American College of Allergy, Asthma & Immunology 2009 Annual Meeting
The 2009 Annual Meeting of the American College of Allergy, Asthma & Immunology took place Nov. 5 to 10 in Miami Beach, Fla. Approximately 4,000 participants were expected to attend, including physicians, allergy and immunology specialists, and allied health professionals. Research was presented in over 100 scientific sessions, 250 abstract presentations, and numerous workshops and technical exhibits.
Brian Schroer, M.D., of the Cleveland Clinic, presented research which suggested that obese patients may be more likely to experience poor asthma control compared with lean or overweight patients. In a retrospective chart review, the investigators assessed 184 adult asthma patients (mean age, 47 years) who concurrently completed an asthma control test, spirometry and exhaled nitric oxide tests, and had their body mass index (BMI) calculated; all patient records were from between January and September 2008.
The researchers found that most patients (63 percent) had moderate or severe persistent asthma. Based on BMI, patients were categorized as lean (28 percent), overweight (34 percent), or obese (38 percent). A significantly lower proportion of obese patients reported experiencing well-controlled asthma in the asthma control test compared with lean or overweight patients (50.7 versus 68.1 percent). BMI did not correlate significantly with level of asthma severity.
"These findings suggest that elevated BMI may be associated with impaired asthma control in the absence of increased airway inflammation or airway obstruction," the study authors concluded.
David Pearlman, M.D., of the Colorado Allergy and Asthma Centers in Denver, reported safety and tolerability findings from a clinical trial showing that mometasone furoate/formoterol, an investigational combination asthma therapy, was a safe alternative to traditional therapy with corticosteroids alone or corticosteroids and long-acting β2-agonists. This placebo-controlled, double-blind, multicenter study randomized 781 patients (mean age, 42.4 years) to four treatment arms: mometasone furoate/formoterol combination, mometasone furoate alone, formoterol alone, or placebo.
Overall, the researchers found that the proportion of patients experiencing a treatment-related adverse event was relatively low, and similar among the four treatment arms (mometasone furoate/formoterol combination, 8.9 percent; mometasone furoate alone, 5.7 percent; formoterol alone, 5.4 percent; or placebo, 7.7 percent). The most common adverse events reported during the blinded treatment portion of the study included upper respiratory tract infection (7.2 percent), nasopharyngitis (6.0 percent), and headache (4.1 percent); however, most of these were not considered treatment-related. Only a small number of treatment discontinuations, and no incidences of treatment-related deaths, were reported.
"Mometasone furoate/formoterol combination was considered safe and well tolerated," the study authors concluded.
Barbara Knorr, M.D., of Merck Research Laboratories in Rahway, N.J., reported on a pooled analysis of two randomized, double-blind, placebo-controlled studies which evaluated the efficacy of montelukast compared with placebo in pediatric asthma patients. One study treated patients aged 6 to 24 months over six weeks, while the second study treated patients aged 2 to 5 years over 12 weeks (pooled analysis only included the first 6 weeks).
The researchers found that a total of 632 patients received montelukast and 308 patients received placebo. Compared with placebo, montelukast therapy was associated with a significant increase in the mean percentage of days with β-agonist use (44.0 versus 49.9 percent). Patients in the montelukast arm also experienced a significant decrease in the number of β-agonist treatments per day compared with placebo (1.27 versus 1.44 treatments).
"Montelukast 4 mg, compared with placebo, significantly increased the percent of days without β-agonist use and decreased the number of β-agonist treatments/day needed by young children with asthma," the study authors concluded.
William C. Howland, M.D., of the Allergy and Asthma Center of Austin in Texas presented the results of a phase III clinical study which showed that an ultra short course of subcutaneous immunotherapy increased anti-ragweed IgG antibody levels and decreased anti-ragweed IgE levels in individuals with seasonal ragweed pollen-allergic rhinoconjunctivitis. The ultra short course of subcutaneous immunotherapy was delivered in a pre-seasonal 4-injection course of Ragweed MATA MPL administered over one month. A total of 993 subjects were randomized in a 2:1 fashion to receive either the immunotherapy or placebo; anti-ragweed IgG and IgE levels were determined by immunoassay prior to treatment, post-treatment, and at the end of the pollen season.
The researchers found that those in the placebo group had a median anti-ragweed IgG level of 200 µg/L at both baseline and post-treatment, followed by 419 µg/L at the end of the pollen season. In contrast, participants who received the ultra short immunotherapy experienced an 11-fold increase in IgG level, to a median of 2272 µg/L at post-treatment; this level remained high (median 1548 µg/L) at the end of the pollen season. Median anti-ragweed IgE increased in the placebo group; it also increased from baseline to post-treatment in the ultra short immunotherapy group, but did not increase as expected during the pollen season.
The study authors concluded that this ultra short course of subcutaneous immunotherapy was effective in increasing anti-ragweed IgG levels among individuals with seasonal ragweed pollen-allergic rhinoconjunctivitis. This increase is a "favorable effect and has been associated with successful clinical outcomes," they said.
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