Treating asthma in the time of COVID - 05/04/23
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for the
Precision Interventions for Severe and/or Exacerbation-Prone Asthma Network Research Group
Abstract |
The Precision Interventions for Severe and/or Exacerbation-Prone Asthma clinical trials network is actively assessing novel treatments for severe asthma during the coronavirus disease (COVID-19) pandemic and has needed to adapt to various clinical dilemmas posed by the COVID-19 pandemic. Pharmacologic interactions between established asthma therapies and novel drug interventions for COVID-19 infection, including antivirals, biologics, and vaccines, have emerged as a critical and unanticipated issue in the clinical care of asthma. In particular, impaired metabolism of some long-acting beta-2 agonists by the cytochrome P4503A4 enzyme in the setting of antiviral treatment using ritonavir-boosted nirmatrelvir (NVM/r, brand name Paxlovid) may increase risk for adverse cardiovascular events. Although available data have documented the potential for such interactions, these issues are largely unappreciated by clinicians who treat asthma, or those dispensing COVID-19 interventions in patients who happen to have asthma. Because these drug-drug interactions have not previously been relevant to patient care, clinicians have had no guidance on management strategies to reduce potentially serious interactions between treatments for asthma and COVID-19. The Precision Interventions for Severe and/or Exacerbation-Prone Asthma network considered the available literature and product information, and herein share our considerations and plans for treating asthma within the context of these novel COVID-19–related therapies.
Il testo completo di questo articolo è disponibile in PDF.Key words : Asthma, ritonavir, COVID-19, salmeterol, cytochrome P450, interaction, CYP3A4, long-acting beta-adrenergic agonist, corticosteroids
Abbreviations used : COVID-19, CYP3A4, ICS, LABA, NVM/r, PrecISE Asthma, SARS-CoV-2
Mappa
The PrecISE Asthma study is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health (grant nos. U24 HL138998, 1UG1HL139054, 1UG1HL139098, 1UG1HL139106, 1UG1HL139117, 1UG1HL139118, 1UG1HL139119, 1UG1HL139123, 1UG1HL139124, 1UG1HL139125, 1UG1HL139126, and 1UG1HL146002). Support for site institutional infrastructure came from National Institute of Health Clinical & Translational Science Award (grant nos. UL1TR002451 [Harvard], UL1TR000427 [University of Wisconsin], UL1TR002366 [University of Kansas], UL1TR002389 [University of Chicago], UL1TR002489 [University of North Carolina], UL1TR002548 [Cleveland Clinic], and UL1TR001442 [University of California, San Diego]). The study also gratefully acknowledges receiving contributed product from Vitaeris, owned and operated by the CSL Group (clazakizumab), Vitaflo (MCT), Sun Pharma (imatinib), OM Pharma, a Vifor Pharma Group Company (OM-85, BronchoVaxom), Incyte (itacitinib), Laurel Venture (cavosonstat), and GlaxoSmithKline (Advair Diskus and Ventolin). |
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Disclosure of potential conflict of interest: T. F. Carr has served in an advisory role or as a consultant for AstraZeneca, Genentech, GlaxoSmithKline (GSK), Novartis, and Regeneron and as a writer and editor for Wolters Kluwer UpToDate. M. Kraft has received research funding paid to her institution from the National Institutes of Health, ALA, Sanofi, AstraZeneca, Synairgen, and Janssen; served on an advisory board for AstraZeneca, Sanofi, Chiesi, and Synairgen; has received fees for speaking for Chiesi, AstraZeneca, and Sanofi; is cofounder and CMO, RaeSedo, Inc, a company evaluating peptidomimetics for treatment of inflammatory lung disease; and payments from Elsevier for UptoDate, where she is a section editor for asthma. W. Phipatanakul has served in advisory capacity for Genentech, Novartis, Sanofi, Regenron, Teva, Astra Zeneca, and GSK. S. J. Szefler reports consultant fees paid to the university from AstraZeneca, GSK, Moderna, OM Pharma, Propeller Health, Regeneron Pharmaceuticals, Inc, and Sanofi. A. A. Zeki reports serving as CSO for InStatin, Inc; and on Sanofi/Regeneron consulting and advisory boards. D. P. Beden has served as a consultant for Teva and GSK and receives grant support from the National Heart, Lung, and Blood Institute, National Institute of Environmental Health Sciences, National Institute of Allergy and Infectious Diseases, Department of Defense, and Environmental Protection Agency. S. R. White has served as a consultant and speaker for AstraZeneca, Sanofi, and Regeneron. M. L. Fajt has no relevant conflicts of interest. |
Vol 151 - N° 4
P. 809-817 - Aprile 2023 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.