Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study

Abstract

Background

In Japan, biologic therapy was initiated for patients with severe asthma in 2009. In recent years, four biologics with different mechanisms of action have become available in the clinical setting. However, the efficacy of switching between biologics remains uncertain.

Methods

To elucidate the efficacy of switching between biologics, 97 patients were enrolled who had received any biologic therapy for severe asthma at Jikei University Hospital, Tokyo, Japan, from July 2009 to December 2020. We retrospectively examined the patient characteristics, biomarkers, pulmonary function test results, selected biologics, and efficacy.

Results

Thirty-one males and 66 females received any biologics. The mean age was 53.3 years at the initiation of biologic therapy. Initially, 33, 41, 15 and eight patients received omalizumab, mepolizumab, benralizumab, and dupilumab, respectively. Among three representative indicators for biologics administration, the peripheral blood eosinophil count, serum IgE levels and fractional exhaled nitric oxide, 64% of the patients had two indicators, and 28% had three indicators. Thirty-four patients (35%) switched from the initial biologic to another, and the reasons for switching included persistent asthmatic symptoms (n=22), schedule of hospital visits (n=5), and other reasons. Thus, the treatment was effective in 11 patients after switching. In addition, two patients received combination therapy with different biologics. Eighteen patients (19%) interrupted treatment for various reasons. Regardless of whether the biologic was the initial therapy, the overall efficacy of the four biologics was 60% based on the global evaluation of treatment effectiveness.

Conclusion

Switching between biologics can be a promising option for severe asthma patients in whom treatment with an initial biologic is ineffective.

Keywords:

• benralizumab
• dupilumab
• mepolizumab
• omalizumab
• switching

Abbreviations

ACT, Asthma Control Test; CRSwNP, chronic rhinosinusitis with nasal polyp; ECRS, eosinophilic chronic rhinosinusitis; FeNO, fractional exhaled nitric oxide; GETE, Global Evaluation of Treatment Effectiveness; ICS, inhaled corticosteroid; IL, interleukin; LABA, long-acting β-2 agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroids; PBE, peripheral blood eosinophil count.

Author Contributions

All the authors contributed to data analysis, drafting the manuscript, or revising the manuscript. They have agreed on the journal to which the article will be submitted, have approved the final version to be published, and have agreed to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

There is no funding to report.