Biologic Therapies Enhance Clinical Outcomes in Severe Asthma: Study Findings
Patients grappling with severe asthma experienced notable enhancements in clinical outcomes following a 12-month treatment regimen with omalizumab, benralizumab, or mepolizumab, with the proportion of complete responders exhibiting an uptick during long-term follow-up.
The findings stem from a single-center retrospective cohort study published in the Annals of Medicine.1
Key Insights:
- Biologic therapies exhibit promise as a treatment avenue for severe asthma, with 35.5% of patients achieving complete response after 55 months of treatment.
- Airflow obstruction emerged as a primary obstacle to achieving complete response with biologic therapies.
- Further exploration is warranted to assess the clinical advantages of switching biologics or the ramifications of biologic discontinuation.
The researchers noted, "These findings demonstrate an improvement across all asthma control parameters after 12 months of treatment among the overall study cohort." They added that these outcomes align with those reported in real-world clinical studies and systematic reviews, underscoring the efficacy of mepolizumab, benralizumab, and omalizumab as asthma therapies.
The advent of novel biological therapies, coupled with advances in biomarkers, has ushered in a new era of targeted and individualized treatment options for severe asthma. Presently, five biologics have garnered approval for severe eosinophilic asthma: benralizumab, dupilumab, mepolizumab, omalizumab, and reslizumab.
In this investigation, the researchers aimed to assess the clinical profiles of complete responders versus noncomplete responders to long-term treatment with omalizumab, benralizumab, and mepolizumab within a real-world setting.
The study cohort comprised patients from an acute tertiary care hospital in Barcelona, Spain, who initiated biologic therapy for a minimum of 6 months and underwent follow-up for at least 12 months post-initiation. Patient follow-up extended until March 2022.
The efficacy of treatments was gauged using various clinical parameters, including exacerbation frequency (evaluated via Asthma Control Test [ACT] scores), lung function, utilization of maintenance oral corticosteroids (mOCS), fractional exhaled nitric oxide levels, and blood eosinophil counts at baseline, 12 months, and the conclusion of follow-up.
Complete response to treatment was delineated by the absence of exacerbations or mOCS usage, an ACT score surpassing 20, and forced expiratory volume in one second (FEV1) exceeding 80% of the predicted value.
Among the 97 patients meeting inclusion criteria and receiving biologic treatment, 44 received omalizumab, 24 benralizumab, and 22 mepolizumab. Most patients were female (73%), with a mean age of 55.3 years.
Following a 12-month treatment period, 27.2% of patients attained complete response, a figure that rose to 35.5% over an average follow-up duration of 55 months.
The rates of complete response varied across treatments: 30.2% for omalizumab, 30.4% for benralizumab, and 52.6% for mepolizumab.
Long-term complete response correlated with improved lung function in patients treated with mepolizumab and omalizumab, whereas fewer prior exacerbations were associated with long-term complete response in benralizumab recipients.
Moreover, airflow obstruction, detected in 32.5% of cases at 12 months and 34.5% at follow-up's conclusion, emerged as the primary impediment to achieving complete treatment response.
Despite these promising findings, the study has limitations, including its retrospective nature, small sample size, and the persistence of pulmonary function improvement and lung remodeling as unmet needs to attain clinical remission in biologic-treated patients.
The researchers advocate for further investigation into the clinical benefits of switching biologics or discontinuing their use. They assert that long-term clinical remission should be considered a therapeutic objective in asthma treatment studies, emphasizing the importance of data on sustained complete response to enhance personalized care.
Despite these constraints, the study underscores the substantive improvements in clinical outcomes afforded by biologic therapies in severe asthma management.
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