Published online 2020 Jul 31. doi: 10.1016/j.waojou.2020.100441
Andras Bikov,a,bIpek Kivilcim Oğuzülgen,cIlaria Baiardini,dMarco Contoli,eAlexander Emelyanov,fOmar Fassio,gJuan Carlos Ivancevich,hIgor Kaidashev,iKrzysztof Kowal,jMarina Labor,k,lLies Lahousse,mStefan Mihaicuta,nSilviya Novakova,oAlicia Padilla Galo,pAlexander Simidchiev,qAngelica Tiotiu,r,sIgnacio J. Ansotegui,tJonathan A. Bernstein,uLouis Philippe Boulet,vGiorgio Walter Canonica,w,xLawrence Dubuske,yNelson Rosario,zPierachille Santus,aaFulvio Braido,ab,ac,∗ and Interasma Scientific Network (INES)1Author informationArticle notesCopyright and License informationDisclaimer
Severe asthma is a serious condition with a significant burden on patients’ morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore the beliefs and practices in the use of biological therapies in severe asthma, hypothesizing that differences will occur depending on the prescribers’ specialty and experience.
We conducted an online survey composed of 35 questions in English. The survey was circulated via the INterasma Scientific Network (INESNET) platform as well as through social media. Responses from allergists and pulmonologists, both those with experience of prescribing omalizumab with (OMA/IL5) and without (OMA) experience with anti-IL5 drugs, were compared.
Two hundred eighty-five (285) valid questionnaires from 37 countries were analyzed. Seventy-on percent (71%) of respondents prescribed biologics instead of oral glucocorticoids and believed that their side effects are inferior to those of Prednisone 5 mg daily. Agreement with ATS/ERS guidelines for identifying severe asthma patients was less than 50%. Specifically, significant differences were found comparing responses between allergists and pulmonologists (Chi-square test, p < 0.05) and between OMA/IL5 and OMA groups (p < 0.05).
Uncertainties and inconsistencies regarding the use of biological medications have been shown. The accuracy of prescribers to correctly identify asthma severity, according to guidelines criteria, is quite poor. Although a substantial majority of prescribers believe that biological drugs are safer than low dose long-term treatment with oral steroids, and that they must be used instead of oral steroids, every effort should be made to further increase awareness. Efficacy as disease modifiers, biomarkers for selecting responsive patients, timing for outcomes evaluation, and checks need to be addressed by further research. Practices and beliefs regarding the use of asthma biologics differ between the prescriber’s specialty and experience; however, the latter seems more significant in determining beliefs and behavior. Tailored educational measures are needed to ensure research results are better integrated in daily practice. Keywords: Severe asthma, Biological drug, Belief, Behavior Abbreviations: ICS, inhaled corticosteroids; Eos: Eosinophil, IL5; interleukine 5, IgE; Immunoglobulin E, INESNET; INterasma Scientific Network, LABA; long-acting beta2-agonist, OMA; Omalizumab. OMA/IL5, Omalizumab plus anti-IL5 molecule.