COVID-19 and biologics in severe asthma: data from the Belgian Severe Asthma Registry

Abstract

Epidemiological studies suggest that patients with asthma are not at an increased risk of severe coronavirus disease 2019 (COVID-19) caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1–3]. Recent studies indicate that the severity of COVID-19 in patients with asthma is likely to depend on multiple factors. A type 2-low asthma phenotype, use of oral corticosteroids and severe asthma could be aggravating factors, while maintenance treatment with inhaled corticosteroids (ICS) and good asthma control are probably protective [4]. However, there is currently scarce information on the risk associated with COVID-19 in subjects with severe asthma and/or the use of biologics. Since eosinopenia is a biomarker for the severity of COVID-19 [5], the eosinophil depletion induced by anti-IL5 and anti-IL5 receptor blocking monoclonal antibodies raises concern in patients and their treating physicians.

Asthma and COVID-19: do we finally have answers?

“…Only two out of 20 infected patients on asthma biologics (10%) were hospitalised. While these numbers are small, they are consistent with other reports suggesting that there is no increased risk of a poor outcome in asthma patients on biologics [ 21 , 26 ].…”

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

“…Only three patients received oxygen supplementation. Additionally, there was no difference in the incidence of SARS-CoV-2 infection between asthmatic patients who were on treatment with biologic therapy (four patients received anti-IgE and seven patients received anti-IL-5 or anti-IL-5R) and asthmatic patients not on treatment with biologics ( Hanon et al, 2020 ). On the other hand, nine patients from the Dutch Severe Asthma Registry under biological treatment received a diagnosis of COVID-19, seven of them were hospitalized, and five entered to ICU.…”

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

“…Biologics may be protective both against the SARS-CoV-2 infection, by downregulating the angiotensin converting enzyme (ACE)2 (115) and the SARS-CoV-2-induced inflammatory response (116). Indeed, a low prevalence of COVID-19 was observed in European severe asthma cohorts (117,118), although a recent report suggests that severe asthmatics receiving biologic treatments may suffer from a more severe disease compared with the general population (119). Current international guidelines suggest that all patients with asthma should be considered eligible for the approved mRNA COVID-19 vaccines (120).…”