Real world residual disease manifestations after 2-years anti-IL-5 treatment for severe asthma

Abstract

Background: Patients with severe eosinophilic asthma may respond differently to various anti-IL-5 biologics. Many patients experience residual disease manifestations, causing physicians to switch between these biologics. Insight into these residual disease manifestations could increase our understanding of mechanisms of severe asthma and reveal unmet therapeutic needs in these patients. Aim: We aimed to: (1) assess the frequency and reasons for switching between anti-IL-5 biologics, and; (2) evaluate whether residual disease manifestations still exist after 2 years anti-IL-5 treatment in patients with severe eosinophilic asthma. Methods: In this real world cohort study, severe asthma patients were included who had been treated with an anti-IL-5 biologic (mepolizumab, reslizumab, benralizumab) ≥2yr (n=95). Data on disease manifestations (asthma control, exacerbations, FEV1, blood eosinophils, exhaled NO, symptoms of sinonasal disease, atopy and adrenal insufficiency) and medication history, were collected at baseline and after 2 years of anti-IL-5 treatment. Results: Switches between anti-IL-5 biologics occurred in 41% of patients, mainly because of insufficient clinical response. After 2 years anti-IL-5 treatment 79 patients (83%) experienced residual disease manifestations: uncontrolled sinonasal symptoms (49%), impaired lung function (48%) and uncontrolled asthma (41%). 26% were still OCS dependent (8% adrenal insufficient). Conclusion: Despite significant clinical improvements, the majority of severe eosinophilic asthma patients showed residual disease manifestations after 2 years anti-IL-5 treatment. This suggests that non-IL-5 driven inflammatory pathways may be activated.