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Does switching between severe asthma biologics have any additional value?

Published: April 25, 2022

Severe asthma is a form of asthma that does not respond or responds insufficiently to the current inhaled preventer medication of asthma. In recent years, several biologics have become available for the add-on treatment of patients with severe asthma. These agents inhibit the action of certain molecules (cytokines) that play a key role in asthma, and the efficacy of these agents has been convincingly demonstrated in well-conducted clinical trials. While a significant percentage of patients become completely symptom-free through these agents, a proportion still suffer from severe asthma attacks or continue to require daily corticosteroid tablets such as prednisone to control their disease. This is often a reason for the treating physician to switch from one biological to another, in the hope that this will lead to a further improvement of the asthma. The question whether switching between biologics has any additional value or not was recently explored in a study by Hashimoto et al, published in The Journal of Allergy and Clinical Immunology: In Practice.

They studied 134 adult Dutch patients with severe asthma, of whom detailed medical data had been collected in the national registry of severe asthma patients, RAPSODI. After removing identifying information from the data, they evaluated the real-life effectiveness of treatment with the biological agent reslizumab. Reslizumab is an FDA approved intravenously (i.v.) administered monoclonal antibody that inhibits the action of interleukin-5, one of the major cytokines responsible for the difficult-to-control airway inflammation of patients with severe asthma. The authors investigated the effect of 6 months treatment with reslizumab on the rate of severe asthma attacks and maintenance prednisone use both in patients who received reslizumab as their first add-on biologic, and those who had recently switched from another biologic. They also asked clinical asthma experts to complete a survey on their experience with reslizumab treatment in their patients.

Consistent with previous studies, the results showed that reslizumab significantly reduced the rate of severe asthma attacks, the maintenance dose of prednisolone, and the proportion of prednisone-dependent patients in individuals with severe asthma who received reslizumab as their first biologic treatment. More importantly, however, they observed a significant improvement in these outcomes in patients who switched from another biologic to treatment with reslizumab, even if this other biologic inhibited the same cytokine. The added value of reslizumab as a follow-up biologic was also confirmed by the severe asthma experts. The results of this study suggest that it may be worthwhile for clinicians to switch severe asthma patients who do not fully respond to one biologic to another biologic, even if these two biologics target the same cytokine.

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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