Page 69 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 69
lia, b iologics should be discontinued and the therapy with b iologics. In some patients, 69
T 2 low asthma treatment measures should be exacerbations may not decrease significant-
considered11. ly in a short period of time, so the other end- mon i tor i ng a n d eva luat ion of t h e r a peu t ic r e sponse i n pat i e n ts w i t h sev e r e a st h m a on biologic s
points should be used to define a therapeutic
It is important to keep in mind that b io- response11,40.
logics may induce the production of antibod-
ies against drugs (ADAs) that may affect the Effects of biologics on symptoms
loss of a therapeutic response or hypersensi- and quality of life
tivity reaction. The measurement of ADA in
everyday clinical practice has not yet been im- Symptoms of patients with severe asthma that
plemented. As the detection of ADAs is essen- remain uncontrolled despite the maximum
tial for immunogenicity assessment, future intensity of treatment are the most obvious
tasks is to determine how and when to rou- indicator of the severity of the disease if all
tinely measure them in clinical practice32. If other measures are taken to exclude the fac-
the reason for non-response is the develop- tors responsible for uncontrolled disease. Giv-
ment of neutralizing anti- drug antibodies33,34 en the subjectivity, they need to be assessed
or other dysfunctions and autoimmune re- with questionnaires. A clinically significant
sponse, it is justified to switch to another bio- smallest difference in the ACT score is con-
logical drug following the specific characteris- sidered to be three points41. The sum of symp-
tic35. Possibilities of combining two biological toms in severe asthma is usually very low, and
drugs with different mechanisms were also it is difficult to assess the actual improvement
considered but the rationale for such use is based on differences in the ACT score. ACT
still lacking. has known limitations in severe asthma. It
is recommended to reduce the ACT cut-off
Effect of biologics on exacerbations for uncontrolled asthma in severe asthma to
score 1642. Improvement of symptoms dur-
Asthma exacerbations are the most undesira- ing the treatment of severe asthma should be
ble adverse event that can occur during illness assessed by their qualitative and quantitative
and that can be life-threatening to the pa- characteristics as well as by their timing, lo-
tient. Such exacerbations in patients with se- cation, aggravating or alleviating factors, and
vere asthma are frequent and significantly im- associated manifestations. Of particular im-
pair their quality of life. According to EAACI portance is the assessment and treatment of
2021 recommendations, the impact on ex- co-morbidities as they may contribute to poor
acerbations of severe asthma during biologic disease control by aggravating or mimicking
treatment are among critical, the most impor- symptoms of asthma4.
tant outcomes for assessing treatment suc-
cess11. Most studies, including a number of Symptoms greatly impair quality of life
new ones, report that biologics significantly associated with health status (HRQoL) in pa-
reduce the number and severity of exacerba- tients with severe asthma, and the use of b io-
tions in patients with severe asthma15–20,23,24, 28, logics has proven promising in this sense. More
.36–39 The results of a recently published MEX than 60% studies, dealing with the treatment
study call into question the routine use of oral of severe asthma included a HRQoL ques-
corticosteroids to treat all asthma exacerba- tionnaire as a primary, secondary, or research
tions without recognizing an inflammatory outcome43. Research has shown that improv-
phenotype of asthma exacerbations which are ing overall quality of life is the most impor-
not always eosinophilic31. tant outcome for most patients with severe
asthma (44).
The effect of biologic therapy on exac-
erbations should be closely monitored during
T 2 low asthma treatment measures should be exacerbations may not decrease significant-
considered11. ly in a short period of time, so the other end- mon i tor i ng a n d eva luat ion of t h e r a peu t ic r e sponse i n pat i e n ts w i t h sev e r e a st h m a on biologic s
points should be used to define a therapeutic
It is important to keep in mind that b io- response11,40.
logics may induce the production of antibod-
ies against drugs (ADAs) that may affect the Effects of biologics on symptoms
loss of a therapeutic response or hypersensi- and quality of life
tivity reaction. The measurement of ADA in
everyday clinical practice has not yet been im- Symptoms of patients with severe asthma that
plemented. As the detection of ADAs is essen- remain uncontrolled despite the maximum
tial for immunogenicity assessment, future intensity of treatment are the most obvious
tasks is to determine how and when to rou- indicator of the severity of the disease if all
tinely measure them in clinical practice32. If other measures are taken to exclude the fac-
the reason for non-response is the develop- tors responsible for uncontrolled disease. Giv-
ment of neutralizing anti- drug antibodies33,34 en the subjectivity, they need to be assessed
or other dysfunctions and autoimmune re- with questionnaires. A clinically significant
sponse, it is justified to switch to another bio- smallest difference in the ACT score is con-
logical drug following the specific characteris- sidered to be three points41. The sum of symp-
tic35. Possibilities of combining two biological toms in severe asthma is usually very low, and
drugs with different mechanisms were also it is difficult to assess the actual improvement
considered but the rationale for such use is based on differences in the ACT score. ACT
still lacking. has known limitations in severe asthma. It
is recommended to reduce the ACT cut-off
Effect of biologics on exacerbations for uncontrolled asthma in severe asthma to
score 1642. Improvement of symptoms dur-
Asthma exacerbations are the most undesira- ing the treatment of severe asthma should be
ble adverse event that can occur during illness assessed by their qualitative and quantitative
and that can be life-threatening to the pa- characteristics as well as by their timing, lo-
tient. Such exacerbations in patients with se- cation, aggravating or alleviating factors, and
vere asthma are frequent and significantly im- associated manifestations. Of particular im-
pair their quality of life. According to EAACI portance is the assessment and treatment of
2021 recommendations, the impact on ex- co-morbidities as they may contribute to poor
acerbations of severe asthma during biologic disease control by aggravating or mimicking
treatment are among critical, the most impor- symptoms of asthma4.
tant outcomes for assessing treatment suc-
cess11. Most studies, including a number of Symptoms greatly impair quality of life
new ones, report that biologics significantly associated with health status (HRQoL) in pa-
reduce the number and severity of exacerba- tients with severe asthma, and the use of b io-
tions in patients with severe asthma15–20,23,24, 28, logics has proven promising in this sense. More
.36–39 The results of a recently published MEX than 60% studies, dealing with the treatment
study call into question the routine use of oral of severe asthma included a HRQoL ques-
corticosteroids to treat all asthma exacerba- tionnaire as a primary, secondary, or research
tions without recognizing an inflammatory outcome43. Research has shown that improv-
phenotype of asthma exacerbations which are ing overall quality of life is the most impor-
not always eosinophilic31. tant outcome for most patients with severe
asthma (44).
The effect of biologic therapy on exac-
erbations should be closely monitored during
