Ireland has the fourth highest prevalence of asthma globally, with over 470,000 people with an asthma diagnosis. 1 In general, asthma symptoms can be controlled with inhaled corticosteroids, with the addition of a long-acting β 2 -agonist as indicated, alongside other agents including long-acting anti-muscarinic agents and anti-leukotrienes. 2 The GINA 2021 Guidelines state that many cases of difficult-to-treat-asthma are partly secondary to modifiable factors such as incorrect inhaler technique. An important distinction is that in severe refractory asthma, a subset of difficult-to-treat-asthma, despite adherence to maximized optimal therapies and the treatment of contributory factors, asthma remains uncontrolled. 3 In this subset of patients, symptoms remain inadequately controlled despite maximum conventional therapy and adherence, with 3-10% considered to have severe refractory disease. 4 A number of biological agents targeting the components of type 2 inflammation have been transformative in the management of severe refractory asthma. 5 Omalizumab, the first such agent to be approved for use in severe allergic asthma, is a humanized anti-immunoglobulin E (IgE) antibody. 2 In Ireland, omalizumab is not reimbursed by national bodies but paid for directly by individual hospital budgets, potentially limiting access for patients.Anti-interleukin-5 (IL-5) therapies were first approved for use in Ireland in 2018 and there are currently three agents available for treating adults with severe eosinophilic asthma that is inadequately controlled despite maximum conventional therapy. Mepolizumab and reslizumab target IL-5, 4 whereas benralizumab is an anti-eosinophil monoclonal antibody that binds to the alpha subunit of the IL-5 receptor. 6 Irish guidelines state that patients may be eligible for anti-IL-5 therapy if they have a confirmed diagnosis of severe refractory eosinophilic asthma by a respiratory physician, they have been fully adherent to maintenance therapy, the blood eosinophil count is elevated, and they have had two or more exacerbations in the previous 12 months requiring systemic corticosteroids. 7,8 We performed a retrospective, observational, single-centre review of clinical outcomes in patients switched from omalizumab to an anti-IL-5 therapy in a regional specialist asthma centre in Cork University Hospital, Ireland. This study was approved by the Clinical Research Ethics Committee, University College Cork. Informed consent was obtained from each of the included patients. The study complied with the Declaration of Helsinki. Clinical outcomes in severe eosinophilic asthmatics who remained suboptimally controlled despite omalizumab and were therefore switched to an anti-IL-5 therapy were assessed. Suboptimal control was defined as inadequate control of a patient's asthma and/or multiple exacerbations despite omalizumab.All patients ≥18 years old who switched therapy in our centre from 2018 to 2020 were included. The parameters assessed included the Asthma Control Questionnaire (ACQ) score, annual commun...
IntroductionApproximately 3%–10% of asthma patients will remain uncontrolled despite maximum, optimal conventional therapy. Treatment of severe refractory asthma often involves the use of targeted biological therapy. Randomised controlled trials have shown improvements in clinical parameters with these treatments but real-world data is lacking.MethodsThe clinical parameters, frequency of exacerbations, number of hospital admissions, asthma control questionnaire score (ACQ), forced expiratory volume in one second (FEV1) and maintenance oral corticosteroid (OCS) dose of twenty asthma patients switched from reslizumab to benralizumab or mepolizumab at 1 year prior and 6 months after switching were compared, with adjustments for time.ResultsThe mean frequency of exacerbations (0.35 v 0.3) and the mean ACQ were essentially unchanged (1.6 v 1.5) following the switch. The number of hospital admissions was one in the 6 months post switch compared to one in 1-year pre switch. 25% of patients were on maintenance OCS before and after switching but one patient required an increased dose post switch resulting in an increase in the mean maintenance OCS dose (1.6 mg to 2.4 mg). The mean FEV1 was unchanged (80% v 77.9%) six months post switching. Regarding asthma control (n = 19), 47.4% were controlled pre and post switch (ACQ < 1.5), 36.8% remained uncontrolled despite switching, 10.5% improved control while 5.3% disimproved.ConclusionWe present real-world clinical outcomes of asthma patients switched from reslizumab to either benralizumab or mepolizumab without a loss of clinical effectiveness in the majority.
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