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Allergy and Immunology - Asthma and COPD

Tezepelumab for severe asthma (June 2021)

Tezepelumab, an investigational monoclonal antibody to thymic stromal lymphopoietin, has shown promise in reducing asthma exacerbations in patients with moderate-to-severe asthma. In a multicenter, randomized trial (NAVIGATOR) that included 1,059 adolescents and adults with severe uncontrolled asthma and a broad range of blood eosinophil counts, tezepelumab or placebo was administered subcutaneously every 4 weeks for 52 weeks; participants continued previously prescribed inhaled glucocorticoids and other nonbiologic controller medications without change [3]. The tezepelumab group had approximately 50% fewer asthma exacerbations, irrespective of baseline blood eosinophil counts. Asthma control, asthma-related quality of life, and lung function were also improved with tezepelumab. Other biologic agents for severe asthma are limited to patients with high blood eosinophil counts or high immunoglobulin E levels; tezepelumab holds promise for a broader spectrum of patients with severe asthma.

Allergy and Immunology - Immunodeficiency

Lentiviral gene therapy for ADA-SCID (June 2021)

Gene therapy is one of the preferred treatments for severe combined immunodeficiency (SCID) due to adenosine deaminase (ADA) deficiency, but there is a risk of leukemia-like complications from retroviral vectors. Lentiviral vectors, which lack strong enhancer elements that activate proto-oncogenes, should not have the same leukoproliferative complications. In a report of combined results from three phase I/II ADA gene therapy trials of 50 infants and young children who were transplanted using a self-inactivating lentiviral vector, treatment success was equal to or better than that historically seen with retroviral vectors (100 percent survival at 24 and 36 months with only two treatment failures) [4]. No leukoproliferative or other vector-related complications were noted. These findings suggest that lentiviral vectors appear to have similar success rates as retroviral vectors when used for gene therapy but with less risk of leukoproliferative adverse events.

Family Medicine - Adult General Internal Medicine

United States Preventive Services Task Force (USPSTF) recommendations on screening for hypertension (May 2021)

Hypertension is a common condition and risk factor for cardiovascular disease. The 2021 United States Preventive Services Task Force (USPSTF) recommendations on screening for hypertension in adults concluded that all individuals 18 years or older should be evaluated for hypertension, with confirmation by out-of-office blood pressures [2]. Annual evaluation is appropriate for adults 40 years and older or those with risk factors for hypertension, whereas less frequent assessment (every three to five years) is reasonable for younger adults with no risk factors and previously normal blood pressure. This recommendation from the USPSTF is generally consistent with advice from UpToDate.

REFERENCES

1. Lundgren JR, Janus C, Jensen SBK, et al Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. N Engl J Med 2021; 384:1719.

2. Krist AH, Davidson KW, et alUS Preventive Services Task Force Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2021; 325:1650. [Context Link]

3. Menzies-Gow A, Corren J, Bourdin A, et al Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma. N Engl J Med 2021; 384:1800. [Context Link]

4. Kohn DB, Booth C, Shaw KL, et al Autologous Ex Vivo Lentiviral Gene Therapy for Adenosine Deaminase Deficiency. N Engl J Med 2021; 384:2002. [Context Link]

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