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Review
. 2023 Feb 7;12(2):400.
doi: 10.3390/antiox12020400.

Exploring the Interaction between Fractional Exhaled Nitric Oxide and Biologic Treatment in Severe Asthma: A Systematic Review

Tommaso Pianigiani  1 , Lorenzo Alderighi  1 , Martina Meocci  1 , Maddalena Messina  1 , Beatrice Perea  1 , Simona Luzzi  1 , Laura Bergantini  1 , Miriana D'Alessandro  1 , Rosa Metella Refini  1 , Elena Bargagli  1 , Paolo Cameli  1
Affiliations
Review

Exploring the Interaction between Fractional Exhaled Nitric Oxide and Biologic Treatment in Severe Asthma: A Systematic Review

Tommaso Pianigiani et al. Antioxidants (Basel). .

Abstract

Background: Fractional exhaled nitric oxide (FeNO) is a biomarker of airway inflammation associated with airway hyper-responsiveness and type-2 inflammation. Its role in the management of severe asthmatic patients undergoing biologic treatment, as well as FeNO dynamics during biologic treatment, is largely unexplored.

Purpose: The aim was to evaluate published data contributing to the following areas: (1) FeNO as a predictive biomarker of response to biologic treatment; (2) the influence of biologic treatment in FeNO values; (3) FeNO as a biomarker for the prediction of exacerbations in patients treated with biologics.

Methods: The systematic search was conducted on the Medline database through the Pubmed search engine, including all studies from 2009 to the present.

Results: Higher baseline values of FeNO are associated with better clinical control in patients treated with omalizumab, dupilumab, and tezepelumab. FeNO dynamics during biologic treatment highlights a clear reduction in FeNO values in patients treated with anti-IL4/13 and anti-IL13, as well as in patients treated with tezepelumab. During the treatment, FeNO may help to predict clinical worsening and to differentiate eosinophilic from non-eosinophilic exacerbations.

Conclusions: Higher baseline FeNO levels appear to be associated with a greater benefit in terms of clinical control and reduction of exacerbation rate, while FeNO dynamics during biologic treatment remains a largely unexplored issue since few studies have investigated it as a primary outcome. FeNO remains detectable during biologic treatment, but its potential utility as a biomarker of clinical control is still unclear and represents an interesting research area to be developed.

Keywords: biologic; biomarker; nitric oxide; severe asthma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for study selection and inclusion for systematic review.
Figure 2
Figure 2
The size of the circles and the number inside reflect the number of articles reviewed per drug. The color reflects the agreement of the results with the points in examination (Green = concordance; Red = discordance; Orange = no diriment data). *: presence of RCT between the study reviewed.
See this image and copyright information in PMC

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