Combination Biologic Therapy in Severe Asthma: A Case Series

Thomes, R.; Darveaux, Jared I.

doi:10.1016/j.anai.2018.09.297

Cited by 9 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Development of newer agents targeting different pathways has made it possible to use combination therapy in selected patients. Simultaneous use of more than one biological agent has been used in two main scenarios: patients with severe inflammatory disease unresponsive to a single biological agent, or patients with co-existing severe medical conditions, such as Inflammatory Bowel Disease [ 2–4 ], asthma [ 5 , 6 ] and psoriasis [ 7 ]. There is limited real world evidence from case-based literature on combining biological therapies across different clinical specialties.…”

Section: Introductionmentioning

confidence: 99%

Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series

Malik

Jones

Williams

et al. 2022

Rheumatology Advances in Practice

View full text Add to dashboard Cite

Objectives Combination biological therapies are being increasingly considered for patients with multiple comorbidities requiring biologics. There is limited data available on this approach and concerns remain about the possible risk of adverse events, particularly infection. Methods We present three patients on dual biologics for rheumatic disease and asthma. The biologic combinations used include etanercept and mepolizumab, infliximab and omalizumab and etanercept and omalizumab. The time on combination biologic therapies ranges from 24 to 36 months. Patient were monitored for any serious adverse events. Results All three patients were able to tolerate combined biologic therapies, with no serious adverse events. All three patients gained improvement in their rheumatic and asthma disease control, with reduction in disease activity scores and reduction in steroid usage. Conclusion The decision to start dual biologic therapy should be carefully considered on a case-by case basis. The number of patients who are on combination biological therapy is small and data is sparse. Real world data is needed to examine the long-term benefits and risks of different forms of combination biologic therapies. Lay summary What does this mean for patients ? Biological therapies are specific therapies that target particular parts of the immune system. These medications are used in the treatment of autoimmune conditions like rheumatoid arthritis. In rheumatoid arthritis they work by stopping particular chemicals in blood from activating the immune system to attack joints. They are very effective medications which treat inflammatory autoimmune conditions. In some cases, they may be associated with side effects, particularly increased risk of infections. We have written a case series about three people who have inflammatory autoimmune conditions and are receiving two biologics to treat these. All three people have inflammatory arthritis and asthma and are receiving two different biological therapies. They have been receiving these for a period ranging from 24 to 36 months. All three people have been able to tolerate combined biologic therapies with no serious adverse events thus far. They have gained improvement in their arthritis and asthma control, with reduction in disease activity and the use of steroids. Although the number of people receiving more than one biological treatment is small, this study suggests that dual therapy could be used in certain situations. The decision to start dual biologic therapy should be carefully considered on a case-by case basis by the specialists.

show abstract

Section: Introductionmentioning

confidence: 99%

Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series

Malik

Jones

Williams

et al. 2022

Rheumatology Advances in Practice

View full text Add to dashboard Cite

show abstract

“…In a series of case reports, patients with severe asthma and comorbid disease (i.e. atopic dermatitis, CRSwNP, and AERD) who remained refractory despite maximal controller therapy, systemic steroids, and biologic monotherapy demonstrated marked improvement in symptom control, reduced asthma exacerbations, and reduced steroid use after the addition of a second biologic from a different class [ 98 , 99 ]. Combinations of biologics from different classes were determined by treatable traits and included omalizumab and dupilumab, mepolizumab and omalizumab, and benralizumab and omalizumab [ 98 ].…”

Section: Discussionmentioning

confidence: 99%

Canadian multidisciplinary expert consensus on the use of biologics in upper airways: A Delphi study

Thamboo

Lee

Bhutani

et al. 2023

Journal of Otolaryngology - Head & Neck Surgery

View full text Add to dashboard Cite

Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ($$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract

show abstract

“…The literature describing the use of dual biologics for these or other overlapping conditions is currently limited to 16 articles identified by our search (Table 3). [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] In total, these articles summarize 45 patients on dual biologic therapy. The search did not reveal any randomized controlled trials to date, but are currently 12 case reports, 2 case series and 2 retrospective reviews.…”

Section: Pulmonology/allergymentioning

confidence: 99%

Review of Dual Biologics in Specialty Pharmacy Practice

Quiroga

Sabourin

2023

Ann Pharmacother

View full text Add to dashboard Cite

Objective: To describe and review the published evidence on use of multiple biologics within specialty pharmacy practice. Data Sources: A search of PubMed and Embase was conducted from October 2021 through September 2022. Keywords included biologics for immune-mediated conditions along with the terms “dual,” “add-on,” and “combination.” Study Selection and Data Extraction: All human studies in the English language were considered. Published abstracts, case reports, case series, randomized controlled trials, systematic reviews, and meta-analyses were included. Data Synthesis: Although evidence is limited, there are published meta-analyses of combined biologic use within gastroenterology and rheumatology. There are also numerous case reports within dermatology. Clinical trials of dual biologics for severe rheumatologic conditions and inflammatory bowel disease are in progress. Existing evidence for use in pulmonology and allergy suggest dual biologic therapy can be safe and effective, but data are limited. Literature describing use of monoclonal antibodies for other overlapping conditions is lacking. Relevance to Patient Care and Clinical Practice: This article reviews the evidence describing combination biologic use and outlines remaining knowledge gaps. It also describes the essential role that specialty pharmacists play in managing therapeutic mAbs. Conclusions: High-quality evidence describing combination biologic use is limited and long-term safety data are lacking. Pharmacists should utilize their specialized training to assess appropriateness of therapy, provide patient counseling and monitor for safety and efficacy.

show abstract

Combination Biologic Therapy in Severe Asthma: A Case Series

Cited by 9 publications

References 0 publications

Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series

Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series

Canadian multidisciplinary expert consensus on the use of biologics in upper airways: A Delphi study

Review of Dual Biologics in Specialty Pharmacy Practice

Contact Info

Product

Resources

About