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Comparing the efficacy of biologic therapies in aspirin-exacerbated respiratory disease

Published: September 28, 2021

Aspirin-exacerbated respiratory disease (AERD) is a chronic condition presenting with asthma, sinus disease with nasal polyps, and worsening respiratory symptoms in response to nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin. AERD is often difficult to control despite currently available medical and surgical therapies. Biologic therapies omalizumab, benralizumab, reslizumab, mepolizumab, and dupilumab have been proposed as treatment options for this debilitating respiratory disease, though there is limited research exploring their comparative efficacy in AERD.

In a retrospective pilot study published in The Journal of Allergy & Clinical Immunology: In Practice, Wangberg and colleagues explored various clinical outcomes among a cohort of 74 AERD subjects who had used one or more of these respiratory biologic therapies.  Outcomes explored included the symptoms reported by the patient, the number of emergency room visits and hospitalizations, and prescriptions for antibiotics and systemic corticosteroids (CS) used to treat AERD exacerbations pre- versus post-initiation of biologic therapy. The duration of biologic use was also investigated.

This study found that dupilumab therapy in AERD was associated with significantly higher rates of clinical improvement relative to other respiratory biologic therapies. There was a significant overall median reduction in CS bursts (2 to 0) (p<0.0001), median number of antibiotics prescribed (1 to 0) (p=0.05), with improved ratings of sense of smell and taste (5 to 1, p<0.0001) pre-versus post-initiation of dupilumab therapy. Comparatively, these findings were not observed for AERD subjects prescribed omalizumab, mepolizumab, reslizumab or benralizumab. This study observed high rates of discontinuing therapy with mepolizumab, reslizumab, and benralizumab. While this study suggests superior efficacy of dupilumab in AERD, prospective studies would be useful to validate these findings.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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