Patients with uncontrolled severe allergic asthma who received the biologic agents benralizumab, dupilumab, or omalizumab experienced lower asthma exacerbation rates, according to systematic review results published in Allergy.

The researchers conducted a systematic review by searching the MEDLINE, EMBASE, and CENTRAL databases for studies evaluating the evidence of efficacy, safety, and cost effectiveness of benralizumab, dupilumab, and omalizumab for use in patients with uncontrolled severe allergic asthma. The quality of the evidence of efficacy, safety, and economic effect was then rated as high, moderate, low, or very low for each outcome and compared between the biologic agents.

Of the 3441 initial unique search hits, 37 publications from 28 randomized controlled trials were included in the analysis, including 3 trials of benralizumab, 1 trial of dupilumab, and 24 trials of omalizumab. When the efficacy of reducing the asthma exacerbation rate was evaluated, all 3 biologic agents reduced asthma exacerbation rates compared with standard of care with a high certainty of evidence. When asthma control was evaluated, both benralizumab and dupilumab improved asthma control compared with standard of care with a high certainty of evidence, while omalizumab had a high to moderate certainty of evidence.

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“Despite [biologics] showing an improvement in asthma related critical and important outcomes, the observed overall effect is relatively modest (reducing exacerbations but only probably improving asthma control, quality of life, or lung function),” the researchers wrote. “Given the high cost of these drugs their use will probably be limited to very specific circumstances (eg, patients with severe asthma uncontrolled under standard treatment).”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Agache I, Rocha C, Beltran J, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma [WU1] [WU2] [published online February 16, 2020]. Allergy. doi:10.1111/all.14235