Assessing Biologic Therapy in Asthma With/Without CRS in a Real-World Setting

After careful consideration, the American Academy of Allergy, Asthma & Immunology canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from March 13 to 16, because of concerns regarding the coronavirus disease 2019 (COVID-19) outbreak. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting.

In a real-world setting, biologic agents offered diverse clinical benefits in patients with asthma with and without chronic rhinosinusitis (CRS), according to real-world study findings intended to be presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.

Recognizing that respiratory tract infections often lead to exacerbations of asthma, investigators sought to assess the frequency of sinopulmonary infections in individuals who are treated with biologic agents for asthma and/or CRS. A total of 61 patients with moderate to severe persistent asthma and/or CRS who were treated with mepolizumab (n=36), dupilumab (n=20), benralizumab (n=11), or reslizumab (n=1) were evaluated, with 7 individuals switching biologic agents and evaluated on each therapy. Overall, 35 patients were followed prospectively.

Sinopulmonary infections were evaluated based on the number of antibiotic courses used. Asthma control was assessed by asthma control questionnaire-6 (ACQ-6), number of asthma exacerbations, and spirometry. The Sino-Nasal Outcome Test-22 (SNOT-22) was used to evaluate the presence of sinonasal disease.

Overall, 77% of the patients had comorbid asthma and CRS. Pre-treatment and post-treatment antibiotic courses per month were decreased with the use of mepolizumab (0.08 vs 0.07, respectively; P <.01; median, 26 months) and dupilumab (0.08 vs 0.00, respectively; P =.03; median, 3 months). Moreover, the number of asthma exacerbations per month was reduced after the initiation of mepolizumab therapy (0.25 vs 0.12; P <.01) and dupilumab (0.33 vs 0.00; P <.05).

In addition, forced expiratory volume in 1 second (FEV₁) improved with the use of mepolizumab (1.67 L vs 2.13 L; P <.01) and with the use of dupilumab (1.87 L vs 2.18 L; P =.03). Further, median ACQ-6 scores improved with dupilumab therapy (2.30 vs 0.75; P =.04) and with benralizumab therapy (3.0 vs 0.33; P =.01). The use of dupilumab also was associated with reductions in SNOT-22 scores (52 vs 39; P <.01).

The investigators concluded that based on the results of this analysis future prospective studies are warranted, with larger samples of patients, to more clearly differentiate individual biologic-associated outcomes.

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Reference

Patel G, McGrath K, Yeh C, Rosenblum D, Kalhan R, Peters A. Real-world clinical experience of biologics used in moderate-to-severe persistent asthma in patients with and without chronic rhinosinusitis at an academic tertiary care center. J Allergy Clin Immunol. 2020;145(Suppl 2):AB149.