Clinical characteristics and treatment outcomes of severe asthma patients with a history of multiple biologic drugs use

Tomohiro Akaba, Mitsuko Kondo, Soshi Muramatsu, Kazuhiro Abe, Fumi Kobayashi, Azusa Miyoshi, Osamitsu Yagi, Kiyoshi Takeyama, Etsuko Tagaya

Affiliation:
Department of Respiratory Medicine, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

Abstract

Background: Asthma control has been shown to improve after clinical use of molecular-targeted biologic drugs. Although most patients have shown favorable responses to biologic drugs, some individuals need to switch to another biologic drug. To date, limited data are available regarding patients who received multiple biologic drugs.
Objective: We aimed to evaluate the characteristics and outcomes of patients treated with multiple biologic drugs.
Methods: We reviewed severe asthma patients who received biologic drugs between May 2009 and September 2019. Clinical characteristics of patients and changes in annualized asthma exacerbation rates, asthma control test (ACT), and oral corticosteroid (OCS) dose, before and after the use of the final biologic drug, were evaluated.
Results: Of the 105 patients who received biologic drugs, 20 patients received multiple biologic drugs. Twelve patients received two biologic drugs, six received three, and two received four. Patients who received multiple biologic drugs tended to have a significantly higher number of allergic or eosinophilic airway comorbidities (allergic rhinitis: p = 0.02, chronic rhinosinusitis with nasal polyps: p < 0.001). Approximately half of the patients changed to different treatments due to uncontrolled comorbidities. Annualized exacerbation rates, ACT, and OCS dose significantly improved after the latest biologic drug use (p = 0.035, p < 0.001, and p = 0.038, respectively).
Conclusion: The results of this study indicated that allergic and eosinophilic airway comorbidities should be considered during the selection of biologic drugs. Furthermore, most patients who received multiple biologic drugs achieved disease control after switching to the optimal biologic drug.
Key words: severe asthma, biologic drug, allergic comorbidity, allergic rhinitis, chronic rhinosinusitis with nasal polyps