The Many Faces of Ige-Mediated Disease – a Symposia Series
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The many faces of IgE-mediated disease – a symposia series EAACI 2021 Congress 10th, 11th & 12th July − lunchtime symposia Chaired by: Professor Marcus Maurer These virtual symposia are organised and funded by Novartis Pharma AG May 2021 | 119204 Disclaimer You are viewing a symposium organised and funded by Novartis Pharma AG intended for an audience of HCPs as defined by local Polish Law within the context of the EAACI Hybrid Congress 2021, July 10-12, 2021. Novartis Pharma AG provides this information to the best of its knowledge at the time of production of this item in May /June 2021 for the aforementioned congress. In line with Local Polish Pharmaceutical Law, this information is intended solely for medical doctors, physicians in training (graduates of medicine, who are authorized to prescribe medicinal products), medical doctor clinical researchers, pharmacists or industry representatives. The information included in this symposium is not intended for Allied Health Professionals, non-medical doctor clinical researchers, dieticians, journalists, lab technicians, medical students, nurses, scientists or social workers. This symposium is organised and funded by Novartis Pharma AG. This event may include data/information on investigational uses of compounds/drugs that have not yet been approved by regulatory authorities. This presentation is intended for non-promotional scientific purposes only and may contain information on products or indications currently under investigation and/or that have not been approved by the regulatory authorities. The opinions and views expressed in this slide deck are those of the presenters and do not necessarily constitute the opinions or recommendations of Novartis. Any data about non-Novartis products are based on publicly available information at the time of presentation. Prescribing information may vary depending on local health authority approval in each country. Before prescribing any product, always refer to the SmPC or product information approved in your local country. Permissions for all content within have been received from each copyright holder for presentation. Separate use, adaptation, and/or translation requires application for specific use permissions from each copyright holder. © Novartis Pharma AG | CH-4002, Basel, Switzerland | 032322 | June 2021 The many faces of IgE-mediated disease – a symposia series On IgE in asthma and nasal polyposis: your questions answered demand On IgE-mediated food allergy: need for a revolution demand Complete control of CSU - mission (im)possible? Mon 12 13:00 July CEST Chaired by: Prof. Marcus Maurer Complete control of CSU – Mission (im)possible? Professor Marcus Maurer Professor Zenon Brzoza Charité - Universitätsmedizin Berlin, Germany University Hospital in Opole, Poland Housekeeping ? Please use the chat The recording will be Please scan the QR code function to submit available to watch after to complete the questions to the faculty the virtual symposium evaluation form Marcus Maurer Charité - Universitätsmedizin Berlin, Germany Professor Maurer is Professor of Dermatology and Allergy and Head of Dermatological Allergology at the Department of Dermatology and Allergy and Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin Zenon Brzoza University Hospital in Opole, Poland Professor Brzoza is a specialist in internal diseases and allergology and Head of the Department of Internal Diseases with Division of Allergology at the University Hospital in Opole Disclosures § Marcus Maurer is or was a § Zenon Brzoza is or was a speaker speaker and/or advisor for Allakos, and/or advisor for Novartis anD Almirall Hermal, Amgen, Bayer, AstraZeneca. BioCryst, Blueprint, CellDex, Dyax, FAES, Genentech, GIInnovation, Innate Pharma, Leo, Lilly, Merckle RecorDati, Kyowa Kirin, Moxie, MSD, Novartis, Pharvaris, Riemser, Sanofi Aventis, Shire, TakeDa, ThirD Harmonic Bio, Tribute Pharmaceuticals, UCB, anD Uriach. Over 50 years of IgE: key milestones Phase III trials of anti- Receptor of human Role of IgE in Structure of the high- Phase III trials of anti- IgE omalizumab in IgE (FcεRI) found histamine release affinity IgE receptor IgE omalizumab in chronic spontaneous on basophils2 understood2 (FcεRI) determined2 allergic asthma4-6 urticaria7-9 1970 1970s 1989 2001 − 2005 2013 − 2015 d 1966-7 2002 2020 IgE IgE Phase III trials of discovered1 structure anti-IgE omalizumab described3 in nasal polyposis10 FcεRI, high-affinity IgE receptor; IgE, immunoglobulin E 1. Johansson SG. Curr Allergy Asthma Rep 2011;11:173–7; 2. Saito H, et al. Allergol Int 2013;62:3–12; 3. Wan T, et al. Nat Immunol 2002;3:681–6; 4. Busse WW, et al. J Allergy Clin Immunol 2001;108(2):184–190; 5. Solèr M, et al. Eur Respir J. 2001;18(2):254–261; 6. Humbert M, et al. Allergy 2005;60:309–316; 7. Kaplan A et al. J Allergy Clin Immunol. 2013;132(1):101–109;.8. Maurer M et al. N Engl J Med 2013;368:924–935; 9. Saini SS et al. J Invest Dermatol. 2015;135(1):67–75; 10. Gevaert et al. J Allergy Clin Immunol 2020;146:595-60520 IgE plays a role in many diseases Mastocytosis Allergic rhinitis Vernal Allergic Bronchopulmonary keratoconjunctivitis Aspergillosis Nasal polyposis Food allergy Atopic Eosinophilic dermatitis gastroenteritis IgE Allergic Chronic asthma spontaneous urticaria Allergic fungal Bullous Pemphigoid / rhinosinusitis Pemphigus vulgaris Chronic inducible Systemic lupus Eosinophilic urticaria Navinés-Ferrer A, et al. J Immunol Res. 2016; 8163803. erythematosus Humbert M et al. J Allergy Clin Immunol Pract 2019;7:1418-29 eosophagitis The many faces of IgE in allergic and non- allergic disease Food Allergy / Allergic asthma CSU FcεRI receptor Antigen T CELL specific IgE Granules Mediators Autoreactive IgE Self-antigen MAST CELL Antigen B CELL Local IgE SA enterotoxin IgE T CELL IgG Nasal polyposis FcεRI, high-affinity IgE receptor; IgE/G, immunoglobulin E/G 1. Wernersson S and Pejler G. Nat Rev Immunol. 2014;14:478–94; 2. Kaplan A and Greaves M. Clin Exp Allergy. 2009;39:777–87; 3. Bachert C, et al. J Allergy Clin Immunol. 2021: In Press The goal of CSU treatment is to treat the disease until it is gone We recommenD aiming at Consensus-baseD complete symptom control in urticaria, consiDering as much as possible the safety anD the quality 90% of life of each inDiviDual patient EAACI/GA²LEN/EDF/WAO guidelines (2018) Zuberbier T, et al. Allergy. 2018;73:1393–414 Targeting complete response of CSU No disease activity Disease control (no wheals, no itch, (complete control) no angioedema) Complete response Normal QoL (no impact on QoL) QoL, quality of life Symptom severity (UAS7) is associated with least impact on QoL… P<0.0001 16 13.8 (0.3) 14 12 P<0.0001 10 8.9 (0.3) 8 P<0.0001 6 5.6 (0.4) P=0.0003 LS Mean (SE) of LS Mean DLQI total score DLQI total 4 2.3 (0.4) 2 0.8 (0.4) 0 CompleteNo control Well-controlled Mild activity Moderate activity Severe activity activity activity UAS7 disease state UAS7=0 UAS7=1–6 UAS7=7–15 UAS7=16–27 UAS7=28–42 In patients at Week 20 of the Phase IIb QGE031C2201 study DLQI, dermatology life quality index; LS mean, least squares mean; QoL, quality of life; SE, standard error; UAS7, weekly urticaria score Giménez-Arnau AM, et al. EADV 2020 …and less sleep interference P<0.0001 12 10.9 (0.2) 10 P<0.0001 8 5.8 (0.2) 6 P<0.0001 4 P<0.0001 2.9 (0.2) LS Mean (SE) of WSI score LS Mean 2 1.0 (0.2) 0.2 (0.2) 0 CompleteNo control Well-controlled Mild activity Moderate activity Severe activity activity activity UAS7 disease state UAS7=0 UAS7=1–6 UAS7=7–15 UAS7=16–27 UAS7=28–42 In patients at Week 20 of the Phase IIb QGE031C2201 study LS mean, least squares mean; SE, standard error; UAS7, weekly urticaria score; WSI, Weekly Sleep Interference Maurer M, et al. AAD 2021. Virtual Meeting Experience Why do our How can patients fail to targeting IgE help reach complete to achieve the response? aim of treatment? IgE, immunoglobulin E Why do our patients fail to reach complete response? Unmet needs persist despite available treatments Poor adherence to Delays in referral treatment guidelines Incomplete control of urticaria Delays in diagnosis/ Limited treatment misdiagnosis options Maurer M, et al. Allergy. 2017;72:2005–16; Maurer M, et al. Clin Exp Allergy. 2019;49:655‒62 Why the misdiagnosis or delay in diagnosis? ASSURE-CSU Incorrect or incomplete diagnosis leads to inappropriate or suboptimal treatment § In ASSURE-CSU real-world study, diagnosis took an average of 24 months from symptoms onset Mean (SD) age at symptom onset: 42.3 (16.5) years 2 years Mean (SD) age at diagnosis: 44.2 (15.9) years 4.8 years Mean (SD) age at enrollment: 48.8 (15.5) years § Mean (SD) disease duration from symptom onset to diagnosis was 24 (63) months and mean disease duration was 4.8 years, illustrating the significant burden of CSU on patients and healthcare systems as a result of a suboptimal patient journey SD, standard deviation Maurer M, et al. Allergy. 2017;72:2005–16 Physicians may not be aware of the best practice for diagnosis of CSU § Physicians may mistake symptoms for an allergy and search in the wrong direction § There is often a considerable delay before patients are referred to a specialist § Physicians may not use photos and other tools to help their diagnosis § Physicians often do not take into account coexisting angioedema or inducible urticarias symptoms as factors negatively influencing successful treatment Giménez-Arnau A, et al. J Eur Acad Dermatol Venerol. 2015;29(Suppl 3):3–11 International guidelines provide an algorithm to guide diagnosis of specific chronic