“Real-life” management of patients with severe asthma in the biologics era: Can we do better?

Abstract

Background Discrepancies exist between guidelines and real-life practice in severe asthma. Objectives: To establish profiles for severe asthma patients according to their maintenance therapies and identify unmet needs. Methods 2432 French lung specialists and allergists were invited to participate in a severe asthma survey between March and April 2018. Retrospective data were collected using an electronic case report form developed by IQVIA. Results 71 respiratory physicians and/or allergists participated in the study, providing data for 736 severe asthma patients. The annual mean rates of hospitalization and exacerbation in the previous year were 0.65 (SD = 0.5) and 2.25 (SD = 1.0), respectively. One hundred one (13.7%) patients were treated with oral steroids; the mean dosage regimen was 16.1 mg per day (SD = 11.2). ICS-LABA-LAMA triple inhaled therapy was reported for 288 patients (39%); 231 patients (31.4%) had one biologic in their maintenance treatment. Among patients hospitalized at least once in the previous year (n = 311), 89 (28.5%) were currently treated with biologics, and 61 (19.6%) with oral steroids. One hundred sixty-six patients with uncontrolled asthma and no current biologic therapy had data for “T2 status”; 78 (47%), 89 (53.6%) and 137 (82.5%) of them had treatment criteria respectively for an anti -IgE, anti -IL5-pathway or anti -IL-4/IL-13 pathway therapy; 22 (13.2%) were ineligible for any current biologic according to biomarkers. Conclusion Our study updated “real-life” therapeutic management data for severe asthma in France in 2018. We highlighted a need for improved patient-phenotyping. This work also gives a striking insight of the position of current and forthcoming biologics.

Assessment of dupilumab in children with moderate‐to‐severe type 2 asthma with or without evidence of allergic asthma

“…Patients with evidence of allergic asthma demonstrated clinically meaningful responses to dupilumab treatment, supporting the role of IL‐4 and IL‐13, and thus type 2 inflammation, as key drivers of certain patients with allergic asthma. The position of dupilumab among other biologics in severe allergic pediatric asthma remains to be determined by comparative studies, aimed at identifying the most appropriate biomarkers of responsiveness 19,20 …”

Evidence-Based Approach of Biologic Therapy in Bronchial Asthma

“…Current literature reviewing randomized controlled trials (RCTs) suggests that traditional non-biologic therapies are efficacious in improving outcomes of most patients with severe asthma [ 8 ]. GINA 2021 guidelines and the National Asthma Education and Prevention Program (NAEPP) recommend the use of inhaled corticosteroids or beta-agonists in the initial treatment of asthma [ 1 , 9 ]. If symptoms persist and asthma exacerbations remain uncontrolled, long-acting muscarinic antagonists may be employed in addition to the above therapies [ 1 , 9 ].…”

“…GINA 2021 guidelines and the National Asthma Education and Prevention Program (NAEPP) recommend the use of inhaled corticosteroids or beta-agonists in the initial treatment of asthma [ 1 , 9 ]. If symptoms persist and asthma exacerbations remain uncontrolled, long-acting muscarinic antagonists may be employed in addition to the above therapies [ 1 , 9 ]. Until the development of the first biologic agents, such as omalizumab, in the early 2000s, oral corticosteroids were the last line of defense in the treatment of severe asthma.…”

Packaging and Delivery of Asthma Therapeutics

“…However, with the exception of benralizumab, some studies do not reach sufficient statistical power to make concrete determinations of biologic utility for all cases [82]. Moreover, there are patient phenotypes featuring a distinct lack of response biomarkers that are unresponsive even to biologics and these patients may also be resistant to typical ICS+LABA therapy [85]. But, if the patient has a responsive phenotype, combinations of ICS with biologics or even biologics alone could provide reductions in exacerbation with relatively fewer side effects.…”