The ability of different biological therapies to reduce the use of systemic steroids and the rate of asthma exacerbations in severe asthma

Abstract

Objective Biological therapies are used to treat patients with severe asthma (SA) with type 2 inflammation. These biologics have been shown to reduce oral corticosteroids and asthma exacerbations and improve patients’ quality of life. This study will examine the extent to which biological therapies can reduce the frequency of asthma exacerbations and the use of systemic corticosteroids in a cohort of patients with SA. Participants and methods The frequency of exacerbations, use of systemic corticosteroids before and after biological therapy [anti-interleukin (IL)5, anti-IL-4, and anti-immunoglobulin E therapies], and symptom control were studied in 47 adult patients with SA whose asthma was uncontrolled on high-dose inhaled corticosteroids/long-acting beta-2 agonists plus another control group. These patients received biologics therapy, mepolizumab, dupilumab, or omalizumab, for at least 4 months. Results Of 47 patients, 28 were treated with anti-IL-5 (mepolizumab), 11 were treated with anti-IL-4 (dupilumab), and eight were treated with anti-immunoglobulin E (omalizumab). No significant differences in age, sex, BMI, concomitant diseases, oral steroids, duration of biological treatment, and prognosis were observed among patients receiving the three (before the biologics). However, exacerbations/year were significantly higher in patients receiving dupilumab. Before biological therapy, 28 patients had mixed asthma phenotypes and received systemic corticosteroid therapy. Five patients received daily OCSs (5 mg daily), and 23 patients received courses of OCSs before biological therapy. After biological therapy, almost all patients were discontinued from systemic steroid treatment, except one patient. The rate of exacerbations was 68.1% (32/47) and decreased to 10.6% (5/47) after biological therapy. In addition, patients treated with biologics showed a decrease in symptoms, an increase in forced expiratory volume in the first second (FEV1%), and a decrease in peripheral eosinophils. Conclusions In this study, biological therapy reduced asthma exacerbations, the dosage of glucocorticoids used, and SA symptoms.