Patients with atopic dermatitis (AD) may discontinue dupilumab owing to dupilumab-induced ocular adverse events (DOAEs) or dupilumab-induced facial redness (DFR).
Objective
To evaluate DOAE and DFR outcomes after switching to tralokinumab or Janus kinase inhibitor (JAKi).
Methods
This retrospective study included 106 patients discontinuing dupilumab because of DOAEs and/or DFR. The primary outcome was the proportion of patients with resolution of adverse events or improvement between dupilumab discontinuation (M0) and 3 to 6 months of tralokinumab or JAKi (M3-M6) treatment; the secondary outcome was the percentage of patients with controlled AD defined by Investigator’s Global Assessment scores of 0/1 at M3 to M6.
Results
Proportions of patients with DOAE (92% vs 72%; P = .0244) and DFR (85% vs 33%; P = .0006) resolution or improvement were higher with JAKi than with tralokinumab. Proportions of patients reaching an Investigator’s Global Assessment score of 0/1 increased from M0-M3 through M6 (22% vs 42%; P = .0067) in the JAKi group and remained similar (32% vs 35%) in the tralokinumab group. However, 57% discontinued the new treatment after 8 months on average, mainly owing to lack of efficacy.
Conclusions
Janus kinase inhibitor appears to be more efficient than tralokinumab in managing dupilumab-induced AE; however, both strategies may fail to control AD.
背景：特应性皮炎（AD）患者可能会因杜必鲁单抗诱发的眼部不良事件（DOAEs）或杜必鲁单抗诱发的面部发红（DFR）而停止使用杜必鲁单抗：评估改用曲妥珠单抗或Janus激酶抑制剂（JAKi）后的DOAE和DFR结果：这项回顾性研究纳入了106例因DOAE和/或DFR而停用dupilumab的患者。主要结果是停用杜匹鲁单抗（M0）至曲妥珠单抗或JAKi治疗3-6个月（M3-M6）期间AE缓解或改善的患者比例；次要结果是M3-M6期间研究者总体评估（IGA）评分为0/1的AD受控患者比例：接受JAKi治疗的患者中，DOAE（92% vs 72%；p=0.0244）和DFR（85% vs 33%；p=0.0006）缓解或改善的比例高于曲妥珠单抗。在JAKi组，从M0到M3-M6达到IGA评分0/1的患者比例增加（22% vs. 42%，p=0.0067），而在曲妥珠单抗组则保持相似（32% vs. 35%）。然而，平均有57%的患者在8个月后停止了新疗法，主要原因是疗效不佳：结论：在控制杜匹单抗引起的AE方面，JAKi似乎比曲妥珠单抗更有效；但这两种策略都可能无法控制AD。
{"title":"Switching From Dupilumab to Tralokinumab or Janus Kinase Inhibitors in Cases of Ocular and/or Facial Adverse Events in Patients With Atopic Dermatitis: A Multicenter Retrospective Study","authors":"Alexandre Beyrouti MD , Juliette Deuze , Eric Fontas MD, PhD , Aurore Foureau MS , Sébastien Barbarot MD, PhD , Hélène Aubert MD , Claire Bernier MD , Marie Le Moigne MD , Thierry Passeron MD, PhD , Feriel Boukari MD , Margaux Garnier MD , Marie Jachiet MD , Florence Tetart MD , Julien Seneschal MD, PhD , Clémentine Toussaint MD , Emmanuel Mahé MD , Camille Leleu MD , Marie Masson Regnault MD , Justine Pasteur MD , Audrey Nosbaum MD, PhD , Thomas Hubiche MD","doi":"10.1016/j.jaip.2024.12.001","DOIUrl":"10.1016/j.jaip.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atopic dermatitis (AD) may discontinue dupilumab owing to dupilumab-induced ocular adverse events (DOAEs) or dupilumab-induced facial redness (DFR).</div></div><div><h3>Objective</h3><div>To evaluate DOAE and DFR outcomes after switching to tralokinumab or Janus kinase inhibitor (JAKi).</div></div><div><h3>Methods</h3><div>This retrospective study included 106 patients discontinuing dupilumab because of DOAEs and/or DFR. The primary outcome was the proportion of patients with resolution of adverse events or improvement between dupilumab discontinuation (M0) and 3 to 6 months of tralokinumab or JAKi (M3-M6) treatment; the secondary outcome was the percentage of patients with controlled AD defined by Investigator’s Global Assessment scores of 0/1 at M3 to M6.</div></div><div><h3>Results</h3><div>Proportions of patients with DOAE (92% vs 72%; <em>P</em> = .0244) and DFR (85% vs 33%; <em>P</em> = .0006) resolution or improvement were higher with JAKi than with tralokinumab. Proportions of patients reaching an Investigator’s Global Assessment score of 0/1 increased from M0-M3 through M6 (22% vs 42%; <em>P</em> = .0067) in the JAKi group and remained similar (32% vs 35%) in the tralokinumab group. However, 57% discontinued the new treatment after 8 months on average, mainly owing to lack of efficacy.</div></div><div><h3>Conclusions</h3><div>Janus kinase inhibitor appears to be more efficient than tralokinumab in managing dupilumab-induced AE; however, both strategies may fail to control AD.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages 353-360"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2024.10.013
Youxin Puan MBBS, MRCP (UK) , Kheng Yong Ong PharmD , Pei Yee Tiew MBBS, PhD , Gabriel Xu Wen Chen MBBS, MRCP (UK), MMed (Int Med) , Neville Wei Yang Teo MBBS, MRCS (Glasgow), MMed (ORL) , Andrea Hsiu Ling Low BmedSci (UK), MBBS (UK), MRCP (UK), FAMS (Rheumatology), MCI , Michael E. Wechsler MD , Mariko Siyue Koh MBBS, MRCP
Background
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of antineutrophil cytoplasm antibody (ANCA)-associated vasculitis associated with varying clinical presentations and overlapping multiorgan involvement. Asthma is a predominant feature of EGPA, typically in its prodromal phase, often severe, and precedes vasculitic complications. However, there is paucity of studies describing the prevalence and characteristics of EGPA in the asthma population.
Objective
To describe the clinical and serological characteristics and longitudinal therapeutic outcomes of patients with EGPA in the severe asthma (SA) cohort.
Methods
A retrospective study of patients with EGPA attending the multidisciplinary SA clinic in a tertiary hospital from 2011 to 2023 was conducted. Baseline demographics, organ manifestations, biological markers, lung function, and therapeutic outcomes were assessed.
Results
Twenty-three of 596 patients in the SA registry were identified to have EGPA. Median time interval between asthma and EGPA diagnosis was 10 years (range, 2.5-32 years). Almost all patients (95.7%) had peak blood eosinophil count of more than 1.0 × 109/L (range, 0.47-14.08 × 109/L). Upper airway involvement was the most detected manifestation in addition to asthma, followed by neuropathy and renal involvement. Patients who were treated with biologic therapy were significantly younger and had more upper airway, renal, and pulmonary involvement and lower Five Factor Score.
Conclusions
The prevalence of EGPA in the SA population was 3.9% in our cohort. Its diagnosis requires high clinical suspicion in patients with SA and blood eosinophilia, prompting stringent evaluation for extrapulmonary manifestations and multidisciplinary involvement.
{"title":"Characteristics of Severe Asthma Clinic Patients With Eosinophilic Granulomatosis With Polyangiitis","authors":"Youxin Puan MBBS, MRCP (UK) , Kheng Yong Ong PharmD , Pei Yee Tiew MBBS, PhD , Gabriel Xu Wen Chen MBBS, MRCP (UK), MMed (Int Med) , Neville Wei Yang Teo MBBS, MRCS (Glasgow), MMed (ORL) , Andrea Hsiu Ling Low BmedSci (UK), MBBS (UK), MRCP (UK), FAMS (Rheumatology), MCI , Michael E. Wechsler MD , Mariko Siyue Koh MBBS, MRCP","doi":"10.1016/j.jaip.2024.10.013","DOIUrl":"10.1016/j.jaip.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of antineutrophil cytoplasm antibody (ANCA)-associated vasculitis associated with varying clinical presentations and overlapping multiorgan involvement. Asthma is a predominant feature of EGPA, typically in its prodromal phase, often severe, and precedes vasculitic complications. However, there is paucity of studies describing the prevalence and characteristics of EGPA in the asthma population.</div></div><div><h3>Objective</h3><div>To describe the clinical and serological characteristics and longitudinal therapeutic outcomes of patients with EGPA in the severe asthma (SA) cohort.</div></div><div><h3>Methods</h3><div>A retrospective study of patients with EGPA attending the multidisciplinary SA clinic in a tertiary hospital from 2011 to 2023 was conducted. Baseline demographics, organ manifestations, biological markers, lung function, and therapeutic outcomes were assessed.</div></div><div><h3>Results</h3><div>Twenty-three of 596 patients in the SA registry were identified to have EGPA. Median time interval between asthma and EGPA diagnosis was 10 years (range, 2.5-32 years). Almost all patients (95.7%) had peak blood eosinophil count of more than 1.0 × 10<sup>9</sup>/L (range, 0.47-14.08 × 10<sup>9</sup>/L). Upper airway involvement was the most detected manifestation in addition to asthma, followed by neuropathy and renal involvement. Patients who were treated with biologic therapy were significantly younger and had more upper airway, renal, and pulmonary involvement and lower Five Factor Score.</div></div><div><h3>Conclusions</h3><div>The prevalence of EGPA in the SA population was 3.9% in our cohort. Its diagnosis requires high clinical suspicion in patients with SA and blood eosinophilia, prompting stringent evaluation for extrapulmonary manifestations and multidisciplinary involvement.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages 361-368.e2"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/S2213-2198(25)00015-7
{"title":"Continuing Medical Education Calendar","authors":"","doi":"10.1016/S2213-2198(25)00015-7","DOIUrl":"10.1016/S2213-2198(25)00015-7","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages A29-A30"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143319260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2024.11.001
Sara Anvari MD, MS , Ankona Banerjee MS , Stephanie Leonard MD , Purificacion Gonzalez-Delgado MD, PhD , Duc T. Nguyen MD, PhD , Anna Nowak-Wegrzyn MD, PhD
{"title":"Assessing protocol variability for food protein–induced enterocolitis syndrome oral food challenges","authors":"Sara Anvari MD, MS , Ankona Banerjee MS , Stephanie Leonard MD , Purificacion Gonzalez-Delgado MD, PhD , Duc T. Nguyen MD, PhD , Anna Nowak-Wegrzyn MD, PhD","doi":"10.1016/j.jaip.2024.11.001","DOIUrl":"10.1016/j.jaip.2024.11.001","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages 437-439.e2"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2024.11.023
Jinyu Gu BMed , Tongxin Li MSc , Yishan Ding BMed , Chun Chang MD , Siyuan Yin BMed , Yan Wang MD, PhD
{"title":"Reply to “Exploring the link between asthma onset in pregnancy and adverse perinatal events”","authors":"Jinyu Gu BMed , Tongxin Li MSc , Yishan Ding BMed , Chun Chang MD , Siyuan Yin BMed , Yan Wang MD, PhD","doi":"10.1016/j.jaip.2024.11.023","DOIUrl":"10.1016/j.jaip.2024.11.023","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Page 448"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143319505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2025.01.004
{"title":"Two Patients With Angioedema and Persistent Lower Extremity Swelling","authors":"","doi":"10.1016/j.jaip.2025.01.004","DOIUrl":"10.1016/j.jaip.2025.01.004","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Page 446"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143319506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Resolution rates of IgE-mediated cow’s milk allergy (IgE-CMA) by age 5 years and risk factors for its persistence were previously described.
Objective
To extend follow-up until the end of adolescence.
Methods
This is an extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 years, and their history was reviewed. Resolution was determined by regular milk consumption without adverse reactions or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% positive predictive value (PPV) to milk. Risk factors for persistence at age 17 years were examined in the entire cohort.
Results
Of the 23 patients followed, 8 (35%) had spontaneous resolution and 15 had persistent IgE-CMA. Overall, 39 of the 54 patients (72.2%) initially diagnosed with IgE-CMA had spontaneous resolution by age 17 years. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at the time of diagnosis (P = .03), no cow’s milk formula feeding in the nursery (P = .008), and wheezing on diagnostic OFC/initial reaction to milk (P = .04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (P = .045) or anaphylaxis (P = .02) on diagnostic OFC/initial reaction and more current asthma (P = .007).
Conclusions
Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 years, and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of patients with IgE-CMA.
{"title":"Long-Term Outcome of IgE-Mediated Cow’s Milk Allergy and Risk Factors for Persistence","authors":"Liat Nachshon MD , Michael R. Goldberg MD, PhD , Naama Epstein-Rigbi MD , Yitzhak Katz MD , Arnon Elizur MD","doi":"10.1016/j.jaip.2024.10.026","DOIUrl":"10.1016/j.jaip.2024.10.026","url":null,"abstract":"<div><h3>Background</h3><div>Resolution rates of IgE-mediated cow’s milk allergy (IgE-CMA) by age 5 years and risk factors for its persistence were previously described.</div></div><div><h3>Objective</h3><div>To extend follow-up until the end of adolescence.</div></div><div><h3>Methods</h3><div>This is an extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 years, and their history was reviewed. Resolution was determined by regular milk consumption without adverse reactions or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% positive predictive value (PPV) to milk. Risk factors for persistence at age 17 years were examined in the entire cohort.</div></div><div><h3>Results</h3><div>Of the 23 patients followed, 8 (35%) had spontaneous resolution and 15 had persistent IgE-CMA. Overall, 39 of the 54 patients (72.2%) initially diagnosed with IgE-CMA had spontaneous resolution by age 17 years. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at the time of diagnosis (<em>P</em> = .03), no cow’s milk formula feeding in the nursery (<em>P</em> = .008), and wheezing on diagnostic OFC/initial reaction to milk (<em>P</em> = .04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (<em>P</em> = .045) or anaphylaxis (<em>P</em> = .02) on diagnostic OFC/initial reaction and more current asthma (<em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 years, and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of patients with IgE-CMA.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages 369-377.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2025.01.024
Leonie Biener, Slagjana Stoshikj, Jonas Brugger, Christoph Krall, Roland Buhl, Eckard Hamelmann, Stephanie Korn, Christian Taube, Katrin Milger-Kneidinger, Christian Schulz, Hendrik Suhling, Margret Jandl, Rainer Ehmann, Olaf Schmidt, Marco Idzko, Dirk Skowasch
Background: Asthma patients with >10 pack-years are frequently excluded from asthma trials. Little is known about how smoking affects their characteristics, and therefore may impact treatment choices.
Objective: To evaluate the impact of cumulative smoking history on severe asthma patients' characteristics METHODS: We analysed pulmonary function tests, asthma control, exacerbation rate and biomarkers. We compared active and ex-smokers (=ever-smokers) vs. never-smokers and performed linear models for three groups stratified by smoking history (<10 pack-years (py), 10-20 py, >20 py). Data was obtained from the severe asthma registry German Asthma Net (GAN).
Results: We included 2.478 patients: 65 (2.6%) active smokers, 1.005 (40.6%) ex-smokers and 1.408 (56.8%) never-smokers. Of the 1070 ever-smokers, 529 patients (21.3%) had <10 py, 304 (12.3%) 10-20 py and 237 (9.6%) >20 py. Cumulative smoking history was associated with worse asthma control (>20 py: ACT -1.76 [-2.76; -0.77] points (p <.001); mini-AQLQ -0.31 [-0.53; -0.10] points (p=0.004)), while exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (p=.13 and p=1.0). Cumulative smoking history was associated with smoking-related lung injury e.g. DLCO (-0.37 mmol/min/kPa for 10-20 py (p=.014) respectively -0.92 for >20 py (p<.001)), but FEV1 and FEV1-reversibility were similar. Cumulative smoking history was furthermore associated 0.84- [0.73; 0.97] fold lower FeNO concentrations (p=.007) while blood eosinophil count and IgE-levels were comparable (BEC p=1.0, IgE p=.49) CONCLUSION: Cumulative smoking history in asthma patients is associated with worse disease control, lower FeNO levels and smoking-related lung-injuries. Despite these differences, key asthma characteristics like BEC, IgE, OCS dose and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.
{"title":"The impact of smoking history on baseline characteristic in patients with severe asthma in the German Asthma Net (GAN).","authors":"Leonie Biener, Slagjana Stoshikj, Jonas Brugger, Christoph Krall, Roland Buhl, Eckard Hamelmann, Stephanie Korn, Christian Taube, Katrin Milger-Kneidinger, Christian Schulz, Hendrik Suhling, Margret Jandl, Rainer Ehmann, Olaf Schmidt, Marco Idzko, Dirk Skowasch","doi":"10.1016/j.jaip.2025.01.024","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.01.024","url":null,"abstract":"<p><strong>Background: </strong>Asthma patients with >10 pack-years are frequently excluded from asthma trials. Little is known about how smoking affects their characteristics, and therefore may impact treatment choices.</p><p><strong>Objective: </strong>To evaluate the impact of cumulative smoking history on severe asthma patients' characteristics METHODS: We analysed pulmonary function tests, asthma control, exacerbation rate and biomarkers. We compared active and ex-smokers (=ever-smokers) vs. never-smokers and performed linear models for three groups stratified by smoking history (<10 pack-years (py), 10-20 py, >20 py). Data was obtained from the severe asthma registry German Asthma Net (GAN).</p><p><strong>Results: </strong>We included 2.478 patients: 65 (2.6%) active smokers, 1.005 (40.6%) ex-smokers and 1.408 (56.8%) never-smokers. Of the 1070 ever-smokers, 529 patients (21.3%) had <10 py, 304 (12.3%) 10-20 py and 237 (9.6%) >20 py. Cumulative smoking history was associated with worse asthma control (>20 py: ACT -1.76 [-2.76; -0.77] points (p <.001); mini-AQLQ -0.31 [-0.53; -0.10] points (p=0.004)), while exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (p=.13 and p=1.0). Cumulative smoking history was associated with smoking-related lung injury e.g. DLCO (-0.37 mmol/min/kPa for 10-20 py (p=.014) respectively -0.92 for >20 py (p<.001)), but FEV1 and FEV1-reversibility were similar. Cumulative smoking history was furthermore associated 0.84- [0.73; 0.97] fold lower FeNO concentrations (p=.007) while blood eosinophil count and IgE-levels were comparable (BEC p=1.0, IgE p=.49) CONCLUSION: Cumulative smoking history in asthma patients is associated with worse disease control, lower FeNO levels and smoking-related lung-injuries. Despite these differences, key asthma characteristics like BEC, IgE, OCS dose and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jaip.2024.10.016
Junhyuk Chang PharmD , Hyun-Seob Jeon MD , Chungsoo Kim PharmD , ChulHyoung Park MD , Jae-Hyuk Jang MD , Youngsoo Lee MD , Eunyoung Lee MS , Rae Woong Park MD, PhD , Hae-Sim Park MD, PhD
Background
Inhaled corticosteroid (ICS) and oral corticosteroid (OCS) are often used in asthma management.
Objective
To evaluate the long-term effect of ICS/OCS on osteoporosis, osteopenia, fractures, and bone metabolism in adult patients with asthma in real-world clinical practice.
Methods
This is a retrospective study investigating deidentified electronic health records from Ajou University Medical Center (Korea). Adult patients with asthma receiving maintenance ICS with/without OCS for at least 1 year were enrolled. They were classified into the high/low-dose of ICS or OCS group. Primary outcomes (incidences of osteoporosis, osteopenia, and fractures) and secondary outcomes (drug prescription and laboratory values related to bone metabolism including albumin and alkaline phosphatase) were compared after 5 years of follow-up.
Results
After propensity score matching, both high- and low-dose OCS groups included 468 patients, and high/low-dose ICS groups each comprised 1252 patients. The risk of osteoporosis/major fracture was higher (hazard ratio [95% CI], 2.00 [1.15-3.57]/3.03 [1.04-11.11]) in the high-dose OCS group (especially in females aged ≥50 years) than in the low-dose group, although the ICS groups showed no significant differences. The high-dose ICS group showed a higher risk of osteopenia (1.92 [1.05-3.70]) than the low-dose ICS group. The linear mixed model of laboratory values showed significantly decreased serum albumin and increased alkaline phosphatase in the high-dose OCS group than in the low-dose OCS group.
Conclusions
The results of this study suggest that long-term use of OCS can increase the risk of osteoporosis and osteoporosis-related fractures, whereas long-term use of ICS may increase the risk of osteopenia in adult patients with asthma.
{"title":"Adverse Impacts of Corticosteroid Treatment on Osteoporosis/Osteopenia in Adult Asthmatics: A Retrospective ICARUS Cohort Study","authors":"Junhyuk Chang PharmD , Hyun-Seob Jeon MD , Chungsoo Kim PharmD , ChulHyoung Park MD , Jae-Hyuk Jang MD , Youngsoo Lee MD , Eunyoung Lee MS , Rae Woong Park MD, PhD , Hae-Sim Park MD, PhD","doi":"10.1016/j.jaip.2024.10.016","DOIUrl":"10.1016/j.jaip.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Inhaled corticosteroid (ICS) and oral corticosteroid (OCS) are often used in asthma management.</div></div><div><h3>Objective</h3><div>To evaluate the long-term effect of ICS/OCS on osteoporosis, osteopenia, fractures, and bone metabolism in adult patients with asthma in real-world clinical practice.</div></div><div><h3>Methods</h3><div>This is a retrospective study investigating deidentified electronic health records from Ajou University Medical Center (Korea). Adult patients with asthma receiving maintenance ICS with/without OCS for at least 1 year were enrolled. They were classified into the high/low-dose of ICS or OCS group. Primary outcomes (incidences of osteoporosis, osteopenia, and fractures) and secondary outcomes (drug prescription and laboratory values related to bone metabolism including albumin and alkaline phosphatase) were compared after 5 years of follow-up.</div></div><div><h3>Results</h3><div>After propensity score matching, both high- and low-dose OCS groups included 468 patients, and high/low-dose ICS groups each comprised 1252 patients. The risk of osteoporosis/major fracture was higher (hazard ratio [95% CI], 2.00 [1.15-3.57]/3.03 [1.04-11.11]) in the high-dose OCS group (especially in females aged ≥50 years) than in the low-dose group, although the ICS groups showed no significant differences. The high-dose ICS group showed a higher risk of osteopenia (1.92 [1.05-3.70]) than the low-dose ICS group. The linear mixed model of laboratory values showed significantly decreased serum albumin and increased alkaline phosphatase in the high-dose OCS group than in the low-dose OCS group.</div></div><div><h3>Conclusions</h3><div>The results of this study suggest that long-term use of OCS can increase the risk of osteoporosis and osteoporosis-related fractures, whereas long-term use of ICS may increase the risk of osteopenia in adult patients with asthma.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 2","pages":"Pages 310-319"},"PeriodicalIF":8.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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