Efficacy and safety of multiple doses of QGE031 (ligelizumab) versus omalizumab and placebo in inhibiting allergen-induced early asthmatic responses.

BACKGROUND: Omalizumab is an established anti-IgE therapy for the treatment of allergic diseases that prevents IgE from binding to its receptor. QGE031 is an investigational anti-IgE antibody that binds IgE with higher affinity than omalizumab. OBJECTIVE: This study compared the effects of QGE031 with those of omalizumab on clinical efficacy, IgE levels, and FcεRI expression in a clinical model of allergic asthma. METHODS: Thirty-seven patients with mild allergic asthma were randomized to subcutaneous omalizumab, placebo, or QGE031 at 24, 72, or 240 mg every 2 weeks for 10 weeks in a double-blind, parallel-group multicenter study. Inhaled allergen challenges and skin tests were conducted before dosing and at weeks 6, 12, and 18, and blood was collected until 24 weeks after the first dose. RESULTS: QGE031 elicited a concentration- and time-dependent change in the provocative concentration of allergen causing a 15% decrease in FEV1 (allergen PC15) that was maximal and approximately 3-fold greater than that of omalizumab (P = .10) and 16-fold greater than that of placebo (P = .0001) at week 12 in the 240-mg cohort. Skin responses reached 85% suppression at week 12 in the 240-mg cohort and were maximal at week 18. The top doses of QGE031 consistently suppressed skin test responses among subjects but had a variable effect on allergen PC15 (2-fold to 500-fold change). QGE031 was well tolerated. CONCLUSION: QGE031 has greater efficacy than omalizumab on inhaled and skin allergen responses in patients with mild allergic asthma. These data support the clinical development of QGE031 as a treatment of asthma.

Effects of interleukin-13 blockade on allergen-induced airway responses in mild atopic asthma.

RATIONALE: Extensive evidence in animal models supports a role for IL-13 in the pathobiology of asthma. IMA-638 and IMA-026 are fully humanized IgG(1) antibodies that bind to different epitopes and neutralize IL-13 bioactivity. OBJECTIVES: We hypothesized that anti-IL-13 treatment would inhibit allergen-induced late-phase asthmatic responses, airway hyperresponsiveness, and inflammation in subjects with asthma. METHODS: Fifty-six subjects with mild, atopic asthma were recruited for two double-blind, randomized, placebo-controlled, parallel group trials to compare IMA-638 and IMA-026 IL-13 antibody treatments with placebo treatment. Drug was administered on Days 1 and 8, and allergen challenges were performed on Days 14 and 35. The primary outcome variable was the late-phase area under the curve (AUC), and secondary outcome variables were the early- and late-phase maximum percent fall in FEV(1), early AUC, allergen-induced shift in airway hyperresponsiveness, and sputum eosinophils. MEASUREMENTS AND MAIN RESULTS: The treatment difference with IMA-638 on Day 14 was -19.1 FEV(1) × hour (95% confidence interval: -36.2, -1.9) for the allergen-induced early AUC and -23.8 FEV(1) × hour (95% confidence interval: -46.4, -1.2) for the late AUC (both P < 0.05), but this effect was lost by Day 35. Treatment with IMA-026 did not attenuate the asthmatic responses on Day 14 or Day 35. There was no effect of either antibody on allergen-induced airway hyperresponsiveness or sputum eosinophils. The frequency of adverse events after administration of the IL-13 antibodies was similar to placebo. CONCLUSIONS: IL-13 has a role in allergen-induced airway responses in humans. Further study is required to determine whether anti-IL-13 monoclonal antibodies will be beneficial clinically.

Widened pulse pressure is a potential risk factor for significant cognitive impairment among community-dwelling Chinese younger old people.

Hypertension is a risk factor for dementia, but its exact role in contributing to dementia remains unknown. We conducted a community-based retrospective cohort study to examine the association of hypertension and widened pulse pressure (PP) with incident significant cognitive impairment (SCI) in Chinese older people in Hong Kong. A total of 1,925 subjects who were 65 years and older, ethnic Chinese, and community-living, with no history of cerebrovascular accidents or dementia, were recruited. Demographics, medical history, and physical parameters recorded at baseline were retrieved for analysis. Primary outcome was SCI developed in 6 years, which was defined by the presence of clinical dementia, scoring below the cutoff point on the Cantonese version of the Mini-Mental State Examination, and/or a global Clinical Dementia Rating of 1 to 3. Our data showed no difference in the point prevalence of pre-existing hypertension between subjects who remained cognitively stable and those who developed SCI (64.2% versus 65.8%; χ2 test, p = 0.68). However, subjects with incident SCI had a higher baseline PP (70 mmHg versus 66 mmHg; Mann-Whitney U-test, p = 0.03) and a decreasing trend in PP with time. Multiple logistic regression analysis showed that PP had a small but significant effect on the risk of SCI among the younger old subjects (OR = 1.02, p = 0.03). Our findings suggested that widened PP might be a risk factor for SCI among the younger old people. Further studies are needed to ascertain the association between hypertension and SCI in the Chinese older population and how widened PP contributes to SCI.