Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion

Abstract

Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an

Biologic Therapies for Severe Asthma

“…In patients with oral glucocorticoid-dependent severe asthma, the percentage reduction in the glucocorticoid dose with maintenance of asthma control is a critical outcome measure. 73 In addition, use of health care services, degree The management of uncontrolled severe asthma encompasses multiple steps: first, confirming the diagnosis by differentiating difficult-to-treat asthma from severe asthma; second, determining the phenotype of severe asthma by integrating clinical characteristics, biomarkers, and coexisting conditions in order to choose the appropriate initial biologic therapy 72 ; and finally, monitoring the therapeutic response and side effects to decide whether the biologic agent should be continued or stopped (and switched, if feasible). An increasing blood eosinophil count indicates improvement in the treatment response to the biologic agent.…”

Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

“…The development of monoclonal antibodies aimed at specific underlying biological mechanisms has led to substantial reductions in symptoms and exacerbations (and associated hospital admissions) in some subsets of patients with severe refractory asthma. 27 This precision approach has been widely discussed but infrequently tested in patients with COPD.…”

Eosinophilia Induced by Blocking the IL-4/IL-13 Pathway: Potential Mechanisms and Clinical Outcomes

“…In such cases, an anti-IL-5/IL-5R agent is preferable, as recommended in the EAACI guidelines on biologics for treatment of severe asthma [103]. Furthermore, dupilumab should not be used in severe asthma with hypereosinophilia, as this was an exclusion criterion in the pivotal clinical trials [80][81][82] and a recommendation in recent algorithms [5,104,105]. A similar approach should be adopted when considering changing from an anti-IL-5/5R agent to an anti-IL-4/13 agent.…”