to ICU (all three patients were obese). Finally, only one patient died, but he had obesity and diabetes, known comorbidities for fatal outcome (Eger et al, 2020). Other case reports do not indicate a worse clinical course in COVID-19 patients exposed to anti-IgE omalizumab (Lommatzsch et al, 2020) and, anti-IL-5R benralizumab (Renner et al, 2020a;Renner et al, 2020b).…”

Section: Severe Asthma In Covid-19 Patients: a Case-studymentioning

confidence: 91%

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Pala

Pistis

2021

Front. Pharmacol.

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SARS-CoV-2 infection stimulates a complex activation of the immune system. Eosinophils belong to the host’s defense equipment against respiratory viruses. In the first phase of the infection, eosinophils contribution is probably appropriate and beneficial, as they facilitate the suppression of the viral replication. However, in severe COVID-19 patients, during the second and third phases of the disease, eosinophils may participate in a maladaptive immune response and directly contribute to immunopathology. In fact, in severe patients, the immune response is prevalently T helper 1 type, but T helper 2 is also present. Eosinophils’ expansion and activation are stimulated by Type 2 cytokines, especially IL-5. Moreover, bronchial asthma, in which eosinophils play a central role, seems not to be a major risk factor for severe COVID-19. Among possible explanations, asthmatic patients are often treated with corticosteroids, which have been demonstrated to reduce the progression to critical COVID-19 in hospitalized patients. In addition to steroids, severe asthmatic patients are currently treated with biological drugs that target Type 2 immune response. Because IL-5 is necessary for the growth, survival, and activation of eosinophils, IL-5 inhibitors, such as mepolizumab, decrease the peripheral blood count of eosinophils, but do not influence eosinophils activation in the airway. In severe COVID-19 patients, the blockade of eosinophils’ activation might contrast harmful immunity.

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Section: Severe Asthma In Covid-19 Patients: a Case-studymentioning

confidence: 91%

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Pala

Pistis

2021

Front. Pharmacol.

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“…Biologics may be protective both against the SARS-CoV-2 infection, by downregulating the angiotensin converting enzyme (ACE)2 (115) and the SARS-CoV-2-induced inflammatory response (116). Indeed, a low prevalence of COVID-19 was observed in European severe asthma cohorts (117,118), although a recent report suggests that severe asthmatics receiving biologic treatments may suffer from a more severe disease compared with the general population (119). Current international guidelines suggest that all patients with asthma should be considered eligible for the approved mRNA COVID-19 vaccines (120).…”

Section: Pulmonary Diseasesmentioning

confidence: 99%

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

et al. 2021

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Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.

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“…Interestingly, none of the patients with COVID-19 experienced severe asthma exacerbations, ICU admissions, noninvasive/mechanical ventilation or extracorporeal membrane oxygenation, and no deaths. In a similar study, the incidence of COVID-19 in patients with severe asthma who received biological therapy (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) was 1.4% ( 107 ). In this study however, severe asthma patients on biological therapy exhibited severe course and poor outcome of COVID-19.…”

Section: Implications Of Asthma Therapeutic Strategies On Covid-19 Pathogenesismentioning

confidence: 88%

Implications of preexisting asthma on COVID-19 pathogenesis

Ramakrishnan

Heialy

Hamid

2021

American Journal of Physiology-Lung Cellular and Molecular Phys

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The coronavirus disease 2019 (COVID-19) pandemic spreading at an alarming rate has taken a heavy toll on the public healthcare systems and economies worldwide. An abnormal and overactivated inflammatory response is occasionally elicited by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and this hyperinflammation is associated with worse prognosis of COVID-19. Theoretically, one would expect asthma patients to be at a greater risk of SARS-CoV-2 infection considering their increased susceptibility to common respiratory virus-associated exacerbations. Surprisingly, current data do not consistently suggest an increased prevalence of asthma among COVID-19 patients. Considering the high global prevalence of asthma, the characteristics of the disease and/or their conventional therapy might play a role in their potential defense against COVID-19. This may be attributed to the T helper type 2 immune response predominantly seen in asthmatics. Likewise, asthma therapeutics, including corticosteroids and biologics, may in fact benefit the asthmatics by alleviating the development of hyperinflammation. On the other hand, elevated IL-17 levels are characteristically seen in a subset of asthma patients with severe disease as well as in COVID-19 patients. Targeting the IL-17 pathway as a treatment strategy could plausibly alleviate acute respiratory distress syndrome (ARDS) in COVID-19 patients with asthma demonstrating a predominant T helper type 17 response. A clinical trial including a drug targeting this pathway may thus, constitute a logical addition to the global pursuit for effective therapeutics against COVID-19. The complex interplay between the asthma endotypes and COVID-19 is not very well understood and will be discussed in this mini-review.

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Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy

Cited by 47 publications

References 37 publications

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

Implications of preexisting asthma on COVID-19 pathogenesis

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