TY - JOUR
T1 - Real-World Effectiveness of IL-5/5Ra Targeted Biologics in Severe Eosinophilic Asthma With Comorbid Bronchiectasis
AU - Bendien, Sarah A.
AU - Kroes, Johannes A.
AU - van Hal, Lotte H. G.
AU - Braunstahl, Gert-Jan
AU - Broeders, Marielle E. A. C.
AU - Oud, Karen T. M.
AU - Patberg, Kornelis Wiebe
AU - Smeenk, Frank W. J. M.
AU - van Veen, Ilonka H. P. A. A.
AU - Weersink, Els J. M.
AU - Fieten, Karin B.
AU - Hashimoto, Simone
AU - van Veen, Anneke
AU - Sont, Jaap K.
AU - van Huisstede, Astrid
AU - van de Ven, Marjo J. T.
AU - Langeveld, Bas
AU - Maitland-van der Zee, Anke-Hilse
AU - Registry of Adult Patients With Severe Asthma for Optimal Disease Management Team
AU - ten Brinke, Anneke
N1 - Publisher Copyright: © 2023 American Academy of Allergy, Asthma & Immunology
PY - 2023/9
Y1 - 2023/9
N2 - Background: Bronchiectasis is a common comorbidity in patients with asthma and is associated with increased disease severity. In patients with severe eosinophilic asthma, biologics targeting IL-5/5Ra have beneficial effects on oral corticosteroid (OCS) use and exacerbation frequency. However, how coexisting bronchiectasis affects the response to such treatments is unknown. Objective: To evaluate the real-world effectiveness of anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma and comorbid bronchiectasis on exacerbation frequency and daily maintenance and cumulative OCS dose. Methods: This real-world study evaluated data from 97 adults with severe eosinophilic asthma and computed tomography–confirmed bronchiectasis from the Dutch Severe Asthma Registry, who initiated anti-IL5/5Ra biologics (mepolizumab, reslizumab, and benralizumab) and had follow-up data for 12 months or greater. The analysis was performed for the total population and subgroups with or without maintenance OCS use. Results: Anti-IL-5/5Ra therapy significantly reduced exacerbation frequency in patients with maintenance OCS use as well as in those without it. In the year before biologic initiation, 74.5% of all patients had two or more exacerbations, which decreased to 22.1% in the follow-up year (P < .001). The proportion of patients on maintenance OCS decreased from 47% to 30% (P < .001), and in the OCS-dependent patients (n = 45) maintenance OCS dose decreased from median (interquartile range) of 10.0 mg/d (5-15 mg/d) to 2.5 mg/d (0-5 mg/d) after 1 year (P < .001). Conclusions: This real-world study shows that anti-IL-5/5Ra therapy reduces exacerbation frequency and daily maintenance as well as the cumulative OCS dose in patients with severe eosinophilic asthma and comorbid bronchiectasis. Although it is an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma.
AB - Background: Bronchiectasis is a common comorbidity in patients with asthma and is associated with increased disease severity. In patients with severe eosinophilic asthma, biologics targeting IL-5/5Ra have beneficial effects on oral corticosteroid (OCS) use and exacerbation frequency. However, how coexisting bronchiectasis affects the response to such treatments is unknown. Objective: To evaluate the real-world effectiveness of anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma and comorbid bronchiectasis on exacerbation frequency and daily maintenance and cumulative OCS dose. Methods: This real-world study evaluated data from 97 adults with severe eosinophilic asthma and computed tomography–confirmed bronchiectasis from the Dutch Severe Asthma Registry, who initiated anti-IL5/5Ra biologics (mepolizumab, reslizumab, and benralizumab) and had follow-up data for 12 months or greater. The analysis was performed for the total population and subgroups with or without maintenance OCS use. Results: Anti-IL-5/5Ra therapy significantly reduced exacerbation frequency in patients with maintenance OCS use as well as in those without it. In the year before biologic initiation, 74.5% of all patients had two or more exacerbations, which decreased to 22.1% in the follow-up year (P < .001). The proportion of patients on maintenance OCS decreased from 47% to 30% (P < .001), and in the OCS-dependent patients (n = 45) maintenance OCS dose decreased from median (interquartile range) of 10.0 mg/d (5-15 mg/d) to 2.5 mg/d (0-5 mg/d) after 1 year (P < .001). Conclusions: This real-world study shows that anti-IL-5/5Ra therapy reduces exacerbation frequency and daily maintenance as well as the cumulative OCS dose in patients with severe eosinophilic asthma and comorbid bronchiectasis. Although it is an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma.
KW - Biologic therapy
KW - Bronchiectasis
KW - Oral corticosteroids
KW - Severe asthma
UR - http://www.scopus.com/inward/record.url?scp=85165633950&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jaip.2023.05.041
DO - https://doi.org/10.1016/j.jaip.2023.05.041
M3 - Article
C2 - 37295671
SN - 2213-2198
VL - 11
SP - 2724-2731.e2
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 9
ER -