Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo

Elisangela Santos-Valente¹, Heike Buntrock-Döpke^{1

2}, Rola Abou Taam³, Stefania Arasi⁴, Arzu Bakirtas⁵, Jaime Lozano Blasco⁶, Klaus Bønnelykke⁷, Mihai Craiu⁸, Renato Cutrera⁹, Antoine Deschildre¹⁰, Basil Elnazir^{11

12}, Louise Fleming^{13

14}, Urs Frey¹⁵, Monika Gappa¹⁶, Antonio Nieto García¹⁷, Kirsten Skamstrup Hansen⁷, Laurence Hanssens¹⁸, Karina Jahnz-Rozyk¹⁹, Milos Jesenak^{20

21}, Sebastian Kerzel¹, Matthias V Kopp^{22

23}, Gerard H Koppelman^{24

25}, Uros Krivec²⁶, Kenneth A MacLeod²⁷, Mika Mäkelä²⁸, Erik Melén^{29

30}, Györgyi Mezei³¹, Alexander Moeller³², Andre Moreira^{33

34}, Petr Pohunek³⁵, Predrag Minić³⁶, Niels W P Rutjes³⁷, Patrick Sammut³⁸, Nicolaus Schwerk^{39

40}, Zsolt Szépfalusi⁴¹, Mirjana Turkalj⁴², Iren Tzotcheva⁴³, Alexandru Ulmeanu⁴⁴, Stijn Verhulst^{45

46}, Paraskevi Xepapadaki⁴⁷, Jakob Niggel⁴⁸, Susanne Vijverberg^{49

50}, Anke H Maitland-van der Zee^{49

50}, Uroš Potočnik^{51

52}, Susanne M Reinartz⁵³, Cornelis M van Drunen⁵⁴, Michael Kabesch^{1

2}

Affiliations

¹ Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.
² Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany.
³ Service de pneumologie pédiatrique, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.
⁴ Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy.
⁵ Dept of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, Turkey.
⁶ Dept of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
⁷ Dept of Pediatrics, Herlev and Gentofte Hospital, University Hospital Copenhagen, Denmark.
⁸ Respiratory Dept, National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest, Romania.
⁹ Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Dept of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ University of Lille, CHU Lille, Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
¹¹ Children's Health Ireland (CHI) at Tallaght University Hospital, Dublin, Ireland.
¹² Trinity College, Dublin, Ireland.
¹³ Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁴ Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
¹⁵ University Children's Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ Evangelisches Krankenhaus Düsseldorf, Children's Hospital, Düsseldorf, Germany.
¹⁷ Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe and Health Research Institute La Fe, Valencia, Spain.
¹⁸ Service de Pneumologie-Allergologie, Centre de reference de Mucoviscidose de l'ULB, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
¹⁹ Dept of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland.
²⁰ Dept of Paediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia.
²¹ Dept of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia.
²² University Children's Hospital Bern, Inselspital, University of Bern, Switzerland.
²³ German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
²⁴ Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
²⁵ Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²⁶ Dept of Paediatric Pulmology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia.
²⁷ Royal Hospital for Children and Young People, Edinburgh, UK.
²⁸ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁹ Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
³⁰ Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³¹ Allergy Unit, First Dept of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
³² Division of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland.
³³ Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal.
³⁴ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
³⁵ Pediatric Pulmonology, Pediatric Dept, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic.
³⁶ Mother and Child Health Institute of Serbia, Belgrade, Serbia.
³⁷ Dept of Paediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³⁸ Dept of Paediatrics, Respiratory Medicine and Allergy, Mater Dei Hospital, Malta.
³⁹ Dept of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
⁴⁰ German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany.
⁴¹ Division of Pediatric Pulmonology, Allergology and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria.
⁴² Srebrnjak Children's Hospital, Zagreb, and School of Medicine, University of Osijek "Josip Juraj Strossmayer", Osijek, and Catholic University of Croatia, Zagreb, Croatia.
⁴³ Dept of Pediatrics, University Hospital for Emergency Medicine "N. I. Pirogov", Medical University, Sofia, Bulgaria.
⁴⁴ "Grigore Alexandrescu" Emergency Hospital for Children, Bucharest, Romania.
⁴⁵ Dept of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
⁴⁶ Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁴⁷ Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
⁴⁸ Datadesk Limited, Regensburg, Germany.
⁴⁹ Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵⁰ Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵¹ Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia.
⁵² Centre for Human Molecular Genetics and Pharmacogenomics, Medical Faculty, University of Maribor, Maribor, Slovenia.
⁵³ Dept of Otorhinolaryngology, Tergooi Hospitals, Hilversum, the Netherlands.
⁵⁴ Dept of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

PMID: 34409097
PMCID: PMC8365152
DOI: 10.1183/23120541.00143-2021

Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo

Elisangela Santos-Valente et al. ERJ Open Res. 2021.

. 2021 Aug 16;7(3):00143-2021.

doi: 10.1183/23120541.00143-2021. eCollection 2021 Jul.

Authors

Affiliations

¹ Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.
² Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany.
³ Service de pneumologie pédiatrique, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.
⁴ Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy.
⁵ Dept of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, Turkey.
⁶ Dept of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
⁷ Dept of Pediatrics, Herlev and Gentofte Hospital, University Hospital Copenhagen, Denmark.
⁸ Respiratory Dept, National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest, Romania.
⁹ Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Dept of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ University of Lille, CHU Lille, Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
¹¹ Children's Health Ireland (CHI) at Tallaght University Hospital, Dublin, Ireland.
¹² Trinity College, Dublin, Ireland.
¹³ Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁴ Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
¹⁵ University Children's Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ Evangelisches Krankenhaus Düsseldorf, Children's Hospital, Düsseldorf, Germany.
¹⁷ Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe and Health Research Institute La Fe, Valencia, Spain.
¹⁸ Service de Pneumologie-Allergologie, Centre de reference de Mucoviscidose de l'ULB, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
¹⁹ Dept of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland.
²⁰ Dept of Paediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia.
²¹ Dept of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia.
²² University Children's Hospital Bern, Inselspital, University of Bern, Switzerland.
²³ German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
²⁴ Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
²⁵ Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²⁶ Dept of Paediatric Pulmology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia.
²⁷ Royal Hospital for Children and Young People, Edinburgh, UK.
²⁸ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁹ Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
³⁰ Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³¹ Allergy Unit, First Dept of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
³² Division of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland.
³³ Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal.
³⁴ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
³⁵ Pediatric Pulmonology, Pediatric Dept, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic.
³⁶ Mother and Child Health Institute of Serbia, Belgrade, Serbia.
³⁷ Dept of Paediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³⁸ Dept of Paediatrics, Respiratory Medicine and Allergy, Mater Dei Hospital, Malta.
³⁹ Dept of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
⁴⁰ German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany.
⁴¹ Division of Pediatric Pulmonology, Allergology and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria.
⁴² Srebrnjak Children's Hospital, Zagreb, and School of Medicine, University of Osijek "Josip Juraj Strossmayer", Osijek, and Catholic University of Croatia, Zagreb, Croatia.
⁴³ Dept of Pediatrics, University Hospital for Emergency Medicine "N. I. Pirogov", Medical University, Sofia, Bulgaria.
⁴⁴ "Grigore Alexandrescu" Emergency Hospital for Children, Bucharest, Romania.
⁴⁵ Dept of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
⁴⁶ Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁴⁷ Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
⁴⁸ Datadesk Limited, Regensburg, Germany.
⁴⁹ Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵⁰ Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵¹ Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia.
⁵² Centre for Human Molecular Genetics and Pharmacogenomics, Medical Faculty, University of Maribor, Maribor, Slovenia.
⁵³ Dept of Otorhinolaryngology, Tergooi Hospitals, Hilversum, the Netherlands.
⁵⁴ Dept of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

PMID: 34409097
PMCID: PMC8365152
DOI: 10.1183/23120541.00143-2021

Abstract

Introduction: Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe.

Methods: Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data.

Results: We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals.

Conclusion: Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident.

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Conflict of interest statement

Conflict of interest: E. Santos-Valente has nothing to disclose. Conflict of interest: H. Buntrock-Döpke has nothing to disclose. Conflict of interest: R. Abou Taam has nothing to disclose. Conflict of interest: S. Arasi has nothing to disclose. Conflict of interest: A. Bakirtas has nothing to disclose. Conflict of interest: J. Lozano Blasco reports personal fees from Novartis and GSK outside the submitted work. Conflict of interest: K. Bønnelykke has nothing to disclose. Conflict of interest: M. Craiu reports a speaker fee for a scientific meeting regarding 5 years of Xolair in Romania (9 May 2018) from Novartis Romania outside the submitted work. Conflict of interest: R. Cutrera has nothing to disclose. Conflict of interest: A. Deschildre reports personal fees and other support from Novartis, GSK and Sanofi outside the submitted work. Conflict of interest: B. Elnazir has nothing to disclose. Conflict of interest: L. Fleming reports grants from Asthma UK, and speakers fees or fees for expert consultation from Teva, Astra Zeneca, Sanofi, Respiri, Novartis; all fees paid direct to her institution and outside the submitted work. Conflict of interest: U. Frey has nothing to disclose. Conflict of interest: M. Gappa reports personal fees from Boehringer Ingelheim, GSK, Novartis and Sanofi outside the submitted work. Conflict of interest: A. Nieto García reports grants for clinical studies and advisory boards membership, as well as lecture fees from Novartis, GSK and MSD. Conflict of interest: K. Skamstrup Hansen has nothing to disclose. Conflict of interest: L. Hanssens has nothing to disclose. Conflict of interest: K. Jahnz-Rozyk received lecture and advisory board fees from AstraZeneca, Novartis, GSK, and Sanofi Aventis, outside the submitted work. Conflict of interest: M. Jesenak has nothing to disclose. Conflict of interest: S. Kerzel reports a speaker fee from Novartis for a lecture that has no topical overlap at all with the current manuscript. Conflict of interest: M. V. Kopp reports personal fees from ALK-Abello GmbH, Chiesi GmbH, Infectopharm GmbH, Novartis GmbH, Sanofi Aventis HmbH and Vertex GmbH, and grants and personal fees from Allergopharma GmbH, outside the submitted work. Conflict of interest: G.H. Koppelman reports grants from Lung Foundation Netherlands, TETRI Foudation, Ubbo Emmius Foundation, Vertex, Teva the Netherlands, GSK, European Union, outside the submitted work; and he participated in advisory board meetings to GSK and Pure IMS (money to institution). Conflict of interest: U. Krivec has nothing to disclose. Conflict of interest: K.A. MacLeod has nothing to disclose. Conflict of interest: M. Mäkelä has nothing to disclose. Conflict of interest: E. Melén reports personal fees from AstraZeneca, Chiesi, Novartis and Sanofi (advisory board fees), outside the submitted work. Conflict of interest: G. Mezei reports a travel grant from LOFARMA outside the submitted work. Conflict of interest: A. Moeller has nothing to disclose. Conflict of interest: A. Moreira has nothing to disclose. Conflict of interest: P. Pohunek reports personal fees for advisory board membership from Novartis and GlaxoSmithKline, and for consultation from Chiesi and AstraZeneca, outside the submitted work. Conflict of interest: P. Minić has nothing to disclose. Conflict of interest: N.W.P. Rutjes reports personal fees from GSK (advisory board on mepolizumab) and Sanofi (advisory board on dupilumab) outside the submitted work. Conflict of interest: P. Sammut has nothing to disclose. Conflict of interest: N. Schwerk reports lecture and advisory board fees from Novartis, Sanofi and Allergopharma; advisory board fees from Boehringer Ingelheim; and lecture fees from Abvie and Infectopharm, all outside the submitted work. Conflict of interest: Z. Szépfalusi has nothing to disclose. Conflict of interest: M. Turkalj has nothing to disclose. Conflict of interest: I. Tzotcheva has nothing to disclose. Conflict of interest: A. Ulmeanu has nothing to disclose. Conflict of interest: S. Verhulst reports grants from GSK during the conduct of the study. Conflict of interest: P. Xepapadaki reports personal fees for advisory services from Uriach, Novartis, Nestle and Nutricia outside the submitted work. Conflict of interest: J. Niggel has nothing to disclose. Conflict of interest: S. Vijverberg reports grants from ZonMW during the conduct of the study. Conflict of interest: A-H. Maitland van der Zee has received research grants outside the submitted work from GSK, Boehringer Ingelheim and Vertex; she is the principal investigator of a P4O2 (Precision Medicine for more Oxygen) public–private partnership sponsored by Health Holland involving many private partners that contribute in cash and/or in kind (Boehringer Ingelheim, Breathomix, Fluidda, Ortec Logiqcare, Philips, Quantib-U, Smartfish, SODAQ, Thirona, TopMD and Novartis); and she has served in advisory boards for AstraZeneca, GSK and Boehringer Ingelheim, with money paid to her institution. Conflict of interest: U. Potocnik was funded by the Ministry of Education, Science and Sport of the Republic of Slovenia, grant PERMEABLE (contract number C3330-19-252012), during the conduct of the study. Conflict of interest: S. M. Reinartz has nothing to disclose. Conflict of interest: C. M. van Drunen has nothing to disclose. Conflict of interest: M. Kabesch reports grants to his institution from the European Union, the German Ministry of Education and Research, and the German Research Foundation, during the conduct of the study; and consultancy fees from Bionorica, Sanofi, Novartis and Bencard, payments for lectures form the ERS, EAACI, ATS, Novartis, Glaxo, Nutricia, Hipp and Allergopharma, and a patent for a method for testing a subject thought to have or be disposed to asthma (European patent application 5 EP070301 135.5), outside the submitted work.

Figures

**FIGURE 1**
Map of Europe with location of centres contributing to the survey and centre size by colour code. Participating countries are depicted in green, and locations of survey centres are given. Colour codes for overall centre experience in biological treatment (number of children ever treated with biologicals) are shown according to five categories.

**FIGURE 2**
a) Number of centres with experience of different biologicals for severe asthma and b) percentage of paediatric asthma patients currently treated with the respective biologicals. All centres have experience of treatment with anti-IgE (omalizumab), except for one centre where approval for treatment is still pending as the drug only became available for children recently. Treatment with anti-interleukin (IL)-5 comprises mepolizumab and reslizumab, and further discrimination due to low numbers did not seem justified. Anti-IL4Rα treatment is dupilumab. IgE: immunoglobulin E.

**FIGURE 3**
Medical disciplines allowed to initiate biological therapy for severe asthma in children across Europe. Cumulative numbers are given (multiple answers were possible per country). Paediatric centres are hospitals specialised in treatment of children where paediatric experts for severe asthma are available (paediatric allergist or pneumologist where subspecialisation is available). GP: general practitioner.

**FIGURE 4**
Time point for evaluation of therapy success with biologicals and minimal duration of therapy before discontinuation trial is initiated by centre, sorted by centre size. Centres are grouped according to experience in treatment and colour coded as in figure 1. Time point or time frame for assessment of therapy success is depicted in green; the blue bars indicate minimal duration of therapy before a trial for discontinuation is made in the respective centres. *: for centre 13, approval for first patient on biological is still pending.

See this image and copyright information in PMC

Comment in

Mepolizumab Treatment in Severe Pediatric Asthma: First Multicentric Real-World Data.
Wetzke M, Funken D, Ahrens FO, Gappa M, Hansen G, Koerner-Rettberg C, Koester H, Schulze J, Schwerk N, Zielen S, Happle C. Wetzke M, et al. Klin Padiatr. 2022 Sep;234(5):305-308. doi: 10.1055/a-1717-2234. Epub 2022 Mar 22. Klin Padiatr. 2022. PMID: 35319087 English. No abstract available.

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Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo

Affiliations

Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

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