Type-2 severe asthma comorbidities in the era of biologics: time to rethink clinical response?

ABSTRACT

Introduction

The use of monoclonal antibodies in patients with severe asthma has led clinicians to explore new levels of clinical improvement, as testified by the growing interest on clinical remission achievement. In this context, a major role is played by asthma-related comorbidities, which can influence asthma pathophysiology and treatment response.

Areas covered

In this special report, we highlighted how asthma-related comorbidities could deeply affect monoclonal antibody response as well as clinical remission achievement. As examples, we provided data from clinical trials and real-life experiences involving patients with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA) or bronchiectasis.

Expert Opinion

Comorbidities associated with severe asthma development should be carefully assessed in everyday clinical practice, even with the help of new diagnostic technologies, artificial intelligence and multidisciplinary teams. Future studies should address the role of comorbidities in remission achievement, describing how these diseases could generate new trajectories of clinical and functional response in patient treated with monoclonal antibodies.

KEYWORDS:

• Asthma
• biologic
• comorbidities
• CRSwNP
• EGPA
• bronchiectasis
• remission

Article highlights

• Asthma-related comorbidities could significantly impact clinical response to biologic therapies.

• Time for clinical improvement in patients with severe asthma and CRSwNP tends to be uneven across different endpoints.

• The association of severe asthma and EGPA influence baseline and follow-up features of patients showing a better response to biologics.

• The coexistence of severe asthma and bronchiectasis is a negative predictive factor for clinical remission achievement in patients treated with anti-IL5/IL5R.

• FeNO measurement and chest imaging could provide useful insights to assess the clinical impact of bronchiectasis in patients with severe asthma treated with monoclonal antibodies.

Abbreviations

Oral corticosteroids (OCS), super-responders (SR), Eosinophilic Granulomatosis with Polyangiitis (EGPA), Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP), Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT), monoclonal antibodies (mAbs), Minimal Clinically Important Difference (MCID), Fraction of exhaled nitric oxide (FeNO), Inducible nitric oxide synthases (iNOS), Computed tomography (CT), magnetic resonance imaging (MRI)

Declaration of interest

A. Portacci reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline, Chiesi, Sanofi

G. E. Carpagnano reported grants or contracts from AstraZeneca, Chiesi, GlaxoSmithKline, Sanofi, Grifols; payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from AstraZeneca, GlaxoSmithKline, Sanofi; support for attending meetings and/or travel from AstraZeneca, Menarini, Chiesi.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.