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Medical Journal Review

June 2022

WAO Reviews – Editors' Choice

The WAO Reviews editors, Juan Carlos Ivancevich, MD, and John J. Oppenheimer, MD - FACAAI - FAAAAI, select articles on a monthly basis for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases.

Systemic immunomodulatory treatments for atopic dermatitis: Update of a living systematic review and network meta-analysis
Drucker AM, Morra DE, Prieto-Merino D et al.
JAMA Dermatology 2022;158(5):532-532 (16 March)

The purpose of the manuscript was to evaluate the comparative efficacy and assessments of safety in clinical trials of systemic treatments for atopic dermatitis through use of a network meta-analysis. The authors found that overall, abrocitinib (200 mg) and upadacitinib (30 mg daily) were associated with slightly better scores than dupilumab; and upadacitinib (15 mg daily) was associated with similar scores to dupilumab. Abrocitinib (100 mg daily), baricitinib (4 mg and 2 mg daily), and tralokinumab (300 mg) every 2 weeks were associated with slightly worse scores.

Personalized treatment of asthma: The importance of sex and gender differences
Jenkins CR, Boulet LP, Lavoie K et al
JACI: In Practice 2022;10(4):963-971.e3 (8 February)

In this commentary, the authors explore the impact of an individual’s sex and gender influence on the clinical course of asthma in several ways. It is well known that more boys than girls have asthma, but after puberty, more women than men have asthma. The authors point out that despite the widely reported sex- and gender-based differences in asthma and asthma management, these issues are rarely considered by health care professionals. This review details the impact an individual’s sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.

Common exacerbation-prone phenotypes across asthma and chronic obstructive pulmonary disease (COPD)
Hyodo K, Masuko H, Oshimo H et al
PLoS One 2022;17(3):e0264397 (21 March)

It is well known that chronic inflammatory airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are complex syndromes with diverse clinical symptoms due to multiple pathophysiological conditions. In this study, using common and shared risk factors for the exacerbation of asthma and COPD, the authors attempted to clarify the exacerbation-prone phenotypes beyond disease labels. This included investigating the role of the IL4RA gene polymorphism, which is related to type 2 inflammation, in these exacerbation-prone phenotypes. To do so, they examined a study population comprised of patients with asthma (n = 117), asthma-COPD overlap (ACO; n = 37) or COPD (n = 48), and a history of exacerbation within the previous year utilizing analyses. Two-step cluster analyses identified five clusters. Cluster 1 was characterized by high eosinophil counts, cluster 2 was characterized by smokers with impaired lung function, cluster 3 was characterized by the presence of gastroesophageal reflux, cluster 4 was characterized by non-allergic females, and cluster 5 was characterized by allergic rhinitis and elevated total IgE levels. A significant association with rs8832 was observed for cluster 5 (odds ratio, 3.88 (1.34–11.26), p = 0.013) and also for the type 2 exacerbation-prone phenotypes (clusters 1 and 5: odds ratio, 2.73 (1.45–5.15), p = 1.9 × 10−3. Overall, these data indicate that the clinical heterogeneity of disease exacerbation may reflect the presence of common exacerbation-prone endotypes across asthma and COPD, and may support the use of the treatable traits approach for the treatment of exacerbations of chronic inflammatory airway diseases.

Development of the cold urticaria activity score
Ahsan DM, Altrichter S, Gutsche A et al
Allergy 2022; Published online ahead of print (11 April)

In this study, the authors share the development of the  ColdUAS , which is the first disease-specific PROM to assess ColdU disease activity. The ColdUAS, a self-administered questionnaire for the prospective assessment of disease activity in patients with ColdU, consists of 4 items: 1. the frequency and severity of the signs (wheals and/or angioedema), 2. the frequency and severity of the symptoms (e.g., itch and burn), 3. the exposure to specific triggers, and 4. the avoidance of these triggers. The recall period for each item is the last 24 h. The authors hope that through the use of this tool we can better assess patients' disease status in routine clinical practice as well as in clinical trials.

Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis:
A systematic review and network meta-analysis

Journal of Allergy and Clinical Immunology 2022;149(4):1286-1295 (17 September 2021)

In this very interesting report by Oykhman and colleagues, the authors compared the relative efficacy of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP through use of a network meta-analysis of sinusitis symptoms, heath-related quality of life, rescue oral corticosteroids and surgery, endoscopic and radiologic scores, and adverse events, utilizing the GRADE approach. They identified 29 randomized controlled trials evaluating 8 treatments (n =3461) which were included in their analysis, finding a moderate-to-high certainty evidence that health-related quality of life (SNOT-22) improved with dupilumab (mean difference [MD] -19.91 [95% confidence interval (CI) -22.50, -17.32]), omalizumab (MD -16.09 [95% CI -19.88, -12.30]), mepolizumab (MD -12.89 [95% CI -16.58, -9.19], ASA-D (MD -10.61 [95% CI -14.51, -6.71]), and benralizumab (MD -7.68 [95% CI -12.09, -3.27]). The risk of rescue nasal polyp surgery decreased with dupilumab (risk difference [RD] -16.35% [95% CI -18.13, -13.48]), omalizumab (RD -7.40% [95% CI -11.04, -2.43]), mepolizumab (RD -12.33% [95% CI -15.56, 27.22]), and ASA-D (RD -16.00% [95% CI -19.79, 0.21]; all moderate certainty). Overall, they found with moderate to high certainty that dupilumab ranks among the most beneficial for 7 of 7 outcomes, omalizumab for 2 of 7, mepolizumab for 1 of 7, and ASA-D for 1 of 7.

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