Understanding Differential Response to Biologic Therapies in Severe Asthma: Retrospective study

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Laila Salameh Fatema Abdulkarim Maitha Al Hammadi Mona Elhassan Andre Barreiros Mohammad T. Al Bataineh Poorna Bhamidimarri Bassam Mahboub


Severe asthma, characterized by airway inflammation and debilitating symptoms, poses a significant challenge to millions of people worldwide. Traditional treatments for treating severe cases are limited, leading to the emergence of biologic therapies as promising alternatives. This retrospective cohort study from a tertiary hospital in Dubai aimed to explore the differential response to biologics in severe asthma patients and identify predictors of treatment outcomes.

The baseline characteristics of 129 severe asthma patients receiving biologic therapy were analyzed, revealing a greater incidence of allergic diseases among responders. Multivariate Cox regression analysis revealed that early-onset asthma, urticaria, and rhinosinusitis (p =0.027, 0.037, and <0.001, respectively) were predictors of a positive treatment response. Compared with non-responders, responders demonstrated improved asthma control, reduced exacerbations, and decreased oral corticosteroid usage.

Despite the limitations inherent in retrospective studies, our findings underscore the significant clinical benefits of biologic therapy in severe asthma patients. Tailored treatment strategies based on patient characteristics and biologic class could optimize outcomes in this population, emphasizing the importance of personalized medicine in managing severe asthma. Further research into predictive biomarkers and larger cohort studies are warranted to validate these findings and enhance treatment efficacy in severe asthma management.

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SALAMEH, Laila et al. Understanding Differential Response to Biologic Therapies in Severe Asthma: Retrospective study. Medical Research Archives, [S.l.], v. 12, n. 3, mar. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5227>. Date accessed: 13 apr. 2024. doi: https://doi.org/10.18103/mra.v12i3.5227.
Research Articles


1. Asher MI, García-Marcos L, Pearce NE, Strachan DP. Trends in worldwide asthma prevalence. European Respiratory Journal. 2020;56(6):2002094.
2. Holguin F, Cardet JC, Chung KF, et al. Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal. 2020;55(1):1900588.
3. Bel EH, Wenzel SE, Thompson PJ, et al. Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. N Engl J Med. 2014;371(13):1189-1197.
4. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β(2)-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388(10056):2115-2127.
5. Charles D, Shanley J, Temple SN, Rattu A, Khaleva E, Roberts G. Real-world efficacy of treatment with benralizumab, dupilumab, mepolizumab and reslizumab for severe asthma: A systematic review and meta-analysis. Clin Exp Allergy. 2022;52(5):616-627.
6. Normansell R, Walker S, Milan SJ, Walters EH, Nair P. Omalizumab for asthma in adults and children. Cochrane Database Syst Rev. 2014(1):Cd003559.
7. Khaleva E, Rattu A, Brightling C, et al. Definitions of non-response and response to biological therapy for severe asthma: a systematic review. ERJ Open Research. 2023;9(3):00444-02022.
8. McGregor MC, Krings JG, Nair P, Castro M. Role of Biologics in Asthma. Am J Respir Crit Care Med. 2019;199(4):433-445.
9. Chen W, Tran TN, Sadatsafavi M, et al. Impact of Initiating Biologics in Patients With Severe Asthma on Long-Term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER): Data From the International Severe Asthma Registry. J Allergy Clin Immunol Pract. 2023;11(9):2732-2747.
10. Teague WG, Phillips BR, Fahy JV, et al. Baseline features of the Severe Asthma Research Program (SARP III) cohort: differences with age. The Journal of Allergy and Clinical Immunology: In Practice. 2018;6(2):545-554. e544.
11. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388(10056):2128-2141.
12. Nair P, Wenzel S, Rabe KF, et al. Oral Glucocorticoid-Sparing Effect of Benralizumab in Severe Asthma. N Engl J Med. 2017;376(25):2448-2458.
13. Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198-1207.
14. Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet. 2012;380(9842):651-659.
15. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2018;391(10118):350-400.
16. Bakakos A, Rovina N, Bakakos P. Treatment Challenges in Severe Eosinophilic Asthma: Differential Response to Anti-IL-5 and Anti-IL-5R Therapy. Int J Mol Sci. 2021;22(8).
17. Papaioannou AI, Fouka E, Papakosta D, Papiris S, Loukides S. Switching between biologics in severe asthma patients. When the first choice is not proven to be the best. Clin Exp Allergy. 2021;51(2):221-227.
18. Flood-Page P, Swenson C, Faiferman I, et al. A study to evaluate safety and efficacy of mepolizumab in patients with moderate persistent asthma. American journal of respiratory and critical care medicine. 2007;176(11):1062-1071.
19. Leckie MJ, ten Brinke A, Khan J, et al. Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response. The Lancet. 2000;356(9248):2144-2148.
20. Jacobsen EA, Jackson DJ, Heffler E, et al. Eosinophil Knockout Humans: Uncovering the Role of Eosinophils Through Eosinophil-Directed Biological Therapies. Annu Rev Immunol. 2021;39:719-757.
21. Haldar P, Brightling CE, Hargadon B, et al. Mepolizumab and exacerbations of refractory eosinophilic asthma. New England Journal of Medicine. 2009;360(10):973-984.
22. Kaditis AG, Winnie G, Syrogiannopoulos GA. Anti‐inflammatory pharmacotherapy for wheezing in preschool children. Pediatric pulmonology. 2007;42(5):407-420.
23. Moore WC, Meyers DA, Wenzel SE, et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. American journal of respiratory and critical care medicine. 2010;181(4):315-323.
24. Abuzakouk M, Ghorab O, Wahla AS, et al. Efficacy and Safety of Biologic Agents in Chronic Urticaria, Asthma and Atopic Dermatitis - A Real-life Experience. Open Respir Med J. 2020;14:99-106.
25. Volmer T, Effenberger T, Trautner C, Buhl R. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Eur Respir J. 2018;52(4).
26. Pham T-H, Damera G, Newbold P, Ranade K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respiratory Medicine. 2016;111:21-29.