Barrier Factors of Adherence to Dupilumab Self-Injection for Severe Allergic Disease: A Non-Interventional Open-Label Study.

Purpose: The status of dupilumab self-injection at home is not well understood. We therefore aimed to identify the barriers to adherence to dupilumab self-injection. Patients and Methods: This non-interventional open-label study was conducted between March 2021 and July 2021. Patients with atopic dermatitis, bronchial asthma, and chronic rhinosinusitis with nasal polyps receiving dupilumab, from 15 sites, were requested to complete a self-administered questionnaire regarding the frequency and effectiveness of dosing as well as their use and satisfaction with dupilumab. Barriers to adherence were assessed using the Adherence Starts with Knowledge-12. Results: We included 331 patients who used dupilumab for atopic dermatitis (n = 164), chronic rhinosinusitis with nasal polyps (n = 102), and bronchial asthma (n = 65). The median efficacy of dupilumab scored 9.3 on the visual analog scale. Overall, 85.5% of the patients self-injected dupilumab, and 70.7% perfectly complied with the established injection dates. The pre-filled pen was significantly superior to the conventional syringe in terms of usability, operability, ease of pushing the plunger, and patient satisfaction. However, the pre-filled pen caused more pain during self-injection than did the syringe. Multivariate logistic regression analysis showed that adherence decreased with longer dupilumab treatment duration (p = 0.017) and was not associated with age, sex, underlying disease, or device type. There was a difference in responses related to "inconvenience/forgetfulness" between the good and poor adherence groups. Conclusion: The pre-filled dupilumab pen was superior to the syringe in terms of usability, operability, ease of pushing the plunger, and satisfaction. Repetitive instructions are recommended for preventing poor adherence to dupilumab self-injection.

Potential involvement of subclinical Sjögren's syndrome in various lung diseases.

OBJECTIVES: Sjögren's syndrome (SS) affects the respiratory system, but previous studies have not assessed the role of subclinical SS in lung disease. The aim of this investigation was to explore the potential role of subclinical SS as a factor in the pathogenesis of various diffuse lung diseases. METHODOLOGY: This single-cohort prospective study was performed over a 5-year period in 313 consecutive patients with diffuse lung disease, who had neither primary xerosis nor a diagnosis of SS. They were referred for the Saxon test and underwent additional tests for SS when decreased saliva production was detected. RESULTS: The subjects included 109 patients with sarcoidosis, 77 with various interstitial pneumonias, 49 with bronchiectasis, and 78 with other diseases. The incidence of decreased saliva production was 17.3% (54 out of 313). A total of 40 of the 54 patients completed further examinations, and definite or probable SS was diagnosed in 29 (9.3% of the original 313). Definite SS was diagnosed in six patients with interstitial pneumonia, three with bronchiolitis, three with sarcoidosis, and five with other diseases. CONCLUSIONS: The prevalence of decreased saliva production and SS without obvious symptoms of dryness was high among patients with diffuse lung disease. In these patients, it is important to screen for SS, even if symptoms are not apparent.

[Pulmonary involvement in sarcoidosis: CT findings at diagnosis and their changes at follow-up in cases without corticosteroid treatment].

To review the pulmonary CT findings in sarcoidosis at diagnosis, and to analyze the change in each finding at follow-up in cases without corticosteroid treatment. The study included 21 cases of pulmonary involvement of sarcoidosis. We analyzed the presence or absence and grade of each HRCT finding: bronchial wall thickening, enlargement of vascular shadows, pleural involvement, septal thickening, small nodules, ground-glass opacities, centrilobular opacities, consolidation, nodules, and volume loss. Afterwards, we compared the initial CT with the follow-up CT, and described the change of each finding as "improved" or "not improved". Furthermore, we decided if each case as a whole was improved or not after considering all of the pulmonary CT findings. Twelve of the 21 cases were improved. Small nodules, ground-glass opacities, centrilobular opacities, and nodules had improved in more than 50% of the cases since the initial CT. However, pleural involvement (10/11) and volume loss (6/9) were not improved. Pleural involvement and volume loss correlated the radiological irreversibility (p < 0.05). Of the several pulmonary CT findings in sarcoidosis, pleural involvement and volume loss show the highest rates of irreversible pulmonary changes.