The use of biologics for asthma can vary by outcome

This is an abstract illustration of the lungs and a collage of medical formulas.

A comprehensive study has shed new light on the effectiveness of biologic treatments for adults with severe asthma, revealing the complex nature of treatment response and identifying critical patient characteristics that influence outcomes.

The study, “Exploring Definitions and Predictors of Response to Biologics for Severe Asthma,” concluded that patients with greater impairment before initiating biologic treatment for asthma had better response across all assessed outcomes. The study was published in The Journal of Allergy and Clinical Immunology: In Practice. It involved more than 2,200 patients from 21 countries.

Although biologic treatments have become a cornerstone in managing severe asthma, defining what constitutes a “responder” has been challenging, according to the study’s lead author, Ghislaine Scelo, PhD, a senior epidemiologist with the Observational and Pragmatic Research Institute in Singapore. This study was designed to clarify these definitions and explore the factors that predict a positive response to biologic therapy.

Researchers evaluated changes in four asthma outcome domains before and after biologic initiation. These domains included exacerbation rate (a 50% or greater reduction), long-term oral corticosteroid use (a 50% or greater reduction), asthma control and lung function (FEV1).

Greater impairments in each domain prior to biologic initiation increased the odds for being a responder in each domain, the researchers wrote, with other characteristics that increased the odds for meeting criteria for being a responder varying by domain.

The study’s key findings indicated that 80.7% of patients experienced a significant reduction in exacerbations, while only 10.6% met the criteria for improvement across all four domains. Despite improvements, many patients continued to experience significant asthma symptoms. For example, nearly half of the patients who showed better asthma control still had uncontrolled asthma after starting biologic therapy.

Additionally, the study suggested the likelihood of a positive response varied depending on the outcome measured. Higher pre-treatment levels of FeNO and shorter asthma duration were linked to better lung function responses. Higher blood eosinophil counts and the presence of type 2-related comorbidities were associated with better overall outcomes.

In general, there were wide variations in findings that led researchers to conclude that response may be complex and depend on patients and the assessed outcomes. As such, the researchers suggested the study underscores the importance of a personalized approach to asthma treatment. Although biologics can significantly improve outcomes for many patients, the persistence of symptoms in some patients confirms the need for ongoing management and tailored treatment plans.

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