Characteristics of severe asthmatics treated with omalizumab, mepolizumab or no biotherapy. Data from the Belgian Severe Asthma Registry (BSAR)

Abstract

This observational study presents the clinical characteristics of adult severe asthmatics, defined according to ERS/ATS, receiving either anti-IgE or anti-IL5 as compared to patients who did not fulfil reimbursement criteria for these biotherapies. Follow-up data were recorded on a yearly basis if available. Results: Among 1087 severe asthmatics included since 2009 (24 centers), longitudinal data were available for 345 patients of whom 57 started mepolizumab, 59 omalizumab whereas 229 did not receive any biologics (naive). All the variables scores were analyzed using a repeated measure multivariate ANOVA. Baseline characteristics As compared to naive, patients receiving mepolizumab or omalizumab had poorer lung function, worse asthma control and quality of life, higher exacerbation rate and higher serum IgE at baseline. The mepolizumab group had higher FENO, blood and sputum eosinophils at baseline. Before starting biotherapy, 32% of mepolizumab, 17% of omalizumab and 25% of naive group were on maintenance oral corticosteroids (OCS)(p=0.032). Follow-up data As compared to naive, patients receiving omalizumab or mepolizumab showed an improvement in ACT and ACQ. As opposed to mepolizumab, omalizumab significantly decreased FENO. Mepolizumab allowed a significant decrease in OCS dose median from 8mg to 3mg prednisolone per day after 1yr. We found a significant decrease in exacerbations in all groups with the highest decrease in the omalizumab group (p=0.0009). Conclusion: These real-life data confirm clinical benefit of both omalizumab and mepolizumab on asthma control and exacerbation rate as well as on OCS sparing with mepolizumab.