ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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OCS Reduction According to the Presence of Nasal Polyps or Atopic Status in the PONENTE Study
Session Title
TP6 - TP006 CLINICAL STUDIES OF ALLERGIC AIRWAY DISEASES, LUPUS, AND EOSINOPHILIC DISEASES
Abstract
A1355 - OCS Reduction According to the Presence of Nasal Polyps or Atopic Status in the PONENTE Study
Author Block: L. G. Heaney1, A. Menzies-Gow2, M. Gurnell3, J. Corren4, E. Bel5, J. Maspero6, T. Harrison7, D. Jackson8, D. Price9, N. L. Lugogo10, J. L. Kreindler11, A. Burden12, A. De Giorgio-Miller13, K. Padilla14, U. J. Martin15, E. Garcia Gil16; 1Queen's University Belfast, Belfast, United Kingdom, 2Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom, 3Wellcome-MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom, 4David Geffen School of Medicine at UCLA and Allergy Medical Clinic Inc., Los Angeles, CA, United States, 5Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, 6Fundación CIDEA, Buenos Aires, Argentina, 7Nottingham Respiratory NIHR BRC, University of Nottingham; AstraZeneca, Nottingham, United Kingdom, 8Guy's Severe Asthma Center, Guy’s & St. Thomas’ NHS Trust; Asthma UK Centre, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom, 9Observational and Pragmatic Research Institute; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Singapore, Singapore, 10University of Michigan Medical Center, Ann Arbor, MI, United States, 11Global Medical Respiratory, BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States, 12BioPharmaceuticals R&D, Late Respiratory & Immunology, Biometrics, AstraZeneca, Cambridge, United Kingdom, 13Medical & Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, Luton, United Kingdom, 14Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, United States, 15Late Stage Development, Respiratory and Immunology Therapeutic Area, AstraZeneca, Gaithersburg, MD, United States, 16Global Medical Respiratory, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain.
Rationale: Severe asthma is frequently associated with comorbidities. Nasal polyps (NP), in particular, indicate an eosinophilic phenotype and have been shown to predict an enhanced response to benralizumab in terms of asthma exacerbations and lung function. Increased serum immunoglobulin (Ig) E levels and atopy are also common in severe asthma, although they tend not to be associated with increased risk of exacerbations or predict response to biologics. Benralizumab has been shown to decrease long-term oral corticosteroid (OCS) use among patients with severe asthma, but whether the presence of comorbid NP, elevated serum IgE, or the presence of atopy impacts the degree of OCS reduction achieved with benralizumab is unknown. Methods: An analysis of 598 patients in the multicenter, open-label phase IIIb PONENTE trial was conducted to demonstrate the ability of benralizumab to eliminate or reduce the daily OCS dosage according to the presence of comorbidities before a personalized, variable OCS down-titration was initiated. Endpoints included the proportion of patients eliminating OCS use, the proportion achieving a dosage ≤5 mg if adrenal insufficiency was the cause of stopping the OCS taper, and the proportion achieving a dosage ≤5 mg regardless of the cause of stopping the OCS taper. Results: At baseline, 20.9% of patients had nasal polyps, the median IgE level was 130.7 (range, 1.5-17840.7) IU/mL, and 47.2% were atopic with positive Phadiatop results to common aeroallergens. More patients without chronic rhinosinusitis (CRS) than with CRS achieved the endpoints. Of patients with CRS, a higher proportion of those with NP than without NP achieved the endpoints. Similar proportions of atopic and non-atopic patients, as well as of patients with different IgE levels, achieved OCS elimination or a daily dosage ≤5 mg. A greater proportion of atopic patients achieved OCS elimination than non-atopic patients, but no difference was observed among patients with different IgE levels (Table). Conclusions: Most patients achieved elimination or lowest possible daily OCS dosage irrespective of baseline atopic status or IgE levels. Among those with CRS, more patients with NP reduced or eliminated OCS than those without NP.
Author Block: L. G. Heaney1, A. Menzies-Gow2, M. Gurnell3, J. Corren4, E. Bel5, J. Maspero6, T. Harrison7, D. Jackson8, D. Price9, N. L. Lugogo10, J. L. Kreindler11, A. Burden12, A. De Giorgio-Miller13, K. Padilla14, U. J. Martin15, E. Garcia Gil16; 1Queen's University Belfast, Belfast, United Kingdom, 2Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom, 3Wellcome-MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom, 4David Geffen School of Medicine at UCLA and Allergy Medical Clinic Inc., Los Angeles, CA, United States, 5Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, 6Fundación CIDEA, Buenos Aires, Argentina, 7Nottingham Respiratory NIHR BRC, University of Nottingham; AstraZeneca, Nottingham, United Kingdom, 8Guy's Severe Asthma Center, Guy’s & St. Thomas’ NHS Trust; Asthma UK Centre, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom, 9Observational and Pragmatic Research Institute; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Singapore, Singapore, 10University of Michigan Medical Center, Ann Arbor, MI, United States, 11Global Medical Respiratory, BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States, 12BioPharmaceuticals R&D, Late Respiratory & Immunology, Biometrics, AstraZeneca, Cambridge, United Kingdom, 13Medical & Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, Luton, United Kingdom, 14Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, United States, 15Late Stage Development, Respiratory and Immunology Therapeutic Area, AstraZeneca, Gaithersburg, MD, United States, 16Global Medical Respiratory, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain.
Rationale: Severe asthma is frequently associated with comorbidities. Nasal polyps (NP), in particular, indicate an eosinophilic phenotype and have been shown to predict an enhanced response to benralizumab in terms of asthma exacerbations and lung function. Increased serum immunoglobulin (Ig) E levels and atopy are also common in severe asthma, although they tend not to be associated with increased risk of exacerbations or predict response to biologics. Benralizumab has been shown to decrease long-term oral corticosteroid (OCS) use among patients with severe asthma, but whether the presence of comorbid NP, elevated serum IgE, or the presence of atopy impacts the degree of OCS reduction achieved with benralizumab is unknown. Methods: An analysis of 598 patients in the multicenter, open-label phase IIIb PONENTE trial was conducted to demonstrate the ability of benralizumab to eliminate or reduce the daily OCS dosage according to the presence of comorbidities before a personalized, variable OCS down-titration was initiated. Endpoints included the proportion of patients eliminating OCS use, the proportion achieving a dosage ≤5 mg if adrenal insufficiency was the cause of stopping the OCS taper, and the proportion achieving a dosage ≤5 mg regardless of the cause of stopping the OCS taper. Results: At baseline, 20.9% of patients had nasal polyps, the median IgE level was 130.7 (range, 1.5-17840.7) IU/mL, and 47.2% were atopic with positive Phadiatop results to common aeroallergens. More patients without chronic rhinosinusitis (CRS) than with CRS achieved the endpoints. Of patients with CRS, a higher proportion of those with NP than without NP achieved the endpoints. Similar proportions of atopic and non-atopic patients, as well as of patients with different IgE levels, achieved OCS elimination or a daily dosage ≤5 mg. A greater proportion of atopic patients achieved OCS elimination than non-atopic patients, but no difference was observed among patients with different IgE levels (Table). Conclusions: Most patients achieved elimination or lowest possible daily OCS dosage irrespective of baseline atopic status or IgE levels. Among those with CRS, more patients with NP reduced or eliminated OCS than those without NP.
