Advancing Care in Severe Asthma: The Art of Switching Biologics
Abstract
:Highlights
- Switching between different monoclonal antibodies can be beneficial for patients with severe asthma, especially when the initial biologic therapy does not provide sufficient symptom control or presents severe side effects.
- Considering individual patient factors and biomarkers in determining the effectiveness of biologics is fundamental. This personalized approach helps predict positive responses and optimize treatment efficacy.
- The need for a more personalized approach in severe asthma treatment, using patient-specific characteristics and biomarker assessment to guide the selection and switching of biologics.
- The importance of flexibility in treatment strategies for severe asthma, acknowledging the dynamic nature of the disease and the evolving landscape of biologic therapies.
Abstract
1. Introduction
2. Initial Selection of Biologics
3. Rationale for Switching Biologics
4. Existing Literature about Switching Biologics in Severe Asthma
Significant Adverse Effects and Considerations in Switching Biologics
5. Molecular and Immunological Considerations
6. Patient-Centered Approach
7. Future Directions
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Biological Drug | Target Mechanism | Indications | Common Side Effects |
---|---|---|---|
Mepolizumab | IL-5 pathway | Eosinophilic asthma | Headache, injection site reaction, fatigue, flu symptoms, urinary tract infection, abdominal pain, itching, eczema, muscle spasms |
Reslizumab | IL-5 pathway | Eosinophilic asthma (≥400 eosinophils/μL) | Cough, dizziness, itching, skin rash, fatigue |
Benralizumab | IL-5 receptor α | Eosinophilic asthma (≥300 eosinophils/μL) | Fever (after first injection), headache, pharyngitis |
Dupilumab | IL-4 and IL-13 pathways | Type 2 asthma, eosinophilic asthma, OCS-dependent asthma | Transitory increase of blood eosinophilia, reduction in T2 inflammation markers |
Omalizumab | IgE pathway | Allergic asthma | Headache, injection site reaction, sore throat, fatigue, joint pain, skin rash |
Tezepelumab | TSLP pathway | Allergic and eosinophilic asthma, non-type-2 asthma | Similar to other biologics, potential for headache, injection site reactions, etc. |
Reference | Study | Population | Intervention | Outcome |
---|---|---|---|---|
[6] | Chapman et al., 2019 | 138 patients with allergic eosinophilic asthma | Switch from Omalizumab to Mepolizumab | Improved asthma control, health status, reduced exacerbation rates |
[7] | Menzies-Gow et al. | 3531 patients, 384 switched biologics | Switching biologics, primarily from Omalizumab to anti-IL-5/5R | Changes based on inadequate effectiveness or negative side effects |
[8] | Liu et al., 2021 | 138 patients from the OSMO study | Transition from Omalizumab to Mepolizumab | Improvements regardless of various baseline characteristics |
[9] | Magnan et al., 2016 | 120 patients from MENSA and SIRIUS studies | Effectiveness of Mepolizumab after Omalizumab | Positive response to Mepolizumab irrespective of prior Omalizumab use |
[10] | Bagnasco et al., 2019 | 27 patients with severe allergic eosinophilic asthma | Switch to Mepolizumab due to insufficient control with Omalizumab | Reduced exacerbations, decreased prednisone dosage, improved FEV1 and ACT scores |
[11] | Carpagnano et al., 2020 | 41 patients with severe allergic eosinophilic asthma | Switch to Mepolizumab without a washout period | Increased ACT scores, improved pre-bronchodilator FEV1, reduced exacerbations and corticosteroid dependency |
[12] | Carpagnano et al., 2021 | 33 patients with severe eosinophilic asthma | Switch to Mepolizumab from Omalizumab | Decrease in annual exacerbations and adverse events, reduction in lost working days |
[13] | Pelaia et al., 2021 | 20 patients with severe persistent allergic and eosinophilic asthma | Switch to Benralizumab from Omalizumab | Significant improvements in asthma exacerbation rates, rescue medication usage, ACT scores, FEV1, and blood eosinophil counts |
[14] | O’Reilly et al., 2022 | 10 patients | Switch to anti-IL-5 therapy from Omalizumab | Significant reductions in community exacerbation rates, serum eosinophil counts, and improvement in FEV1 |
[15] | Gómez-Baster Fernádez et al., 2022 | 40 patients | Switch from Omalizumab or Mepolizumab to Benralizumab | Significant decrease in exacerbations, emergency department visits, corticosteroid cycles, and improvement in ACT scores |
[16] | Caruso et al., 2022 | 205 asthma patients (147 biologic-naïve and 58 biologic-experienced) | Switch to Benralizumab from Omalizumab or Mepolizumab | Similar reductions in exacerbations, OCS usage, ACT improvement, and lung function in both groups |
[17] | Numata et al., 2020 | 24 patients treated with Mepolizumab | Switch to Benralizumab due to inadequate control | Slight improvements in some parameters but no significant differences observed |
[18] | Drick et al., 2020 | 60 patients receiving anti-IL5 treatment | Switch to Benralizumab | Progressive improvement in symptom control, OCS intake, and lung function |
[19] | Kavanagh et al., 2021 | 33 asthmatic patients | Switch to Benralizumab from Mepolizumab | 58% reduction in the annualized exacerbation rate, significant improvement in symptom control and quality of life |
[20] | Martínez-Moragón et al., 2021 | Patients treated with anti-IL5 therapy | Switch to Benralizumab | Significant improvements in ACT scores, annualized asthma exacerbation rates, and OCS intake |
[21] | Mümmler et al., 2021 | 38 severe asthma patients | Switch to Dupilumab from a previous anti-IgE or anti-IL5/IL5R medication | Improvements in asthma control, lung function, exacerbation rates, FENO, and IgE levels |
[22] | Campisi et al., 2021 | 5 patients | Switch to Dupilumab from Omalizumab, Mepolizumab, or Benralizumab | Reduction in exacerbations, OCS usage, improvement in FEV1% values, and enhanced asthma control |
[23] | Numata et al., 2022 | 26 patients (10 Dupilumab as first biologic, 16 switched from other biologics) | Switch to Dupilumab | Reductions in exacerbations, OCS maintenance doses, and improvements in asthma symptoms |
[24] | Eger et al., 2021 | 4 patients treated with anti-IL-5 or anti-IL-5R biologics | Switch to Dupilumab | Development of hypereosinophilia, sudden deterioration in asthma symptoms, tissue infiltration by eosinophils |
[25] | Caminati et al., 2023 | 68 patients with severe eosinophilic asthma | Switch from Mepolizumab to Benralizumab | Improved outcomes including oral corticosteroid reduction, lung function, and blood eosinophil levels |
[26] | Higo et al., 2023 | 27 severe asthma patients | Switch to Dupilumab from other biologics without a gap | Significant improvements in lung function and asthma control, 77.8% response rate to Dupilumab |
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Dragonieri, S.; Portacci, A.; Quaranta, V.N.; Carpagnano, G.E. Advancing Care in Severe Asthma: The Art of Switching Biologics. Adv. Respir. Med. 2024, 92, 110-122. https://doi.org/10.3390/arm92020014
Dragonieri S, Portacci A, Quaranta VN, Carpagnano GE. Advancing Care in Severe Asthma: The Art of Switching Biologics. Advances in Respiratory Medicine. 2024; 92(2):110-122. https://doi.org/10.3390/arm92020014
Chicago/Turabian StyleDragonieri, Silvano, Andrea Portacci, Vitaliano Nicola Quaranta, and Giovanna Elisiana Carpagnano. 2024. "Advancing Care in Severe Asthma: The Art of Switching Biologics" Advances in Respiratory Medicine 92, no. 2: 110-122. https://doi.org/10.3390/arm92020014