Ron Goldberg
In adults with severe asthma, poor response to omalizumab and benralizumab is significantly associated with pediatric-onset asthma, bronchiectasis, poor symptom control, maintenance oral corticosteroid (mOCS) use, and severe airway obstruction, according to study findings published in BMC Pulmonary Medicine.
Investigators sought to characterize factors contributing to poor response to omalizumab and benralizumab therapy in severe adult asthma.
The investigators conducted a single-center retrospective cohort study that included 162 adult patients at least 18 years of age with severe asthma and prescribed omalizumab or benralizumab as adjunctive therapy between January 2010 and May 2023 at the Al-Rashed Allergy Center in Kuwait.
Omalizumab had been prescribed for patients with documented positive skin test or in vitro reactivity to perennial aeroallergens, history of asthma exacerbations requiring systemic glucocorticoids, total serum immunoglobulin E (IgE) levels 30 to 1500 IU/mL, and forced expiratory volume in 1 second (FEV1) less than 80%. Benralizumab was prescribed for patients with blood eosinophil at least 300/µL, history of asthma exacerbations requiring systemic glucocorticoids, at least 2 exacerbations in the previous 12 months or 1 exacerbation with ongoing OCS use.
Among the patients studied (mean [SD] age, 44.95 [12.84] years; 64.81% women; 21.60% who currently smoked), 55.56% had obesity, 55.56% had allergic rhinitis (48.77% with chronic rhinosinusitis), and 43.21% had childhood-onset asthma. Prior to therapy, symptom control was poor (mean asthma control test [ACT] score, 13), mean FEV1 percent predicted was 58.25%, and inflammation levels were intermediate to high (mean total serum IgE 523.9uL/mL, max; mean blood eosinophil count, 499.9 cells/microL).
The investigators found poor response to omalizumab and benralizumab therapy was significantly associated with mOCS use (P =.006 and P =.02, respectively), FEV1 percent predicted less than 60% (P =.05 and P =.04, respectively), poor symptom control (P =.01 and P =.001, respectively), bronchiectasis (P =.003 and P =.01, respectively), and childhood-onset asthma (P =.04 and P =.01, respectively).
IgE less than 220 kIU/L (P =.04) and chronic rhinosinusitis (P =.01) were associated with higher poor response rates to omalizumab. Blood eosinophil levels below 500 cells/mm3 (P =.01) and being a woman (P =.02) were associated with higher poor response rates to benralizumab.
The likelihood of poor response to omalizumab was increased by 21 times with ischemic heart disease (P =.004), 7 times with bronchiectasis (P =.008), and 24 times with continued use of OCS (P =.004). The likelihood of poor response to benralizumab was increased by 7 times with being a woman (P =.03), 7 times with childhood-onset asthma (P =.02), and 2 times with higher body mass index (P = .05).
The study authors did not note any study limitations.
“Poor response to omalizumab treatment was independently associated with ischemic heart disease (IHD), bronchiectasis, and a history of maintenance oral corticosteroid (mOCS) use,” said the investigators. “Conversely, poor response to benralizumab therapy was independently linked to female gender, childhood-onset asthma and higher body mass index.”
References:
Al-Ahmad M, Ali A, Maher A. Factors influencing poor response to type 2 targeted therapies in severe asthma: a retrospective cohort study. BMC Pulm Med. Published online December 5, 2023. doi:10.1186/s12890-023-02786-w