Utilizing Predictive Inflammatory Markers for Guiding the Use of Biologicals in Severe Asthma

Runnstrom, Martin; Pitner, Hilary; Xu, Jennifer; Lee, F Eun-Hyung; Kuruvilla, Merin

doi:10.2147/jir.s269297

Cited by 6 publications

(5 citation statements)

References 58 publications

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“…The measurement of blood eosinophil count, the most established predictive biomarker for targeted biologic treatment response (13), is an important step towards the phenotypic characterization of patients with asthma and assessing targeted biologic therapy eligibility (16). This large, retrospective study provided insight into the real-world prevalence of blood eosinophil count testing for patients with asthma in the US.…”

Section: Discussionmentioning

confidence: 99%

“…Identifying an eosinophilic phenotype in patients with moderate-to-severe asthma enhances therapeutic options, allowing for targeted therapy eligibility to be established (1). Targeted therapies reduce clinically signi cant exacerbation frequency and oral corticosteroid (OCS) dependence (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), in addition to improvements in asthma control, lung function, and health-related quality of life (HRQoL) versus placebo (6)(7)(8)(9)(10)(11)(12)14). Consequently, current Global Initiative for Asthma (GINA) 2022 recommendations suggest testing blood eosinophil counts to facilitate asthma phenotype identi cation (1).…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED: Eosinophil count testing in patients with asthma varies by healthcare provider type in the US

Mathur¹,

Corbridge²,

Packnett³

et al. 2023

Preprint

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Background Patients with asthma with an eosinophilic phenotype may be eligible for additional treatment options to improve disease control; however, the prevalence and frequency of eosinophil testing is unknown. This study assessed blood eosinophil count testing prevalence in patients with asthma by healthcare provider (HCP) type and exacerbation frequency. Methods This was a retrospective, longitudinal, real-world study (GSK ID: 214470) utilizing the Merative Explorys® Universe electronic health records database. Eligible patients had ≥ 2 asthma diagnostic codes (January, 2016–December, 2018) (Index date: first asthma diagnosis). Outcomes included patient demographics and clinical characteristics (12-months pre-index [baseline]), and prevalence of blood eosinophil count testing, stratified by primary HCP (Allergist/Pulmonologist, a primary care physician [PCP] or other HCP) or by exacerbation frequency (frequent exacerbations [≥ 2] or infrequent exacerbations [< 2]) during the 12 months post-index (follow-up). Results Of 400,254 patients included (mean age: 51.2 years; 70.8% female), the most common provider type at baseline was a PCP (76.8%). More patients in the Allergist/Pulmonologist subgroup had ≥ 1 blood eosinophil count test result compared with patients in the PCP subgroup at both baseline (59.9% vs. 50.7%) and follow-up (59.0% vs. 56.2%). A higher proportion of patients with frequent exacerbations had blood eosinophil count tests at baseline (55.4–69.5%) and follow-up (67.9–75.1%), compared with patients with infrequent exacerbations (55.5–63.7%, 62.4–67.3%). In the total population, the mean (SD) number of tests ordered was 3.4 (5.3) and 4.1 (6.4) during the baseline and follow-up periods, respectively. A greater number of tests were ordered for patients with frequent exacerbations, most apparently in the Allergist/Pulmonologist subgroup during baseline and follow-up (7.4 vs. 4.9). For patients with frequent exacerbations with a blood eosinophil count test result, the mean (SD) number of tests ranged from 3.1 (4.6) to 5.8 (8.3) at baseline and 5.1 (8.5) to 7.4 (10.6) during follow-up. Conclusions The prevalence of BEC testing in patients with asthma remains suboptimal. Routine BEC testing should be considered by HCPs for patients with asthma, increasing identification of the eosinophilic asthma phenotype, which may inform the decision to consider advancing to targeted biologic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

RETRACTED: Eosinophil count testing in patients with asthma varies by healthcare provider type in the US

Mathur¹,

Corbridge²,

Packnett³

et al. 2023

Preprint

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“…Clinical practice guidelines ( 19 – 21 ) and experts’ opinions ( 18 , 83 , 84 , 88 , 90 ) proposed algorithms to choose MA based on biomarkers mainly FeNO and blood or sputum eosinophil count. The algorithm we propose in this article tries to guide the MA election in each case as we do in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…There are different biomarkers to identify high T2 inflammation ( 15 – 18 ): blood and sputum eosinophils, exhaled fraction of nitric oxide (FeNO).…”

Section: Introductionmentioning

confidence: 99%

Uncontrolled severe T2 asthma: Which biological to choose? A biomarker-based approach

López-Viña

Campos²,

Alonso³

et al. 2022

Front. Allergy

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In recent years, advances in knowledge of molecular mechanisms involved in asthma have changed uncontrolled severe asthma (USA) treatment, with the appearance of biological treatment. USA is a heterogeneous entity with different endotypes and phenotypes. Nowadays, the biological drugs approved with asthma indication are omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab. Tezepelumab is approved by the Food and Drug Administration (FDA) in the United States and, recently, by the European Medicines Agency (EMA). All these biological drugs have shown their efficacy in clinical trials, especially in reducing exacerbations, improving asthma control, quality of life, pulmonary function, and withdrawing systemic corticosteroids or at least reducing their daily dose, with some differences between them. Except for mepolizumab and reslizumab, biological drugs have different targets and thus different therapeutic indications should be expected; however, in some patients, more than one drug could be indicated, making the election more difficult. Because there are no direct comparisons between biological drugs, some biomarkers are used to choose between them, but they are not unbeatable. In this article, an algorithm to choose the first biological drug in a specific patient is proposed based on different study results and patient’ characteristics.

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“…Practical considerations for clinicians before they choose a particular biological agent in a severe asthmatic with overlapping phenotype are many. [ 19 , 20 ] [ Figure 2 ] depicts some considerations for the choice of biological agents in Indian practice settings.…”

Section: Attitudes Of Indian Patients To Asthma Therapymentioning

confidence: 99%

Biological therapy for severe asthma – Indian perspectives and challenges

et al. 2023

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Asthma is a complex and heterogeneous disease. Severe asthma makes up only a minority of asthma patients encountered in clinical settings but accounts for substantial healthcare utilisation in terms of manpower as well as economic allocation. The availability of monoclonal antibodies has a major impact on severe asthmatics and has provided excellent clinical results in properly selected patients. The discovery of new molecules might present uncertainties to clinicians as to the best agent to institute in an individual patient. The practice scenario in India is unique when it comes to the commercial availability of monoclonal antibodies, patient attitudes, and allocation of the healthcare budget. The present review dissects and summarises the available monoclonal antibodies for asthma treatment in India, the perspectives of Indian patients on biological therapy, and the challenges encountered by patients and physicians in this regard. We provide practical suggestions for utilising monoclonal antibodies and deciding on the optimal agent for a given patient.

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Utilizing Predictive Inflammatory Markers for Guiding the Use of Biologicals in Severe Asthma

Cited by 6 publications

References 58 publications

RETRACTED: Eosinophil count testing in patients with asthma varies by healthcare provider type in the US

RETRACTED: Eosinophil count testing in patients with asthma varies by healthcare provider type in the US

Uncontrolled severe T2 asthma: Which biological to choose? A biomarker-based approach

Biological therapy for severe asthma – Indian perspectives and challenges

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