Can Biologics Cut Steroid Exposure in Aspirin-Exacerbated Respiratory Disease?

Biologic therapy may reduce cumulative systemic steroid exposure in aspirin-exacerbated respiratory disease (AERD), according to authors of a retrospective study  presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, from November 4 to 8.

To assess whether the cumulative systemic corticosteroid exposure in patients with AERD differs after initiating a respiratory biologic therapy, the investigators conducted a retrospective chart review of patients who received biologic therapy lasting at least 12 months.

Total systemic corticosteroid use in the 12-month period before and after initiation of 1 of the 5 respiratory biologic therapies approved by the US Food and Drug Administration. The primary outcome was median cumulative corticosteroid exposure pre- and post-initiation of the biologic therapy.

In total, 32 patients initiated a biologic therapy (omalizumab, n=5; dupilumab, n=23; benralizumab, n=2; and mepolizumab, n=2). Prior to starting biologic therapy, the median cumulative steroid exposure was 215 mg, while after initiating therapy, it was 0 mg, yielding a median change of −178.2 mg (P <.0001).

In comparing outcomes with specific biologic agents, the researchers found a significant change among patients receiving dupilumab (median change in steroid exposure, −156.3 mg; P =.0008). Patients receiving treatment with omalizumab had a median change of −300 mg; P =.18). Due to the small sample sizes, statistical analyses could not be performed on the data from patients receiving benralizumab and mepolizumab (median change, −835 mg and −697.5 mg, respectively).

“Biologic therapy in AERD appears to significantly reduce cumulative steroid exposure in the 12-month period following initiation,” the investigators concluded.

Reference

Ghiasi Y, Wangberg H, Spierling Bagsic S, White A. A new frontier: Do biologics reduce cumulative steroid exposure in AERD? Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P025.