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Anti-IL5 Remedies In contrast in Sufferers With Extreme Eosinophilic Bronchial asthma

 

September 11, 2018

All 3 treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control in all blood eosinophil subgroups

All 3 treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control in all blood eosinophil subgroups

In patients with severe asthma, mepolizumab significantly reduced clinically significant exacerbations and improved asthma control across all eosinophil levels compared with benralizumab and reslizumab. Findings from this indirect treatment comparison were published in The Journal of Allergy and Clinical Immunology.

Currently, 3 anti-interleukin (IL)5 pathway-directed treatments (benralizumab, mepolizumab, reslizumab) have been approved by the Food and Drug Administration for the treatment of severe asthma with an eosinophilic phenotype. For this study, researchers used a recent Cochrane review on anti-IL5 treatments as well as additional studies involving patients ≥12 years with severe asthma treated with anti-IL5 therapy. “Only licensed doses used in clinical practice were included and patients were matched according to blood eosinophil counts and asthma control scores. This approach ensured a robust comparison, which will help inform doctors when making clinical decisions about treating their patients,” said lead author Dr William Busse, Professor of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Department at the University of Wisconsin Medical School in Madison, Wisconsin.

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Results showed that compared with placebo, all 3 treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control in all blood eosinophil subgroups.

Compared with benralizumab, mepolizumab reduced clinically significant exacerbations by 34-45% across blood eosinophil subgroups (all P<.05):

  • ≥400 cells/µL: rate ratio (RR) 0.55 (95% CI, 0.35, 0.87)
  • ≥300 cells/µL: RR 0.61 (95% CI, 0.37, 0.99)
  • ≥150 cells/µL: RR 0.66 (95% CI, 0.49, 0.89)

Moreover, compared with reslizumab, mepolizumab reduced clinically significant exacerbations by 45% in the ≥400cells/µL subgroup (P<.007).

With regard to asthma control, mepolizumab was associated with significantly greater improvements in change from baseline in the Asthma Control Questionnaire score vs benralizumab and reslizumab. No significant differences were noted between the 3 agents with regard to lung function or reductions in exacerbations requiring emergency department visit/hospitalization.

“In the absence of head-to-head comparisons, this indirect treatment comparison provides clinically relevant, comparative information on the efficacy of licensed formulations of the 3 approved anti-IL5 pathway therapies in [severe eosinophilic asthma] by baseline blood eosinophil count,” write the authors.

For more information visit jacionline.org.

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Tezepelumab Will get Breakthrough Remedy Designation for Extreme Bronchial asthma

 
Tezepelumab is a potential first-in-class medication that works by blocking thymic stromal lymphopoietin

Tezepelumab is a potential first-in-class medication that works by blocking thymic stromal lymphopoietin

Amgen and AstraZeneca announced that the Food and Drug Administration (FDA) has granted Breakthrough Therapy Designation for tezepelumab in patients with severe asthma without an eosinophilic phenotype. 

Tezepelumab is a potential first-in-class medication that works by blocking thymic stromal lymphopoietin (TSLP), an epithelial cytokine that is involved in the initiation and persistence of airway inflammation. Inhibition of TSLP is thought to prevent the release of pro-inflammatory cytokines by immune cells resulting in the prevention of asthma exacerbations and improved asthma control. Biologic therapies currently on the market only target type 2 driven inflammation.  

The designation was based on data from the Phase 2b PATHWAY trial that evaluated 3 doses of tezepelumab as add-on therapy in patients with a history of asthma exacerbations and uncontrolled asthma receiving inhaled corticosteroids/long-acting β-agonist with or without oral corticosteroids and additional asthma controllers vs placebo.  

Data showed that treatment with tezepelumab led to significant reductions (62% [70mg every 4 weeks], 71% [210mg every 4 weeks], and 66% [280mg every 2 weeks]) in the annual asthma exacerbation rate vs placebo (P <.001 for all) in patients with severe asthma. This effect was seen regardless of baseline blood eosinophil count or other type 2 inflammatory biomarkers. Asthma-related effects, nasopharyngitis, headaches, and bronchitis were the most common adverse events associated with tezepelumab.

Tezepelumab is being investigated in the Phase 3 PATHFINDER clinical program, which includes planned mechanistic and long-term safety trials.