Page 134 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 134
Different health care providers and in- patients’ therapy. It is of utter importance to
surance companies have different indications assess the duration of therapy seriously, with
severe asthma forum 1: severe asthma - basic and clinical views as well as rules for assessing the efficacy of bi- all sides and on a multidisciplinary basis, i.e.
ological therapy in severe asthma, sometimes clinically, functional measurements, and lab-
even medically and scientifically non-log- oratory biomarkers, as well as to discuss with
ical and not correct. An example is that in the patient, and only then the proper decision
some countries if a patient during omalizum- should be made.
ab treatment for the first 4 months could not
stop oral steroids, he or she is considered a Sixth Dilemma: Should we Treat
non-responder, which is wrong. Many stud- a Patient With Severe Asthma
ies conducted with any biological treatment and Another Significant Disease,
have revealed that more than a third of pa- Like Allergic Broncho-pulmonary
tients with severe asthma could not stop their Aspergillosis (ABPA), or Eosinophilic
steroid treatment (51), despite step 5 GINA Granulomatosis with Polyangiitis
treatment, good adherence and proper inhal- (EGPA)?
er technique applied, with administered bio-
logicals in concordance with asthma pheno- Biologics have been used in recent years to
type and type 2 inflammation (although 80% treat ABPA and EGPA in patients with severe
of patients significantly reduce steroid dos- asthma. However, robust clinical evidence of
age52). Although patients could not stop ster- biological therapy efficacy in severe asthma
oids, they experience other benefits from bi- with allergic broncho-pulmonary aspergillo-
ologicals, like less frequent exacerbations and sis (ABPA) is lacking and still out of the label55.
overall quality of life, so it is an injustice to ABPA develops in susceptible patients whose
withdraw omalizumab after such a short peri- airways are colonized with Aspergillus fumig-
od of treatment. GINA strategy suggests that atus. ABPA develops in 1-5% of asthmatic pa-
4 months should be adequate for assessment tients or 2-15% of patients with cystic fibrosis.
of mepolizumab response, but NICE guide-
lines indicated 12 months of treatment of me- Biologics are used in patients with severe
polizumab53. asthma and ABPA who have frequent acute
exacerbations, who did not have a response
The next question is about the dura- to antifungal medication and in patients with
tion of biological treatment when a person stage IV ABPA (steroid-dependent asthma).
has at least a partial response. Some coun- All biologicals available for severe asthma
tries have the rule to quit biologicals after 2 have been applied, anti-IgE (omalizumab),
years of treatment, despite good response, anti-IL-5 (mepolizumab and benralizum-
which is considered too short in the asthma ab), and anti IL4/13(dupilumab). In all treat-
scientific community. There are not many ed groups an improvement has been shown,
studies published on the length of biological with fewer exacerbations and symptoms with
treatment, as well as what happens after the a steroid-sparing effect. The best improve-
discontinuation of biological therapy. Results ment was found in lung function measured by
from the Spanish severe asthma registry have FEV1 in the vast majority of patients, where
shown that the effects of 6 years of omalizum- an improvement of more than 10% has been
ab may persist after discontinuation of ther- considered clinically relevant based on patient
apy in 60% of patients for at least 4 years54. perception56. With the purpose to avoid hy-
There are no published data with results for per-eosinophilia, dupilumabwas introduced
other biologicals because they are of a short- simultaneously with oral steroids57.
er time in real life praxis with severe asthma
EGPA became an indication for target-
ed biological anti-IL-5 treatment, with the
surance companies have different indications assess the duration of therapy seriously, with
severe asthma forum 1: severe asthma - basic and clinical views as well as rules for assessing the efficacy of bi- all sides and on a multidisciplinary basis, i.e.
ological therapy in severe asthma, sometimes clinically, functional measurements, and lab-
even medically and scientifically non-log- oratory biomarkers, as well as to discuss with
ical and not correct. An example is that in the patient, and only then the proper decision
some countries if a patient during omalizum- should be made.
ab treatment for the first 4 months could not
stop oral steroids, he or she is considered a Sixth Dilemma: Should we Treat
non-responder, which is wrong. Many stud- a Patient With Severe Asthma
ies conducted with any biological treatment and Another Significant Disease,
have revealed that more than a third of pa- Like Allergic Broncho-pulmonary
tients with severe asthma could not stop their Aspergillosis (ABPA), or Eosinophilic
steroid treatment (51), despite step 5 GINA Granulomatosis with Polyangiitis
treatment, good adherence and proper inhal- (EGPA)?
er technique applied, with administered bio-
logicals in concordance with asthma pheno- Biologics have been used in recent years to
type and type 2 inflammation (although 80% treat ABPA and EGPA in patients with severe
of patients significantly reduce steroid dos- asthma. However, robust clinical evidence of
age52). Although patients could not stop ster- biological therapy efficacy in severe asthma
oids, they experience other benefits from bi- with allergic broncho-pulmonary aspergillo-
ologicals, like less frequent exacerbations and sis (ABPA) is lacking and still out of the label55.
overall quality of life, so it is an injustice to ABPA develops in susceptible patients whose
withdraw omalizumab after such a short peri- airways are colonized with Aspergillus fumig-
od of treatment. GINA strategy suggests that atus. ABPA develops in 1-5% of asthmatic pa-
4 months should be adequate for assessment tients or 2-15% of patients with cystic fibrosis.
of mepolizumab response, but NICE guide-
lines indicated 12 months of treatment of me- Biologics are used in patients with severe
polizumab53. asthma and ABPA who have frequent acute
exacerbations, who did not have a response
The next question is about the dura- to antifungal medication and in patients with
tion of biological treatment when a person stage IV ABPA (steroid-dependent asthma).
has at least a partial response. Some coun- All biologicals available for severe asthma
tries have the rule to quit biologicals after 2 have been applied, anti-IgE (omalizumab),
years of treatment, despite good response, anti-IL-5 (mepolizumab and benralizum-
which is considered too short in the asthma ab), and anti IL4/13(dupilumab). In all treat-
scientific community. There are not many ed groups an improvement has been shown,
studies published on the length of biological with fewer exacerbations and symptoms with
treatment, as well as what happens after the a steroid-sparing effect. The best improve-
discontinuation of biological therapy. Results ment was found in lung function measured by
from the Spanish severe asthma registry have FEV1 in the vast majority of patients, where
shown that the effects of 6 years of omalizum- an improvement of more than 10% has been
ab may persist after discontinuation of ther- considered clinically relevant based on patient
apy in 60% of patients for at least 4 years54. perception56. With the purpose to avoid hy-
There are no published data with results for per-eosinophilia, dupilumabwas introduced
other biologicals because they are of a short- simultaneously with oral steroids57.
er time in real life praxis with severe asthma
EGPA became an indication for target-
ed biological anti-IL-5 treatment, with the
