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  1. Article: Eosinophilic granulomatosis with polyangiitis: case report and literature review.

    Alam, Vardah / Nanzer, Alexandra M

    Breathe (Sheffield, England)

    2022  Volume 18, Issue 4, Page(s) 220170

    Abstract: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, is a multisystem disorder characterised by asthma, blood and tissue eosinophilia and small-vessel vasculitis. Eosinophilic tissue infiltration and ... ...

    Abstract Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, is a multisystem disorder characterised by asthma, blood and tissue eosinophilia and small-vessel vasculitis. Eosinophilic tissue infiltration and extravascular granuloma formation can lead to damage in any organ, but it is classically seen to cause pulmonary infiltrates, sino-nasal disease, peripheral neuropathy, renal and cardiac involvement, and rashes. EGPA is part of the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis syndromes, with the antibody being detected in ∼30-40% of cases and mostly against myeloperoxidase. Two genetically and clinically distinct phenotypes, defined by the presence or absence of ANCA have been identified. Treatment for EGPA focuses on inducing and maintaining disease remission. To date, oral corticosteroids remain first-line agents whilst second-line treatments include immunosuppressants such as cyclophosphamide, azathioprine, methotrexate, rituximab and mycophenolate mofetil. However, long-term steroid usage results in multiple and well-known adverse health effects and new insights into the pathophysiology of EGPA have allowed for the development of targeted biologic therapies, like the anti-eosinophilic, anti-interleukin-5 monoclonal antibodies.
    Language English
    Publishing date 2022-12-13
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2562899-9
    ISSN 2073-4735 ; 1810-6838
    ISSN (online) 2073-4735
    ISSN 1810-6838
    DOI 10.1183/20734735.0170-2022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Transitioning Asthma Care From Adolescents to Adults: Severe Asthma Series.

    Nanzer, Alexandra M / Lawton, Adam / D'Ancona, Grainne / Gupta, Atul

    Chest

    2021  Volume 160, Issue 4, Page(s) 1192–1199

    Abstract: Children with asthma grow to become adults with asthma. Adolescents are not simply older children and do not automatically transform into independent adults, nor do they become proficient in self-management of their condition overnight. Adolescence is a ... ...

    Abstract Children with asthma grow to become adults with asthma. Adolescents are not simply older children and do not automatically transform into independent adults, nor do they become proficient in self-management of their condition overnight. Adolescence is a high-risk time for many people with asthma, with increased risk of asthma-related morbidity and mortality. Children with high-risk asthma attend hospital-based asthma clinics with their parents until they reach young adulthood, and parents usually take on the significant burden of disease management on behalf of their children. Once patients are transferred to adult medical teams, many will continue to have limited knowledge about their asthma, limited understanding of how to manage their symptoms and comorbidities, and limited comprehension of how and why to take their regular medication. Adolescence is a critical time of change during which young people yearn for autonomy. Effective transition gives young people the skills and knowledge necessary to manage their health independently and provides the substrate for autonomous care, the bed rock of long-term conditions. This review focuses on the challenges of adolescent health care and provides guidance on how to take a planned, patient-centered approach to ensure each transition is effective and safe.
    MeSH term(s) Adolescent ; Adolescent Health Services ; Asthma/therapy ; Humans ; Medication Adherence ; Patient-Centered Care ; Severity of Illness Index ; Transition to Adult Care
    Language English
    Publishing date 2021-05-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2021.05.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Long-Term Effectiveness of Anti-IL4R Therapy Following Suboptimal Response to Anti-IL5/5R Therapy in Severe Eosinophilic Asthma.

    Gates, Jessica / Hearn, Andrew / Mason, Tom / Fernandes, Mariana / Green, Linda / Thomson, Louise / Roxas, Cris / Lam, Jodie / d'Ancona, Grainne / Nanzer, Alexandra M / Dhariwal, Jaideep / Jackson, David J

    The journal of allergy and clinical immunology. In practice

    2024  

    Abstract: Background: Dupilumab is an anti-IL4R monoclonal antibody (mAb) with proven efficacy in severe eosinophilic asthma (SEA). A suboptimal response to anti-IL5/5R mAbs is seen in some patients with ongoing evidence of T2 inflammation.: Objective: To ... ...

    Abstract Background: Dupilumab is an anti-IL4R monoclonal antibody (mAb) with proven efficacy in severe eosinophilic asthma (SEA). A suboptimal response to anti-IL5/5R mAbs is seen in some patients with ongoing evidence of T2 inflammation.
    Objective: To understand whether targeting IL-13 pathways with dupilumab in these patients may lead to better clinical outcomes.
    Methods: We performed a retrospective analysis of the extended clinical effectiveness of dupilumab up to 2 years of treatment in patients with SEA who had not responded adequately to anti-IL5/5R biologics. Ability to achieve clinical remission and change in the remission domains of exacerbation rate (AER), maintenance oral corticosteroid dose (mOCS), lung function (FEV1) and asthma control (ACQ6) were recorded.
    Results: Thirty-seven patients (mean age 41, 70% female) were included in the analysis. The mean (SD) AER fell by almost 90% from 3.16(1.28) at dupilumab initiation to 0.35(0.72) after 1 year. The median (IQR) mOCS dose (n=20) fell from 10(5-25) mg to 0 (0-5) mg at 1 year, with 14/20 (70%) able to stop prednisolone altogether. Clinical remission was achieved in 16/37 (43%). Patients who achieved remission had a higher pre-IL5/5R FeNO level (85ppb [39-198] vs 75ppb [42-96], p=0.03).
    Conclusion: Significant improvements in clinical outcomes are possible following a switch to dupilumab in patients experiencing a suboptimal response to anti-IL5/5R therapies. A higher FeNO in poor responders to anti-IL5/5R who achieve remission with dupilumab is suggestive of an IL-13 driven sub-phenotype of T2-high asthma in which the eosinophil appears unlikely to play a key role in the disease pathogenesis.
    Language English
    Publishing date 2024-04-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2024.03.049
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Prescribing Patterns and Treatment Adherence in Patients with Asthma During the COVID-19 Pandemic.

    Dhruve, Hetal / d'Ancona, Grainne / Holmes, Steven / Dhariwal, Jaideep / Nanzer, Alexandra M / Jackson, David J

    The journal of allergy and clinical immunology. In practice

    2021  Volume 10, Issue 1, Page(s) 100–107.e2

    Abstract: Background: The COVID-19 pandemic has witnessed a reduction in asthma exacerbations across the United Kingdom. Several factors may underpin this, including reduced transmission of seasonal viruses and improved adherence to inhaled corticosteroids (ICS). ...

    Abstract Background: The COVID-19 pandemic has witnessed a reduction in asthma exacerbations across the United Kingdom. Several factors may underpin this, including reduced transmission of seasonal viruses and improved adherence to inhaled corticosteroids (ICS). However, little is known about how ICS use has changed during the pandemic.
    Objective: To identify prescribing patterns for asthmatics during the pandemic.
    Methods: Using the OpenPrescribing database, we retrospectively analyzed prescribing patterns of ICS, salbutamol and peak flow meters from January 2019 to January 2021 across England. In addition, using a sample asthma cohort at 3 primary care practices in London, we assessed individual prescription patterns.
    Results: A sharp increase in national ICS prescriptions occurred in March 2020 representing a 49.9% increase compared with February 2020. The sample cohort included 1132 patients (762 ICS treated across both years). Overall ICS adherence improved in 2020 (P < .001), with the proportion of patients meeting "good adherence" (≥75%) increasing from 33.9% to 42.0% (P < .001). The March 2020 spike predominantly reflected improved adherence rather than a hoarding effect of multiple inhalers. Female gender and increasing age were associated with the most significant improvements in adherence. A similar spike in salbutamol occurred in March 2020; however, an overall reduction in salbutamol prescriptions occurred in 2020 (P = .039). National figures highlighted a progressive increase in prescription of peak flow meters over 2020.
    Conclusion: ICS adherence rates remain low; however, a modest improvement in adherence was observed during the first year of the COVID-19 pandemic. Salbutamol prescription rates reduced over the same time period, whereas prescriptions for peak flow meters have steadily increased.
    MeSH term(s) Administration, Inhalation ; Adrenal Cortex Hormones/therapeutic use ; Anti-Asthmatic Agents/therapeutic use ; Asthma/drug therapy ; COVID-19 ; Female ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; Treatment Adherence and Compliance
    Chemical Substances Adrenal Cortex Hormones ; Anti-Asthmatic Agents
    Language English
    Publishing date 2021-10-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2021.09.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The impact of steroid-sparing biologic therapies on weight loss in obese individuals with severe eosinophilic asthma.

    Nanzer, Alexandra M / Taylor, Victoria / Hearn, Andrew P / Kavanagh, Joanne E / Patrick, Tanya / Green, Linda / Thomson, Louise / Lam, Jodie / Fernandes, Mariana / Roxas, Cris / d'Ancona, Grainne / Kent, Brian D / Dhariwal, Jaideep / Jackson, David J

    The European respiratory journal

    2023  Volume 62, Issue 2

    MeSH term(s) Humans ; Asthma/complications ; Asthma/drug therapy ; Biological Therapy ; Steroids ; Obesity/complications ; Weight Loss
    Chemical Substances Steroids
    Language English
    Publishing date 2023-08-03
    Publishing country England
    Document type Letter
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.00245-2023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Diagnosing adrenal insufficiency using ACTH stimulation test.

    Nanzer, Alexandra M / D'Ancona, Grainne / Kelly, Philip A / Jackson, David J

    The European respiratory journal

    2020  Volume 56, Issue 2

    MeSH term(s) Adrenal Insufficiency/diagnosis ; Adrenocorticotropic Hormone ; Asthma ; Biological Therapy ; Humans ; Prevalence ; Steroids
    Chemical Substances Steroids ; Adrenocorticotropic Hormone (9002-60-2)
    Language English
    Publishing date 2020-08-06
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.02149-2020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Long-Term Effectiveness of Benralizumab in Eosinophilic Granulomatosis With Polyangiitis.

    Nanzer, Alexandra M / Maynard-Paquette, Anne-Catherine / Alam, Vardah / Green, Linda / Thomson, Louise / Lam, Jodie / Fernandes, Mariana / Roxas, Cris / d'Ancona, Grainne / Hearn, Andrew / Gates, Jessica / Agarwal, Sangita / Kent, Brian D / Fernando, Michelle / D'Cruz, David P / Hopkins, Claire / Ismail, Tevfik F / Dhariwal, Jaideep / Jackson, David J

    The journal of allergy and clinical immunology. In practice

    2024  Volume 12, Issue 3, Page(s) 724–732

    Abstract: Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease characterized by eosinophilic tissue inflammation. Benralizumab, an anti-IL-5 receptor (anti-IL-5R) monoclonal antibody, induces rapid depletion of eosinophils; ... ...

    Abstract Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease characterized by eosinophilic tissue inflammation. Benralizumab, an anti-IL-5 receptor (anti-IL-5R) monoclonal antibody, induces rapid depletion of eosinophils; its longer-term effect in EGPA is unknown.
    Objective: To assess the real-world effectiveness and clinical remission rates of anti-IL-5R therapy in EGPA.
    Methods: We performed a retrospective cohort analysis of patients with EGPA, who commenced treatment with benralizumab. Clinical remission, assessed at 1 year and 2 years after the initiation of benralizumab, was defined as an absence of active vasculitis (Birmingham Vasculitis Activity Score of 0) and an oral corticosteroid (OCS) dose of ≤4 mg/d of prednisolone. "Super-responders" were defined as patients in remission and free of any significant relapses (asthma or extrapulmonary) over the preceding 12 months. The corticosteroid-sparing capacity of benralizumab, patient-reported outcome measures, and characteristics associated with clinical remission and super-responder status were also analyzed.
    Results: A total of 70 patients completed at least 1 year of treatment with benralizumab, of whom 53 completed 2 years. Of 70 patients, 47 (67.1%) met the definition for clinical remission at 1 year, with a similar proportion in remission at 2 years. Excluding asthma-related relapses, 61 of 70 (87.1%) patients were relapse free at 1 year, and of the 53 who completed 2 years, 45 (84.9%) were relapse free. A total of 67.9% of patients no longer needed any OCS for disease control. No significant difference was seen between antineutrophilic cytoplasmic antibody (ANCA)-positive and ANCA-negative subgroups.
    Conclusions: In this real-world setting of patients with EGPA, treatment with benralizumab was well tolerated and resulted in corticosteroid-free clinical remission for the majority of patients.
    MeSH term(s) Humans ; Churg-Strauss Syndrome/drug therapy ; Granulomatosis with Polyangiitis/drug therapy ; Antibodies, Antineutrophil Cytoplasmic ; Retrospective Studies ; Asthma/drug therapy ; Adrenal Cortex Hormones/therapeutic use ; Eosinophilia ; Recurrence ; Antibodies, Monoclonal, Humanized
    Chemical Substances benralizumab (71492GE1FX) ; Antibodies, Antineutrophil Cytoplasmic ; Adrenal Cortex Hormones ; Antibodies, Monoclonal, Humanized
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2024.01.006
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  8. Article ; Online: COVID-19 in the absence of eosinophils: The outcome of confirmed SARS-CoV-2 infection whilst on treatment with benralizumab.

    Francis, Charles H R / Hearn, Andrew P / Ratnakumar, Sharenja / Taylor, Alexander / Duckitt, Jordan / Ahmed, Usmaan / Dhariwal, Jaideep / Nanzer, Alexandra M / Jackson, David J

    Allergy

    2022  Volume 77, Issue 8, Page(s) 2558–2560

    MeSH term(s) Anti-Asthmatic Agents ; Antibodies, Monoclonal, Humanized/therapeutic use ; COVID-19/drug therapy ; Eosinophils ; Humans ; SARS-CoV-2 ; Treatment Outcome
    Chemical Substances Anti-Asthmatic Agents ; Antibodies, Monoclonal, Humanized ; benralizumab (71492GE1FX)
    Language English
    Publishing date 2022-05-11
    Publishing country Denmark
    Document type Letter
    ZDB-ID 391933-x
    ISSN 1398-9995 ; 0105-4538
    ISSN (online) 1398-9995
    ISSN 0105-4538
    DOI 10.1111/all.15334
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  9. Article: Defining severe asthma - an approach to find new therapies.

    Nanzer, Alexandra M / Menzies-Gow, Andrew

    European clinical respiratory journal

    2014  Volume 1

    Abstract: Asthma is a chronic inflammatory disease that has reached epidemic proportions worldwide. It is treatable in the majority of patients, but there is no cure. Moreover, a proportion of patients suffer from severe, difficult-to-control disease with daily ... ...

    Abstract Asthma is a chronic inflammatory disease that has reached epidemic proportions worldwide. It is treatable in the majority of patients, but there is no cure. Moreover, a proportion of patients suffer from severe, difficult-to-control disease with daily symptoms and high morbidity, making it imperative that we continue to improve our understanding of the underlying mechanisms of this disease. Severe asthma is a heterogeneous condition. A systematic approach to identify specific asthma phenotypes, including clinical characteristics and inflammatory processes, is the first step toward individualized, logical therapy. This review focuses on the need to characterize severe asthma phenotypes and on novel, targeted molecular treatment options currently under development.
    Language English
    Publishing date 2014-06-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2834928-3
    ISSN 2001-8525
    ISSN 2001-8525
    DOI 10.3402/ecrj.v1.24356
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  10. Article ; Online: Real world effectiveness of anti-IL-5/5R therapies is independent of co-eligibility for anti-IgE therapy.

    Hearn, Andrew P / Hug, Oliver D / Somani, Ziana A / Kavanagh, Joanne / d'Ancona, Grainne / Roxas, Cris / Green, Linda / Thomson, Louise / Fernandes, Mariana / Kent, Brian D / Dhariwal, Jaideep / Nanzer, Alexandra M / Jackson, David J

    The European respiratory journal

    2021  Volume 57, Issue 6

    MeSH term(s) Antibodies, Anti-Idiotypic ; Humans ; Interleukin-5 ; Receptors, Interleukin-5
    Chemical Substances Antibodies, Anti-Idiotypic ; Interleukin-5 ; Receptors, Interleukin-5 ; anti-IgE antibodies
    Language English
    Publishing date 2021-06-10
    Publishing country England
    Document type Letter
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.00166-2021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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