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. 2020 Nov 11:13:605-614.
doi: 10.2147/JAA.S270298. eCollection 2020.

Switch from IL-5 to IL-5-Receptor α Antibody Treatment in Severe Eosinophilic Asthma

Nora Drick #  1 , Katrin Milger #  2 , Benjamin Seeliger  1 , Jan Fuge  1 , Stephanie Korn  3 , Roland Buhl  3 , Maren Schuhmann  4 , Felix Herth  4 , Benjamin Kendziora  5 , Juergen Behr  2 , Nikolaus Kneidinger  2 , Karl-Christian Bergmann  5 , Christian Taube  6 , Tobias Welte  1 , Hendrik Suhling  1
Affiliations

Switch from IL-5 to IL-5-Receptor α Antibody Treatment in Severe Eosinophilic Asthma

Nora Drick et al. J Asthma Allergy. .

Abstract

Background: Anti-IL-5 antibodies represent an established therapy for severe eosinophilic asthma (SEA), but some patients show inadequate response. The objective of this study was to assess the effects of a switch to anti-IL-5Rα therapy in patients with inadequate response to anti-IL-5 therapy.

Methods: In this retrospective multi-centre, real-life study, we analysed all SEA patients switched from anti-IL-5 to anti-IL-5Rα therapy due to inadequate response or intolerability. Pulmonary function tests, blood gas analyses, asthma control tests (ACT) and oral corticosteroid (OCS) usage were analysed and compared at three timepoints: baseline (BL, before anti-IL-5 therapy), timepoint 1 (T1, under anti-IL-5 therapy) and timepoint 2 (T2, under anti-IL-5Rα therapy).

Results: Of 665 patients treated with anti-IL-5 antibodies, 70 were switched to anti-IL-5Rα and 60 were included in the analysis. Median treatment duration was 8 months [IQR 5; 15] for anti-IL-5 and 5 months [IQR 4; 6] for anti-IL-5Rα therapy. FEV1 was 61% of predicted at BL [IQR 41; 74], 61% [IQR 43; 79] at T1 and 68% [IQR 49; 87] at T2 (pT1-T2=0.011). ACT score was 10 [IQR 8; 13], 16 [IQR 10; 19] and 19 [IQR 14; 22], respectively (both p<0.001). The number of patients requiring OCS was reduced from 41 (BL) to 32 (T1) and 19 (T2) (both p<0.001). Ten patients discontinued anti-IL-5Rα therapy due to insufficient efficacy (n=7) and adverse events (n=3).

Conclusion: Switching from anti-IL-5 to anti-IL-5Rα therapy in patients with inadequate response was associated with significantly improved FEV1, asthma control and OCS reduction.

Keywords: benralizumab; eosinophils; mepolizumab; reslizumab; severe asthma.

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Conflict of interest statement

Katrin Milger reports personal fees from GSK, AstraZeneca, Novartis, and Sanofi-Aventis, outside the submitted work. Stephanie Korn reports grants, personal fees from AstraZeneca, GlaxoSmithKline, Novartis, and Sanofi, and personal fees from Teva, outside the submitted work. Roland Buhl reports personal fees from AstraZeneca, Chiesi, Cipla, Sanofi, and Teva, grants, personal fees from Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Roche, outside the submitted work. Juergen Behr reports personal fees from Novartis, Astra Zeneca, Boehringer-Ingelheim, and Roche, outside the submitted work. Tobias Welte reports grants from German Ministry of Research and Education (BMBF), during the conduct of the study; and personal fees from AstraZeneca, GSK, Novartis, and Sanofi-Aventis, outside the submitted work. Hendrik Suhling reports personal fee from GSK, AstraZeneca, Novartis and SanofiAvensis outside the submitted work. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Flow chart of study population, number of patients in bold letters.
Figure 2
Figure 2
Change (delta) from baseline to anti-IL-5 (T1) and anti-IL-5Rα (T2) therapy of asthma control (A), pulmonary function tests (C–E), capillary oxygenation (B) and blood eosinophil (eos) counts (F).
Figure 3
Figure 3
(A) Boxplots with individual OCS doses at baseline, under anti-IL5 (T1) and anti-IL5Rα (T2) therapy. The relative dose change of each patient receiving OCS is shown as waterfall plots in (B and C). Patients who never received OCS at any time are not considered in the graph or median dose calculations. *One patient at T1 and T2 newly received OCS and relative dose change is arbitrarily displayed as 150%.
See this image and copyright information in PMC

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