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The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence.

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Michael E. Wechsler, MD, and Geoffrey L. Chupp, MD, prepared useful Practice Aids pertaining to severe asthma for this CME activity titled “The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2tFZQGJ. CME credit will be available until March 5, 2021.

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The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence.

  1. 1. Access the activity,“The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence,”at PeerView.com/MYK40 Patient Handout: Managing Asthma1 PRACTICE AID 1. Asthma and Allergy Foundation of America. www.aafa.org. Accessed March 5, 2020. Know Your Asthma Triggers and Minimize Contact With Them Avoiding your triggers is the best way to prevent asthma episodes and reduce your need for medicine. But first, you have to learn what triggers your asthma. Any time you have an asthma episode, think about where you were and what you were doing the past day or so. In a tracking app, diary, or on your calendar, answer questions like these: • Was I making a bed or vacuuming? • Was I running, playing, or exercising? • Was I near an animal? Cigarette smoke? • Was I upset, excited, or tired? • Did I have a cold or other infection? Discuss your notes with your doctor to look for trends. As you identify your triggers, talk about how to best avoid them. Take Your Asthma Medicines as Prescribed The more you understand about what your asthma medicines do and why they help, the more likely you are to use them correctly. Discuss each of your asthma medicines with your healthcare provider to learn more about their benefits and effects. Track Your Asthma and Recognize Early Signs That It May Be Getting Worse Asthma episodes almost never occur without warning. Some people feel early symptoms, including neck or throat itchiness, chest tightness, and/or feeling tired. Since the airways to the lungs narrow slowly, you may not feel symptoms until your airways are badly blocked. The key to controlling your asthma is taking your medicine at the earliest possible sign that your asthma is getting worse. A peak flow meter may help detect narrowing in your airways hours or days before you feel symptoms. Know What to Do When Your Asthma Is Getting Worse Ask your healthcare provider for an asthma action plan and be sure to follow it so you will know what to do in case of an asthma episode. If you have questions at all, ask your doctor. Your asthma action plan will help you know: • Which medicine to take • How much to take • When to take it • When to call your doctor • When to seek emergency care 3 4 1 2
  2. 2. Guide to Selecting Biologic Therapy for Patients With Severe Asthma Access the activity,“The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence,”at PeerView.com/MYK40 PRACTICE AID Other factors influencing treatment decisions • Patient comfort with a newer versus older agent • Patient comfort with self-administration • Injection frequency • Comorbid conditions Selecting Treatment for Severe Asthma Anti-IgE vs Anti−IL-5 vs Anti–IL-5Rα vs Anti−IL-4/IL-131,2 Anti-IgE, anti–IL-5, anti–IL-5Rα, or anti–IL-4/IL-13 Anti–IL-5, anti–IL-5Rα, or anti–IL-4/IL-13 Anti–IL-4/IL-13 Allergic asthma Allergic eosinophilic asthma Eosinophilic asthma and • Nonallergic • Allergic but with IgE out of dosing range for anti-IgE treatment OCS-dependent asthma Type 2 noneosinophilic asthma with high FeNO Head-to-head studies are needed. Anti-IgE
  3. 3. CRTh2: chemoattractant receptor-homologous molecule expressed on T-helper 2 cells; FeNO: fractional exhaled nitric oxide ICS: inhaled corticosteroids; IL: interleukin; IL-#R: interleukin-# receptor; OCS: oral corticosteroids; TSLP: thymic stromal lymphopoietin. 1. Papathanassiou E et al. Eur Clin Resp J. 2016;3:31813. 2. Magnan A et al. Allergy. 2016;71:1335-1344. 3. Xolair (omalizumab) Prescribing Information. https://www.gene.com/download/pdf/xolair_prescribing. pdf. Accessed January 20, 2020. 4. Nucala (mepolizumab) Prescribing Information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/125526Orig1s000Lbl.pdf. Accessed January 20, 2020. 5. Cinqair (reslizumab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/761033lbl.pdf. Accessed January 20, 2020. 6. Fasenra (benralizumab) Prescribing Information. https://www.azpicentral.com/fasenra/fasenra_pi.pdf#page=1. Accessed January 20, 2020. 7. Dupixent (dupilumab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/ label/2017/761055lbl.pdf. Accessed January 20, 2020. 8. https://www.prnewswire.com/news-releases/tezepelumab-granted-breakthrough-therapy-designation-by-us-fda-for-the-treatment-of-patients-with- severe-asthma-without-an-eosinophilic-phenotype-300708680.html. Accessed January 20, 2020. 9. https://clinicaltrials.gov/ct2/show/NCT03347279. Accessed January 20, 2020. 10. https://clinicaltrials.gov/ct2/ show/NCT03406078. Accessed January 20, 2020. Guide to Selecting Biologic Therapy for Patients With Severe Asthma Access the activity,“The Evolving Landscape of Severe Asthma Management: Selecting Patients for Novel Treatment and Improving Adherence,”at PeerView.com/MYK40 PRACTICE AID Agent/Target Indication/Current Status Route/Dosing Patients ≥6 y with moderate to severe persistent allergic asthma inadequately controlled with ICS Subcutaneous 75-375 mg every 2-4 wk (dosage based on IgE level and body weight) Add-on maintenance treatment of patients ≥6 y with severe asthma and an eosinophilic phenotype Subcutaneous 40 mg every 4 wk for patients 6-12 y, and 100 mg every 4 wk for patients ≥12 y Add-on maintenance treatment of patients ≥18 y with severe asthma and an eosinophilic phenotype Intravenous infusion 3 mg/kg every 4 wk over 20-50 min Add-on maintenance treatment of patients ≥12 y with severe asthma and an eosinophilic phenotype Subcutaneous 30 mg every 4 wk for first 3 doses, then every 8 wk Add-on maintenance treatment of patients ≥12 y with moderate to severe asthma with an eosinophilic phenotype or with OCS-dependent asthma Subcutaneous Initial dose of 400 mg followed by 200 mg every 2 wk or initial dose of 600 mg followed by 300 mg every 2 wk Phase 3 trials; breakthrough designation for noneosinophilic phenotype Subcutaneous 210 mg every 4 wk Dupilumab7 IL-4Rα (IL-4/IL-13) Tezepelumab8-10 TSLP Investigational Omalizumab3 IgE Mepolizumab4 IL-5 Reslizumab5 IL-5 Benralizumab6 IL-5Rα Approved

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