Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience

aydin, omur; Sin, Betül Ayşe; Bavbek, Sevim; Yıldız, Reyhan; Ağca, Meltem; Mungan, Dilşad; Demirel, Yavuz Selim

doi:10.5578/tt.20229702

Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience

Reyhan YILDIZ, (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Yavuz Selim DEMİREL, (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Dilşad MUNGAN, (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Ömür AYDIN, (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Betül Ayşe SİN, (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Meltem AĞCA, (Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Göğüs Hastalıkları Kliniği Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye)

Sevim BAVBEK (İmmünoloji ve Alerjik Hastalıklar Anabilim Dalı, Göğüs Hastalıkları Anabilim Dalı Hastalıklar, Ankara Üniversitesi Tıp Fakültesi, Ankara, Türkiye)

Tüberküloz ve Toraks

4 1

Yıl: 2022 Cilt: 70 Sayı: 3 Sayfa Aralığı: 231 - 241 Metin Dili: İngilizce DOI: 10.5578/tt.20229702 İndeks Tarihi: 10-10-2022

Öz:

Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience Introduction: To assess the incidence and course of COVID-19 in patients with severe asthma/chronic spontaneous urticaria using biological agents. Materials and Methods: A total of 202 patients (142 with asthma, and 60 with urticaria) were enrolled. The subjects were asked via face-to-face or telephone interview whether they had been diagnosed with COVID-19 and the course of the disease. Results: Study group consisted of 132 women, and 70 men (median age= 48 years). Median omalizumab dose was 300 mg/month in asthma (min-max= 150-1200 mg). The mepolizumab dose of two patients diagnosed with EGPA was 300 mg/month. Thirty one (15.3%) patients were diagnosed with COVID-19, 22 (71%) of whom were receiving omalizumab and nine (29%) were receiving mepolizumab. Asthma or chronic spontaneous urticaria diagnosis, age, sex, smoking, weight, comorbidities, atopy, and biological agent use were not statistically different between patients with or without COVID-19. Nine COVID-19 patients were hospitalized, and three of them required intensi- ve care. Mepolizumab usage was higher in hospitalized patients (5, 55.6%), whereas omalizumab usage was higher in home-treated patients (18, 81%). The mean duration of biological use in home-treated patients was significantly higher than that of the hospitalized patients (35.64 months vs. 22.56 months, p= 0.024). Biological treatment was interrupted in 47 (23%) patients, self- interruption due to the infection risk was the foremost reason (34%). Conclusion: The incidence of COVID-19 among patients with asthma and urticaria on mepolizumab and omalizumab was higher compared to studies from other countries. The disease course appeared mild in patients receiving long-term biological therapy.

Anahtar Kelime:

ÖZ Kronik spontan ürtiker ve/veya ağır alerjik astım için omalizumab ve ağır eozinofilik astım için mepolizumab kullanan hastalarda COVID-19 insidansı ve klinik seyri: Tek merkez gerçek yaşam deneyimi

Öz:

Kronik spontan ürtiker ve/veya ağır alerjik astım için omalizumab ve ağır eozinofilik astım için mepolizumab kullanan hastalarda COVID-19 insidansı ve klinik seyri: Tek merkez gerçek yaşam deneyimi Giriş: Biyolojik ajanlar kullanan ağır astımı/kronik spontan ürtikeri (KSÜ) olan hastalarda COVID-19 insidansını ve seyrini değerlen- dirmek amaçlandı. Materyal ve Metod: Toplam 202 hasta (142 astımlı, 60 ürtikerli) kaydedildi. COVID-19 tanısı alıp almadıkları ve hastalığın seyri yüz yüze veya telefon görüşmesi yoluyla sorgulandı. Bulgular: Çalışma grubu 132 kadın, 70 erkekten (ortanca yaş= 48) oluşuyordu. Medyan omalizumab dozu astımda 300 mg/ay (min-maks: 150-1200 mg) idi. EGPA tanılı iki hastada mepolizumab dozu 300 mg/ay idi. Otuz bir (%15,3) hastaya COVID-19 tanı- sı kondu, 22’si (%71) omalizumab ve dokuzu (%29) mepolizumab tedavisi alıyordu. COVID-19 geçiren ve geçirmeyen hastalar arasında astım ya da KSÜ tanılı olma, yaş, cinsiyet, sigara, BMI, komorbiditeler, atopi ve kullanılan biyolojik ajan açısından istatistiksel bir fark saptanmadı. COVID-19 geçiren hastaların dokuzunda hastanede yatış, bunların üçünde de yoğun bakım gerekti. Hastanede yatan hastalarda mepolizumab kullanımı (5, %55,6), evde tedavi gören hastalarda omalizumab kullanımı daha yüksekti (18, %81). Evde tedavi edilen hastalarda ortalama biyolojik kullanım süresi hastanede yatan hastalara göre anlamlı olarak daha yüksekti (35,64 aya karşı 22,56 ay, p= 0,024). Kırk yedi (%23) hastada biyolojik tedavilere ara verilmiş, bulaş riski nedeniyle hastaların kendilerinin kesmesi (%34) en önemli neden olmuştu. Sonuç: Mepolizumab ve omalizumab kullanan astımlı ve KSÜ’lü hastalarda COVID-19 insidansı diğer ülkelerdeki çalışmalara göre daha yüksekti. Uzun süreli biyolojik tedavi alan hastalarda hastalık seyrinin hafif olduğu gözlendi.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Boyman O, Kaegi C, Akdis M, Bavbek S, Bossios A, Chatzipetrou A, et al. EAACI IG biologicals task force paper on the use of biologic agents in allergic disorders. Allergy 2015; 70(7): 727-54. https://doi.org/10.1111/ all.12616
2. Oliver BG, Robinson P, Peters M, Black J. Viral infections and asthma: An inflammatory interface? Eur Respir J 2014; 44(6): 1666-81. https://doi. org/10.1183/09031936.00047714
3. Sitek AN, Ade JM, Chiarella SE, Divekar RD, Pitlick MM, Iyer VN, et al. Outcomes among patients with COVID-19 and asthma: A systematic review and meta-analysis. Allergy Asthma Proc 2021; 42(4): 267-73. https://doi. org/10.2500/aap.2021.42.210041
4. Imbalzano E, Casciaro M, Quartuccio S, Minciullo PL, Cascio A, Calapai G, et al. Association between urticaria and virus infections: A systematic review. Allergy Asthma Proc 2016; 37(1): 18-22. https://doi.org/10.2500/ aap.2016.37.3915
5. Kocaturk E, Salman A, Cherrez-Ojeda I, Criado PR, Peter J, Comert-Ozer E, et al. The global impact of the COVID-19 pandemic on the management and course of chronic urticaria. Allergy 2021; 76(3): 816-30. https://doi. org/10.1111/all.14687
6. Vultaggio A, Agache I, Akdis CA, Akdis M, Bavbek S, Bossios A, et al. Considerations on biologicals for patients with allergic disease in times of the COVID-19 pandemic: An EAACI statement. Allergy 2020; 75(11): 2764-74. https://doi.org/10.1111/all.14407
7. Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, et al. COVID-19: Pandemic contingency planning for the allergy and immunology clinic. J Allergy Clin Immunol Pract 2020; 8(5): 1477-88 e5. https://doi. org/10.1016/j.jaip.2020.03.012
8. Global Initiative for Asthma (GINA) Global strategy for asthma management and prevention (2020 Update). Available at: https://ginasthma.org/wp-content/ uploads/2020/06/GINA-2020-report_20_06_04-1-wms. pdf
9. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65(1): 1-11. https://doi.org/10.1002/art.37715
10. Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R, et al. Allergic bronchopulmonary aspergillosis: Review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 2013; 43(8): 850- 73. https://doi.org/10.1111/cea.12141
11. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020; 146(1): 110-8. https://doi.org/10.1016/j.jaci.2020.04.006
12. Izquierdo JL, Almonacid C, Gonzalez Y, Del Rio-Bermudez C, Ancochea J, Cardenas R, et al. The impact of COVID-19 on patients with asthma. Eur Respir J 2021; 57(3). https:// doi.org/10.1183/13993003.03142-2020
13. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020; 323(16): 1574- 81. https://doi.org/10.1001/jama.2020.5394
14. Heffler E, Detoraki A, Contoli M, Papi A, Paoletti G, Malipiero G, et al. COVID-19 in severe asthma network in Italy (SANI) patients: Clinical features, impact of comor - bidities and treatments. Allergy 2021; 76(3): 887-92. https://doi.org/10.1111/all.14532
15. Lommatzsch M, Stoll P, Virchow JC. COVID-19 in a patient with severe asthma treated with Omalizumab. Allergy 2020; 75(10): 2705-8. https://doi.org/10.1111/all.14456
16. Garcia-Moguel I, Diaz Campos R, Alonso Charterina S, Fernandez Rodriguez C, Fernandez Crespo J. COVID-19, severe asthma, and biologics. Ann Allergy Asthma Immunol 2020; 125(3): 357-9 e1. https://doi. org/10.1016/j.anai.2020.06.012
17. Rial MJ, Valverde M, Del Pozo V, Gonzalez-Barcala FJ, Martinez-Rivera C, Munoz X, et al. Clinical characteristics in 545 patients with severe asthma on biological treatment during the COVID-19 outbreak. J Allergy Clin Immunol Pract 2021; 9(1): 487-9 e1. https://doi.org/10.1016/j. jaip.2020.09.050
18. Matucci A, Caminati M, Vivarelli E, Vianello A, Micheletto C, Menzella F, et al. COVID-19 in severe asthmatic patients during ongoing treatment with biologicals target- ing type 2 inflammation: Results from a multicenter Italian survey. Allergy 2021; 76(3): 871-4. https://doi. org/10.1111/all.14516
19. Eger K, Hashimoto S, Braunstahl GJ, Brinke AT, Patberg KW, Beukert A, et al. Poor outcome of SARS-CoV-2 infec- tion in patients with severe asthma on biologic therapy. Respir Med 2020; 177: 106287. https://doi.org/10.1016/j. rmed.2020.106287
20. Diaz-Campos RM, Garcia-Moguel I, Pina-Maiquez I, Fernandez-Rodriguez C, Melero-Moreno C. Prevalence and influence of COVID-19 in asthma control and lung function in severe asthma patients receiving biological treatment. J Investig Allergol Clin Immunol 2021; 31(4): 362-3. https://doi.org/10.18176/jiaci.0695
21. Abduelmula A, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Hong CH, et al. Incidence of COVID-19 in patients with chronic idiopathic urticaria and asthma on omalizumab: A multicentre retrospective cohort study. J Cutan Med Surg 2021: 12034754211049707. https:// doi.org/10.1177/12034754211049707
22. Aksu K, Demir S, Topel M, Yesilkaya S, Ates H, Koca Kalkan I, et al. COVID-19 in patients with severe asthma using biological agents. Tuberk Toraks 2021; 69(3): 433-6. https://doi.org/10.5578/tt.20219721
23. Tuncay G, Cakmak ME, Can Bostan O, Kaya SB, Damadoglu E, Karakaya G, et al. The course of COVID-19 in patients with severe asthma receiving biological treat- ment. J Asthma 2021: 1-7. https://doi.org/10.1080/0277 0903.2021.1996599
24. Tanriover MD, Doğanay HL, Akova M, Güner HR, Azap A, Akhan S, et al; CoronaVac Study Group. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): Interim results of a double-blind, ran- domised, placebo-controlled, phase 3 trial in Turkey. Lancet 2021; 398(10296): 213-22. https://doi. org/10.1016/S0140-6736(21)01429-X
25. Hanon S, Brusselle G, Deschampheleire M, Louis R, Michils A, Peche R, et al. COVID-19 and biologics in severe asthma: Data from the Belgian severe asthma reg- istry. Eur Respir J 2020; 56(6): 2002857. https://doi. org/10.1183/13993003.02857-2020
26. Adir Y, Humbert M, Saliba W. COVID-19 risk and out- comes in adult asthmatic patients treated with biologics or systemic corticosteroids: Nationwide real-world evidence. J Allergy Clin Immunol 2021; 148(2): 361-7 e13. https:// doi.org/10.1016/j.jaci.2021.06.006
27. Yamaya M, Nishimura H, Deng X, Sugawara M, Watanabe O, Nomura K, et al. Inhibitory effects of glycopyrronium, formoterol, and budesonide on coronavirus HCoV-229E replication and cytokine production by primary cultures of human nasal and tracheal epithelial cells. Respir Investig 2020; 58(3): 155-68. https://doi.org/10.1016/j. resinv.2019.12.005
28. Maes T, Bracke K, Brusselle GG. Reply to Lipworth et al. Inhaled Corticosteroids and COVID-19. Am J Respir Crit Care Med 2020; 202(6): 900-2. https://doi.org/10.1164/ rccm.202006-2129LE
29. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O’Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol 2020; 146(1): 203-6 e3. https:// doi.org/10.1016/j.jaci.2020.04.009
30. Keswani A, Dhana K, Rosenthal JA, Moore D, Mahdavinia M. Atopy is predictive of a decreased need for hospitaliza- tion for coronavirus disease 2019. Ann Allergy Asthma Immunol 2020; 125(4): 479-81.https://doi.org/10.1016/j. anai.2020.07.012
31. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospi- talized with COVID-19 in the New York City area. JAMA 2020; 323(20): 2052-9. https://doi.org/10.1001/ jama.2020.6775
32. Erdem Y, Polat Ekinci A, Altunay IK, Sivaz O, Inal S, Gokalp MO, et al. The impact of COVID-19 pandemic on the management of patients with chronic urticaria: An obser- vational two-center study from Turkey. Dermatol Ther 2021; 34(1): e14652. https://doi.org/10.1111/dth.14652

APA	Yıldız R, Demirel Y, Mungan D, aydin o, Sin B, Ağca M, Bavbek S (2022). Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. , 231 - 241. 10.5578/tt.20229702
Chicago	Yıldız Reyhan,Demirel Yavuz Selim,Mungan Dilşad,aydin omur,Sin Betül Ayşe,Ağca Meltem,Bavbek Sevim Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. (2022): 231 - 241. 10.5578/tt.20229702
MLA	Yıldız Reyhan,Demirel Yavuz Selim,Mungan Dilşad,aydin omur,Sin Betül Ayşe,Ağca Meltem,Bavbek Sevim Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. , 2022, ss.231 - 241. 10.5578/tt.20229702
AMA	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. . 2022; 231 - 241. 10.5578/tt.20229702
Vancouver	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. . 2022; 231 - 241. 10.5578/tt.20229702
IEEE	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S "Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience." , ss.231 - 241, 2022. 10.5578/tt.20229702
ISNAD	Yıldız, Reyhan vd. "Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience". (2022), 231-241. https://doi.org/10.5578/tt.20229702

APA	Yıldız R, Demirel Y, Mungan D, aydin o, Sin B, Ağca M, Bavbek S (2022). Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. Tüberküloz ve Toraks, 70(3), 231 - 241. 10.5578/tt.20229702
Chicago	Yıldız Reyhan,Demirel Yavuz Selim,Mungan Dilşad,aydin omur,Sin Betül Ayşe,Ağca Meltem,Bavbek Sevim Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. Tüberküloz ve Toraks 70, no.3 (2022): 231 - 241. 10.5578/tt.20229702
MLA	Yıldız Reyhan,Demirel Yavuz Selim,Mungan Dilşad,aydin omur,Sin Betül Ayşe,Ağca Meltem,Bavbek Sevim Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. Tüberküloz ve Toraks, vol.70, no.3, 2022, ss.231 - 241. 10.5578/tt.20229702
AMA	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. Tüberküloz ve Toraks. 2022; 70(3): 231 - 241. 10.5578/tt.20229702
Vancouver	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience. Tüberküloz ve Toraks. 2022; 70(3): 231 - 241. 10.5578/tt.20229702
IEEE	Yıldız R,Demirel Y,Mungan D,aydin o,Sin B,Ağca M,Bavbek S "Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience." Tüberküloz ve Toraks, 70, ss.231 - 241, 2022. 10.5578/tt.20229702
ISNAD	Yıldız, Reyhan vd. "Incidence and clinical course of COVID-19 in patients using omalizumab for chronic spontaneous urticaria and/or severe allergic asthma and using mepolizumab for severe eosinophilic asthma: A single center real life experience". Tüberküloz ve Toraks 70/3 (2022), 231-241. https://doi.org/10.5578/tt.20229702