Most severe asthma patients are candidates for biologic therapy on a global scale

For the first time, a systematic literature review assessed the frequency of use of biologic therapy for asthma, globally. It revealed that about two-thirds of patients with ERS/ATS-defined severe asthma are suitable candidates for biologic treatment.

“We know that there are significant variations in the eligibility criteria for biologic therapy for asthma,” said Dr Freda Yang (Imperial College London, UK). She emphasised that the current review was the first to assess the use of biologic therapy on a worldwide scale. The researchers performed a literature search using MEDLINE, EMBASE, and ClinicalTrials.gov, selecting studies published between 2000 and 2022 that focused on adult asthma patients eligible for biologic therapy using monoclonal antibodies, including mepolizumab, omalizumab, benralizumab, reslizumab, dupilumab, and tezepelumab. Studies involving children (≤11 years of age), patients receiving biologics, or studies assessing eligibility without phenotyping were excluded. Out of 429 identified records from this search, only 15 articles met the eligibility criteria for analysis after removing duplicates, screening the records, and reviewing the articles. Among the 10,165 asthma patients in these 15 observational studies, 29.4% (n=2,989) had ERS/ATS-defined severe asthma, which was confined to 10 studies.

The prevalence of biologic-eligible patients among those with ERS/ATS-defined severe asthma ranged from 24.1% to 91.4%. Higher proportions were noted when oral corticosteroid use was not a criterion. The prevalence was lower in patients with so called difficult-to treat asthma (13.1–55%). Five studies recorded mild to moderate asthma patients, and the prevalence of biologic-eligible patients in these studies ranged from 1.4% to 19.7%.

The order of preference of biologic drugs was mepolizumab (median proportion [MP] 35.5%; range 2.2–78%), followed by omalizumab (MP 28.1%; range 1.6–66%), benralizumab (MP 25.5%; range 1.3–53%), and reslizumab (MP 24.4%; range 0.5–41%).

The authors concluded that, globally, the need for biologic therapy among patients with asthma varies according to the clinical stage of the disease, with higher demand in cases of ERS/ATS-defined severe asthma. Mepolizumab is the biologic most frequently used worldwide.

1. Yang F, et al. Worldwide variation in the proportion of patients eligible for asthma biologics: a systematic review. ERS International Congress 2023, 9–13 September, Milan, Italy.

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Posted on 29 October 202329 October 2023