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Review
. 2023 May 31;24(11):9563.
doi: 10.3390/ijms24119563.

Switching Biological Therapies in Severe Asthma

Giulia Scioscia  1 , Santi Nolasco  2   3 , Raffaele Campisi  2 , Carla Maria Irene Quarato  4 , Cristiano Caruso  5 , Corrado Pelaia  6 , Andrea Portacci  7 , Claudia Crimi  2   3
Affiliations
Review

Switching Biological Therapies in Severe Asthma

Giulia Scioscia et al. Int J Mol Sci. .

Abstract

Currently, three classes of monoclonal antibodies targeting type 2 inflammation pathways are available in Italy for the treatment of severe asthma: anti-IgE (Omalizumab), anti-IL-5/anti-IL-5Rα (Mepolizumab and Benralizumab), and anti-IL-4Rα (Dupilumab). Numerous randomized controlled trials (RCTs) and real-life studies have been conducted to define their efficacy and identify baseline patients' characteristics potentially predictive of favorable outcomes. Switching to another monoclonal antibody is recommended in case of a lack of benefits. The aim of this work is to review the current knowledge on the impact of switching biological therapies in severe asthma as well as on predictors of treatment response or failure. Almost all of the information about switching from a previous monoclonal antibody to another comes from a real-life setting. In the available studies, the most frequent initial biologic was Omalizumab and patients who were switched because of suboptimal control with a previous biologic therapy were more likely to have a higher baseline blood eosinophil count and exacerbation rate despite OCS dependence. The choice of the most suitable treatment may be guided by the patient's clinical history, biomarkers of endotype (mainly blood eosinophils and FeNO), and comorbidities (especially nasal polyposis). Due to overlapping eligibility, larger investigations characterizing the clinical profile of patients benefiting from switching to different monoclonal antibodies are needed.

Keywords: biologics; biomarkers; efficacy; randomized clinical trials; real-life studies; severe asthma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A chronological and cohort-size summary of the literature review [24,29,30,35,36,37,38,39,65,66,67,68,69,70,90,91,92,93].
See this image and copyright information in PMC

References

    1. Porsbjerg C., Melén E., Lehtimäki L., Shaw D. Asthma. Lancet. 2023;401:858–873. doi: 10.1016/S0140-6736(22)02125-0. - DOI - PubMed
    1. Hekking P.P.W., Wener R.R., Amelink M., Zwinderman A.H., Bouvy M.L., Bel E.H. The prevalence of severe refractory asthma. J. Allergy Clin. Immunol. 2015;135:896–902. doi: 10.1016/j.jaci.2014.08.042. - DOI - PubMed
    1. Lefebvre P., Duh M.S., Lafeuille M.H., Gozalo L., Desai U., Robitaille M.N., Albers F., Yancey S., Ortega H., Forshag M., et al. Acute and chronic systemic corticosteroid-related complications in patients with severe asthma. J. Allergy Clin. Immunol. 2015;136:1488–1495. doi: 10.1016/j.jaci.2015.07.046. - DOI - PubMed
    1. Fahy J.V. Type 2 inflammation in asthma—Present in most, absent in many. Nat. Rev. Immunol. 2014;15:57–65. doi: 10.1038/nri3786. - DOI - PMC - PubMed
    1. Doroudchi A., Pathria M., Modena B.D. Asthma biologics: Comparing trial designs, patient cohorts and study results. Ann. Allergy Asthma Immunol. 2020;124:44–56. doi: 10.1016/j.anai.2019.10.016. - DOI - PMC - PubMed