Page 68 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 68
(AQLQ ) and safety. Lung function, particu- are still met, switching to another biological
larly FEV1 (forced expiratory volume in the agent is a rational option.
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma first second) and dose reduction of OCS and
ICS, as well as the use of rescue drugs are con- Studies have shown that switching to an-
sidered important outcomes, while FeNO and other biologic drug can have a significant ef-
eosinophils in sputum and blood are consid- fect on improving FEV1, controlling asthma
ered less important. The EAACI Guidelines symptoms, and reducing OS in patients with
Development Group (GDG) for the treatment an initially poor response to a previous bio-
of severe asthma with biologics has formulat- logic drug25,29,30. The exact time and manner
ed strong recommendations regarding dose of switching from one biological drug to an-
reduction of OCS and conditional recom- other have not yet been defined. More precise
mendations with respect to other outcomes11. recommendations in this regard are expected
from large ongoing studies aimed at switching
In the observational cohort study by biologic drugs. In a report by Numate et al, an
Eger and coworkers, 11% of patients were analysis of switching from one biological drug
considered as non-responders, 69% as partial to another in randomized studies (omalizum-
responders, and 14% as super-responders af- ab to mepolizumab, mepolizumab to benrali-
ter 2 years of anti–IL-5 treatment for severe zumab, all three biologics from the IL5 / IL-5
eosinophilic asthma26. receptor group to dupilumab) showed effica-
cy. Most reports suggested switching to an-
In patients with a good response on b i- other drug after approximately 4 months. In
ologics to individually predetermined goals, real-life studies, the effectiveness of b iologics
continued treatment is recommended, in ac- stabilized after 16 weeks in 80% of cases and
cordance with local regulatory authorities within 24 weeks in 90% of cases. The me-
and continuous monitoring of effectiveness dian time to change the first biologic in sub-
and safety. The rationale for this recommen- jects who did not respond to treatment was
dation is the evidence that after discontinua- after 8.6 months and for the second after 2.7
tion of biologics, their beneficial effect is lost11. months. In clinical practice, if justified, the
A few clinical studies to date have shown that large number of different biologics available
in many patients, after discontinuation of bi- for severe asthma makes it possible to reduce
ologic therapy, symptom control deteriorates switching interval to each subsequent biolog-
and / or exacerbations recur27,28. So far, there ic treatment25.
are no precise instructions on how long treat-
ment with b iologics should last. A sustained suboptimal therapeutic re-
sponse to a biological drug requires re-pheno-
If there is no therapeutic response to bi- typing and re-examination of biomarkers and
ologics, the clinicians are advised to find pos- immune response pathways. Exacerbations in
sible reasons. Uncontrolled asthma, after ap- patients who do not respond to biologic ther-
plied biological therapy, requires verification apy do not necessarily have to be eosinophil-
of adherence because some patients, following ic and the type of exacerbation cannot be
first few administrations of the biologics, stop inferred without confirmation. The inflam-
taking anti-inflammatory medications with- matory phenotype of asthma exacerbations
out consulting their health care physicians may be distinguished using FeNO31, but in-
and become non-adherent to the overall man- duced sputum is a more desirable option for
agement plan. reassessing whether airway inflammation is
eosinophilic or neutrophilic. If the response
If there is no satisfactory therapeutic re- to treatment is unsatisfactory and a reassess-
sponse to the initially introduced biological ment shows that there is no airway eosino-
drug after sufficient time, but the criteria for
targeted biological treatment of severe asthma
larly FEV1 (forced expiratory volume in the agent is a rational option.
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma first second) and dose reduction of OCS and
ICS, as well as the use of rescue drugs are con- Studies have shown that switching to an-
sidered important outcomes, while FeNO and other biologic drug can have a significant ef-
eosinophils in sputum and blood are consid- fect on improving FEV1, controlling asthma
ered less important. The EAACI Guidelines symptoms, and reducing OS in patients with
Development Group (GDG) for the treatment an initially poor response to a previous bio-
of severe asthma with biologics has formulat- logic drug25,29,30. The exact time and manner
ed strong recommendations regarding dose of switching from one biological drug to an-
reduction of OCS and conditional recom- other have not yet been defined. More precise
mendations with respect to other outcomes11. recommendations in this regard are expected
from large ongoing studies aimed at switching
In the observational cohort study by biologic drugs. In a report by Numate et al, an
Eger and coworkers, 11% of patients were analysis of switching from one biological drug
considered as non-responders, 69% as partial to another in randomized studies (omalizum-
responders, and 14% as super-responders af- ab to mepolizumab, mepolizumab to benrali-
ter 2 years of anti–IL-5 treatment for severe zumab, all three biologics from the IL5 / IL-5
eosinophilic asthma26. receptor group to dupilumab) showed effica-
cy. Most reports suggested switching to an-
In patients with a good response on b i- other drug after approximately 4 months. In
ologics to individually predetermined goals, real-life studies, the effectiveness of b iologics
continued treatment is recommended, in ac- stabilized after 16 weeks in 80% of cases and
cordance with local regulatory authorities within 24 weeks in 90% of cases. The me-
and continuous monitoring of effectiveness dian time to change the first biologic in sub-
and safety. The rationale for this recommen- jects who did not respond to treatment was
dation is the evidence that after discontinua- after 8.6 months and for the second after 2.7
tion of biologics, their beneficial effect is lost11. months. In clinical practice, if justified, the
A few clinical studies to date have shown that large number of different biologics available
in many patients, after discontinuation of bi- for severe asthma makes it possible to reduce
ologic therapy, symptom control deteriorates switching interval to each subsequent biolog-
and / or exacerbations recur27,28. So far, there ic treatment25.
are no precise instructions on how long treat-
ment with b iologics should last. A sustained suboptimal therapeutic re-
sponse to a biological drug requires re-pheno-
If there is no therapeutic response to bi- typing and re-examination of biomarkers and
ologics, the clinicians are advised to find pos- immune response pathways. Exacerbations in
sible reasons. Uncontrolled asthma, after ap- patients who do not respond to biologic ther-
plied biological therapy, requires verification apy do not necessarily have to be eosinophil-
of adherence because some patients, following ic and the type of exacerbation cannot be
first few administrations of the biologics, stop inferred without confirmation. The inflam-
taking anti-inflammatory medications with- matory phenotype of asthma exacerbations
out consulting their health care physicians may be distinguished using FeNO31, but in-
and become non-adherent to the overall man- duced sputum is a more desirable option for
agement plan. reassessing whether airway inflammation is
eosinophilic or neutrophilic. If the response
If there is no satisfactory therapeutic re- to treatment is unsatisfactory and a reassess-
sponse to the initially introduced biological ment shows that there is no airway eosino-
drug after sufficient time, but the criteria for
targeted biological treatment of severe asthma
