Favorable Treatment Response to Anti-IL-5 Biologics Seen in Severe Asthma

A majority of patients with severe eosinophilic asthma responded favorably to treatment with anti-interleukin-5 (IL-5) biologic agents after 2 years of therapy, according to study results published in The Journal of Allergy and Clinical Immunology: In Practice.

Investigators conducted a real-life, prospective, follow-up study in patients with severe asthma who visited the pulmonary outpatient clinics at 2 Dutch asthma expertise centers: Amsterdam University Medical Center and Medical Center Leeuwarden. The researchers sought to evaluate the following: (1) the prevalence and predictors of “super responders” (defined as patients with complete asthma control after 2 years of anti-IL-5 treatment), partial responders (defined as patients who did not fulfill criteria of nonresponders or super responders after 2 years of treatment), and nonresponders to long-term anti-IL-5 treatment in patients with severe asthma; (2) the frequency of and reasons for switches between various anti-IL-5 biologic agents in these individuals; and (3) the nature of residual disease manifestations in these patients.

Real-life data were analyzed from a total of 114 patients with severe eosinophilic asthma who were treated with a variety of anti-IL-5 biologic therapies (mepolizumab, reslizumab, benralizumab) for more than 2 years. Of those evaluated, 59% (67 of 114) did not switch anti-IL-5 biologic agents during the study period, 34% (39 of 114) switched to another anti-IL-5 therapy, and 7% (8 of 114) made 2 switches in anti-IL-5 agents.

Clinical, functional, and inflammatory characteristics were collected at baseline and at 2-year follow-up, along with patients’ comorbidities. Patients who were considered super responders demonstrated no manifestations of residual disease at 2 years. Partial responders experienced residual disease manifestations, whereas those who were nonresponders discontinued anti-IL-5 treatment at 2 years because of clinical worsening of their asthma.

Following 2 years of treatment with an anti-IL-5 biologic agent, a favorable response was reported in 83% of those with severe asthma, with 14% of them considered super responders. Most of those who were partial responders demonstrated impaired pulmonary function or uncontrolled sinonasal disease, which necessitated a switch in biologic agents.

The investigators concluded that although anti-IL-5 biologic therapy effectively reduces exacerbations and the use of glucocorticoids in patients with eosinophilic asthma, in real-life situations, many individuals continue to experience bothersome manifestations of their disease despite the use of these agents and may require additional treatments. Future biologic therapies in this patient population are warranted that simultaneously inhibit multiple inflammatory pathways, thus providing a more complete resolution of severe asthma symptoms and comorbidities.

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

Reference

Eger K, Kroes JA, ten Brinke A, Bel EH. Long-term therapy response to anti-interleukin-5 biologics in severe asthma – a real-life evaluation. Published online October 15, 2020. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2020.10.010