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Revue Des Maladies Respiratoires May 2024Asthma is a pathology that remains severe and is inadequately controlled in 4% of patients. Identification of multiple pathophysiological mechanisms has led to the... (Review)
Review
INTRODUCTION
Asthma is a pathology that remains severe and is inadequately controlled in 4% of patients. Identification of multiple pathophysiological mechanisms has led to the development of biomedicines, of which there are currently five available in France, with a safety profile that appears favorable but remains uncertain due to a lack of real-life experience with these new molecules.
STATE OF KNOWLEDGE
Although relatively benign, the adverse effects of biologics are diverse. Headache, joint pain, skin reactions at the injection site, fever and asthenia are commonly observed during the different treatments. Ophthalmological complications seem restricted to dupilumab, with numerous cases of keratitis and conjunctivitis in patients with atopic dermatitis. Several respiratory complications have also been observed, essentially consisting in pharyngitis and other upper respiratory infections. Hypereosinophilia may occur, mainly with dupilumab, requiring investigation of systemic repercussions or vasculitis. Allergic reactions are uncommon but require careful monitoring during initial injections.
CONCLUSION
Biologics for severe asthma are recent drugs with a favorable safety profile, but with little real-life experience, justifying increased vigilance by prescribing physicians.
Topics: Humans; Asthma; Biological Products; Anti-Asthmatic Agents; Severity of Illness Index; Antibodies, Monoclonal, Humanized; Omalizumab; France
PubMed: 38653607
DOI: 10.1016/j.rmr.2024.04.001 -
The Journal of Allergy and Clinical... Jun 2024The recent approval of omalizumab for the treatment of IgE-mediated food allergy is an important step forward for the millions of food allergy patients in the United... (Review)
Review
The recent approval of omalizumab for the treatment of IgE-mediated food allergy is an important step forward for the millions of food allergy patients in the United States. Through the depletion of circulating IgE and the subsequent reduction of FcεR1 on key effector cells, patients increase their tolerance to food allergens. However, omalizumab does not permit patients to eat foods that they are allergic to with impunity. Rather, it protects them from most accidental exposures. In addition, omalizumab does not cure food allergy and has not demonstrated true immunomodulation. Thus, omalizumab might be a lifelong therapy for some patients. Furthermore, there are many important questions and issues surrounding the appropriate administration of omalizumab to treat food allergy, which we discuss. Managing treatment of patients with disease that falls outside the dosing range, assessing treatment response or nonresponse, addressing its appropriateness for patients older than 55, and determining whether immunotherapy plus omalizumab provides any advantage over omalizumab alone all need to be examined. Identifying appropriate patients for this therapy is critical given the cost of biologics. Indeed, not all food allergy patients are good candidates for this therapy. Also, when and how to stop omalizumab therapy in patients who may have outgrown their food allergy needs to be elucidated. Thus, although this therapy provides a good option for patients with food allergies, much information is needed to determine how best to use this therapy. Despite many unanswered questions and issues, we provide clinicians with some practical guidance on implementing this therapy in their patients.
Topics: Omalizumab; Humans; Food Hypersensitivity; Anti-Allergic Agents; Immunoglobulin E; Practice Guidelines as Topic
PubMed: 38599291
DOI: 10.1016/j.jaci.2024.03.019 -
Journal Der Deutschen Dermatologischen... May 2024
Review
Topics: Humans; Omalizumab; Angioedema; Anti-Allergic Agents; Treatment Outcome; Female; Middle Aged
PubMed: 38593341
DOI: 10.1111/ddg.15359 -
The Medical Letter on Drugs and... Apr 2024
Topics: Humans; Omalizumab; Asthma; Antibodies, Monoclonal; Food Hypersensitivity
PubMed: 38576144
DOI: 10.58347/tml.2024.1699b -
Journal of Evidence-based Medicine Jun 2024
Meta-Analysis
Topics: Omalizumab; Humans; Chronic Urticaria; Anti-Allergic Agents
PubMed: 38572834
DOI: 10.1111/jebm.12604 -
Current Opinion in Allergy and Clinical... Jun 2024The aim is to update the information currently available for the use of biologics in severe asthma in children, in order to facilitate their prescription as far as... (Review)
Review
PURPOSE OF REVIEW
The aim is to update the information currently available for the use of biologics in severe asthma in children, in order to facilitate their prescription as far as possible.
RECENT FINDINGS
The appearance of biologics for the treatment of severe asthma has meant a revolutionary change in the therapeutic approach to this disease. Currently, five biologics have been approved for severe asthma in children and/or adolescents by the regulatory agencies: omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab. But despite their positive results in terms of efficacy, there are still relevant points of debate that should induce caution when selecting the most appropriate biologic in a child with severe asthma. Indeed, safety is essential and, for several of the existing treatments, the availability of medium-term to long-term data in this regard is scarce.
SUMMARY
The use of biologics can facilitate the therapeutic paradigm shift from pleiotropic treatments to personalized medicine. However, the choice of the most appropriate biologics remains a pending issue. On the other hand, to the extent that several of the biologics have been available for a relatively short time, the most robust evidence in terms of efficacy and safety in children is that of omalizumab.
Topics: Humans; Asthma; Child; Anti-Asthmatic Agents; Biological Products; Adolescent; Omalizumab; Antibodies, Monoclonal, Humanized; Precision Medicine
PubMed: 38567842
DOI: 10.1097/ACI.0000000000000987 -
Journal of Drugs in Dermatology : JDD Apr 2024Individuals with chronic spontaneous urticaria (CSU) experience significant sleep disturbances and are at risk of anxiety and depression. (Meta-Analysis)
Meta-Analysis
Individuals with chronic spontaneous urticaria (CSU) experience significant sleep disturbances and are at risk of anxiety and depression.
Topics: Humans; Omalizumab; Chronic Urticaria; Anti-Allergic Agents; Chronic Disease; Urticaria; Treatment Outcome
PubMed: 38564395
DOI: 10.36849/JDD.7919 -
European Journal of Dermatology : EJD Feb 2024Chronic spontaneous urticaria (CSU) is a relatively common dermatological disorder characterized by sudden and unpredictable onset of pruritic wheals and/or angioedema,... (Review)
Review
Chronic spontaneous urticaria (CSU) is a relatively common dermatological disorder characterized by sudden and unpredictable onset of pruritic wheals and/or angioedema, for more than six weeks. It is a mast cell-mediated histaminergic disorder, considerably worsening patients' quality of life. Current treatment options include anti-histamines, omalizumab and cyclosporine, in a step-wise algorithmic approach, aimed at complete symptom control. Patients do not respond uniformly to these therapeutic options due to phenotypic and endotypic heterogeneity, and often remain uncontrolled/poorly controlled. Recent research is focused on identifying certain biomarkers to predict therapeutic response and facilitate patient-targeted personalized treatment, for maximum benefit. The current article summarizes various biomarkers explored to date, and also elaborates their role in predicting therapeutic response to anti-histamines, omalizumab and cyclosporine, in CSU patients. High disease activity, elevated CRP/ESR and elevated D-dimer are the most important predictors of non/poor-response to antihistamines. Low and very low baseline IgE, elevated CRP/ESR, ASST+, BAT/BHRA+, basopenia, eosinopenia, and elevated D-dimer are predictors of poor and good response to omalizumab and cyclosporine, respectively. Additionally, normal or slightly elevated baseline IgE and FceR1 overexpression are predictors of a faster response with omalizumab. However, none of these predictors have so far been completely validated and are not yet recommended for routine use. Thus, large-scale prospective studies are needed to confirm these predictive biomarkers and identify new ones to achieve the goal of personalized medicine for CSU.
Topics: Humans; Omalizumab; Quality of Life; Chronic Disease; Chronic Urticaria; Urticaria; Histamine Antagonists; Biomarkers; Cyclosporine; Immunoglobulin E; Anti-Allergic Agents; Treatment Outcome
PubMed: 38557452
DOI: 10.1684/ejd.2024.4600 -
Current Opinion in Allergy and Clinical... Jun 2024This review aims to explore role of emerging biologics, including ligelizumab, UB-221, dupilumab, and antialarmins, in food allergy management. With a focus on recent... (Review)
Review
PURPOSE OF REVIEW
This review aims to explore role of emerging biologics, including ligelizumab, UB-221, dupilumab, and antialarmins, in food allergy management. With a focus on recent developments, we evaluate their promise in mitigating adverse events during oral immunotherapy (OIT), reducing allergic reactions, and addressing the limitations of current therapeutic options.
RECENT FINDINGS
Antiimmunoglobulin E mAbs, exemplified by omalizumab, demonstrate efficacy in desensitization and safety improvement during multiallergen OIT. Next-generation antibodies like ligelizumab and UB-221 exhibit enhanced potency and unique mechanisms, holding promise for food allergy treatment. Dupilumab, targeting IL-4 receptor alpha, presents potential benefits in decreasing allergen-specific IgE and modifying the atopic march. Exploration of antialarmins, specifically anti-IL-33 (etokimab) and anti-TSLP (tezepelumab), reveals encouraging results, with etokimab showing early success in peanut allergy trials.
SUMMARY
Biologics hold promising potential for food allergy treatment. Tailoring therapeutic approaches based on shared decision-making becomes pivotal. While omalizumab remains a significant option, next-generation anti-IgE antibodies and agents targeting alarmins exhibit unique strengths. Dupilumab, despite limited success as monotherapy, shows promise as an adjunct for OIT. Careful consideration of treatment goals, patient preferences, and the evolving landscape of biologics will shape future clinical practice, offering allergists an expanded toolbox for personalized food allergy management.
Topics: Humans; Food Hypersensitivity; Biological Products; Desensitization, Immunologic; Animals; Anti-Allergic Agents; Immunoglobulin E; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Allergens; Omalizumab
PubMed: 38547423
DOI: 10.1097/ACI.0000000000000981 -
Medicina (Kaunas, Lithuania) Mar 2024: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms,...
: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. : We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund-Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. The overall median (min-max) age was 43 (21-69) years. The median (min-max) of biologic therapy duration was 35 (4-113) months for omalizumab and 13.5 (6-32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0-4] ( < 0.001), but not with mepolizumab [95% CI: -0.5-2] ( = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2-3] ( < 0.001) and [95% CI: 2-5] ( < 0.001); and mepolizumab [95% CI: 0-2] ( = 0.002) and [95% CI: 2-8.5] ( < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.
Topics: Adult; Aged; Humans; Middle Aged; Asthma; Chronic Disease; Nasal Polyps; Omalizumab; Retrospective Studies; Rhinosinusitis; Sinusitis; Turkey; Male; Female; Young Adult
PubMed: 38541174
DOI: 10.3390/medicina60030448