Abstract
Introduction:Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis. These therapeutic agents are especially useful for patients with severe or refractory symptoms. We present the real-life experience of four of the commonly used biologic agents in the United Arab Emirates.Methods:In this retrospective observational study, we reviewed the demographic, clinical, laboratory and treatment parameters for all patients treated with biologic agents.Results:270 patients received biologics at our centre between May 2015 and December 2019 with a median age of 36.5 years. Omalizumab was the most prescribed agent (n=183, 67.8%) followed by dupilumab (n=54, 20%), benralizumab (n=22, 8.1%) and mepolizumab (n=11, 4.1%). Urticaria was the commonest treatment indication (n=148, 55%) followed by asthma (n=105, 39%) and atopic dermatitis (n=13, 5%). All chronic urticaria patients were treated with omalizumab and showed improvement in the mean urticaria control test score from 6.7±4.47 to 12.02±4.17, with a p-value of 0.001. Dupilumab was found to be the most commonly prescribed drug for asthma (37%), followed by omalizumab (32%), benralizumab (21%) and mepolizumab (10%). The mean Asthma control test score for all asthmatics combined increased from 17.06 ± 5.4 to 19.44 ± 5.6, with p-value 0.0012 with treatment; FeNO reduced from 60.02 ± 45.74 to 29.11 ± 27.92, with p-value 0.001 and mean FEV1 improved from 2.38L ± 0.8 to 2.67L ± 0.78, with p-value 0.045. Only 4 patients in the entire cohort reported adverse events.Conclusion:Our study demonstrated that biological agents are a safe and effective treatment for atopic asthma, chronic urticaria and atopic dermatitis.
Highlights
Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis
Urticaria was the commonest indication for biologics use in 148 (55%) patients, followed by asthma in 105 (39%) patients (3 patients in this group had asthma as part of the diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA)) and atopic dermatitis in 13 (5%) patients
One hundred and forty-eight (80.8%) patients were on treatment for chronic urticaria, while 34(18.6%) were receiving the drug for Asthma; one patient was prescribed omalizumab for cystic fibrosis-related ABPA
Summary
Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis. Omalizumab was the first biologic agent approved by the Food and Drug Administration (FDA) for use in atopic disorders It is a recombinant humanised immunoglobulin G1 (IgG1) monoclonal antibody that targets immunoglobulin E (IgE), preventing its interaction with the Fc-epsilon-RI receptor(FcεRI), found on eosinophils, basophils and mast cells [8]. The latest addition to the anti-allergy biologics line up is dupilumab, a fully humanised monoclonal immunoglobulin G4 (IgG4) antibody directed against the alpha subunit of the interleukin-4 (IL-4) receptor, preventing the signalling of IL-4 and interleukin-13 (IL-13) [13] It is the first biologic agent approved by the FDA for the treatment of moderate to severe atopic dermatitis as well as an add-on maintenance treatment of moderate to severe eosinophilic asthma and for the treatment of inadequately controlled chronic rhinosinusitis with nasal polyposis [14]
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