Patients with aspirin-exacerbated respiratory disease (AERD) who repeatedly need to use systemic corticosteroids (SCS) to control respiratory and nasal symptoms may benefit from early initiation of a respiratory biologic agent, according to study findings published in Annals of Allergy, Asthma & Immunology.
AERD is a chronic respiratory disorder characterized by: (1) chronic rhinosinusitis with nasal polyposis (CRSwNP); (2) asthma; and (3) respiratory reactions to aspirin and other cyclooxygenase-1 (COX-1) inhibitors. Patients unable to control AERD with standard treatment for asthma and sinus disease and avoidance of COX-1 inhibitors may require multiple surgeries and systemic corticosteroids (SCS), which are associated with an array of adverse effects. Notably, recent research suggests that biologics may show promise in treating AERD, although no studies have assessed the effect of biologic therapy on levels of SCS use in individuals with AERD.
To address this, researchers at the Scripps Clinic in San Diego, California, conducted a retrospective chart review to assess the effect of biologic initiation on use of SCS. The study compared SCS use in the 12 months before and after initiation of biologics for AERD in 32 patients who they identified as having been on a course of biologic therapy that lasted for at least 12 months. Biologic agents used by these individuals included dupilumab (n=23), omalizumab (n=5), benralizumab (n=2), and mepolizumab (n=2); reslizumab and texepelumab were not prescribed to any participants.
In the 12 months prior to and following initiation of the biologic agent, information on total SCS use — including the agent used, the dose, and the treatment duration — was obtained for study participants. Prior to starting the biologic agent, all 32 study group participants had needed at least 1 course of SCS for AERD — that is, prednisone, intravenous methylprednisolone, and/or intramuscular triamcinolone. The primary study outcome was median cumulative exposure in the 12 months before and after the initiation of biologic therapy.
The median cumulative steroid exposure among study group participants was 215 mg in the 12 months prior to and 0 mg in the 12 months following initiation of a biologic agent, with a median pre-post change of –178.2 mg (P <.0001). Among the biologic agents used, the change was significant in the dupilumab-treated group, with a median pre-post change of –156.3 mg (P =.0008). In the 5 omalizumab-treated participants, the median pre-post change was –300 mg (P =.18).
Limitations of the study include its small sample sizes and lack of patient stratification based on indications for SCS use (ie, CRSwNP vs asthma).
The results of this study “suggest that patients requiring repeated exposure to SCS may benefit from early initiation of a respiratory biologic agent in management of AERD,” the study authors concluded. They also suggested the need for a larger, controlled, prospective study exploring the effects of individual biologic agents on AERD control, as well as studies evaluating the usefulness of aspirin desensitization therapy along with biologic therapy.
Disclosure: One the study author has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
Ghiasi Y, Wangberg H, Bagsic SRS, White A. Type 2 biologics reduce cumulative steroid exposure in AERD. Ann Allergy Asthma Immunol. Published online July 28, 2022.: 10.1016/j.anai.2022.07.023.