Biologics in T2 Severe Asthma: Unveiling Different Effectiveness by Real-World Indirect Comparison

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Aug 29

PMID 39200892

Authors

Elisa Riccardi

Giuseppe Guida

Sonia Garino

Francesca Bertolini

Vitina Carriero

Mattia Brusamento

Stefano Pizzimenti

Fabiana Giannoccaro

Erica Falzone

Elisa Arrigo

Stefano Levra

Fabio Luigi Massimo Ricciardolo

Affiliations

Soon will be listed here.

Abstract

: Indirect comparison among biologics in severe asthma (SA) is a challenging but desirable goal for clinicians in real life. The aim of the study is to define characteristics of a biologic-treated T2-driven-SA population and to evaluate the effectiveness of biologic treatments in a real-world setting by variation in intra/inter-biologic parameters in an up to 4-year follow-up. : Demographic, clinical, functional, and biological characteristics were evaluated retrospectively in 104 patients recruited until July 2022 at baseline (T0) and over a maximum of 4 years (T4) of biologic therapy (omalizumab/OmaG = 41, from T0 to T4, mepolizumab/MepoG = 26, from T0 to T4, benralizumab/BenraG = 18, from T0 to T2, and dupilumab/DupiG = 19, from T0 to T1). Variations of parameters using means of paired Delta were assessed. : At baseline, patients had high prevalence of T2-driven comorbidities, low asthma control test (ACT mean 17.65 ± 4.41), impaired pulmonary function (FEV 65 ± 18 %pred), frequent exacerbations/year (AEs 3.5 ± 3), and OCS dependence (60%). DupiG had lower T2 biomarkers/comorbidities and AEs, and worse FEV (57 ± 19 %pred) compared to other biologics ( < 0.05). All biologics improved ACT, FEV%, FVC%, AEs rate, and OCS use. FEV% improved in MepoG and BenraG over the minimal clinically important difference and was sustained over 4 years in OmaG and MepoG. A significant RV reduction in OmaG (T4) and DupiG (T1), and BenraG normalization (T2) of airflow limitation were found. We observed through inter-biologic parameters pair delta variation comparison a significant nocturnal awakenings reduction in BenraG vs. OmaG/MepoG, and neutrophils reduction in BenraG/DupiG vs. OmaG. : Indirect comparison among biologics unveils clinical and functional improvements that may mark a different effectiveness. These results may highlight the preference of a single biologic compared to another with regard to specific treatable traits.

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