Real-world effectiveness of anti-IL-5/5R therapy in severe eosinophilic asthma with comorbid bronchiectasis

Abstract

<b>Background:</b> Bronchiectasis (BE) is a common co-morbidity in patients with asthma and is associated with increased disease severity. In patients with severe eosinophilic asthma (SEA) biologics targeting interleukin (IL)-5/5R have shown beneficial effects on maintenance oral corticosteroid use and severe asthma exacerbations. However, how coexisting BE affects the response to these treatments is unknown. <b>Aim:</b> To evaluate the real-world effectiveness of anti-IL-5/5R therapy in patients with SEA and comorbid BE on exacerbation rate and maintenance OCS use. <b>Methods:</b> This real-world study evaluated data from 97 adults with SEA and CT-confirmed BE from the Dutch Severe Asthma Registry (RAPSODI) who initiated anti-IL5/5R biologics (mepolizumab, reslizumab, benralizumab) and had follow-up data ≥1yr. <b>Results:</b> In the total group of 97 patients (56% male, 55% non-atopic) anti-IL-5/5R therapy significantly reduced exacerbations in both OCS dependent as well as non-OCS-dependent patients: 75% of all patients had ≥2 exacerbations in the year prior to biologic initiation, which decreased to 22% in the follow-up year (p&lt;0.001). The proportion of all patients with SEA and BE on maintenance OCS decreased from 47% to 30% (p&lt;0.001) and in the OCS dependent patients (n=45) maintenance OCS dose decreased from median(IQR) 10.0 (5-15) to 2.5 (0-5) mg/day after 1 yr (p&lt;0.001). <b>Conclusions:</b> This real-world study shows that anti-IL-5/5R therapy reduces exacerbation rate and OCS use in patients with severe eosinophilic asthma and comorbid bronchiectasis. Though an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5R therapy in patients with severe eosinophilic asthma.