The Effects of Biologics Among Asthmatics with and Without Chronic Rhinosinusitis

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Respiratory infections commonly exacerbate asthma symptoms. A study assessed how often patients with asthma taking biologics experience sinopulmonary infections, with or without chronic rhinosinusitis (CRS). The results were published as part of the AAAAI Annual Meeting.

A total of 61 patients with moderate-to-severe persistent asthma and/or CRS were treated with dupilumab (n=20), mepolizumab (n=36), benralizumab (n=11), or reslizumab (n=1). Seven patients who switched biologics were assessed on each treatment; 35 patients were followed prospectively. Sinopulmonary infections were determined based on the number of courses of antibiotics. The asthma control questionnaire-6 (ACQ-6), spirometry, and the number of exacerbations were used to determine asthma control. The Sinonasal Outcome Test-22 (SNOT-22) was used to analyze sinonasal disease.

Just more than three-quarters of patients (77%) had comorbid CRS. Monthly pre- and post-treatment antibiotic courses were reduced in patients taking dupilumab (0.08 vs. 0.00; P=0.03; median, 3 months) and mepolizumab (0.08 vs. 0.07; P<0.01; median, 26 months). Monthly asthma exacerbations were also reduced after initiating dupilumab (0.33 vs. 0.00; P<0.05) and mepolizumab (0.25 vs. 0.12; P<0.01). Forced expiratory volume also improved with dupilumab (1.87 L vs. 2.18 L; P=0.03) and mepolizumab use (1.67 L vs. 2.13 L; P<0.01). Median ACQ-6 score improved in patients taking dupilumab (2.30 vs. 0.75; P=0.04) and benralizumab (3.0 vs. 0.33; P=0.01; minimal clinically important difference [MCID], 0.5). Dupilumab use was correlated with improved SNOT-22 score (52 vs. 39; P<0.01; MCID, 8.9).

“In a real-world setting, biologics may provide different clinical benefits among asthmatics with and without CRS. Specifically, mepolizumab and dupilumab were associated with reduced sinopulmonary infections,” the study authors summarized. “Future prospective studies with a larger sample may better characterize individual biologic-associated outcomes.”

https://www.jacionline.org/article/S0091-6749(19)32183-9/fulltext