No increase in SARS-CoV-2 infection rates with asthma biologics

Patients with asthma treated with biologics did not have higher rates of SARS-CoV-2 infection than the general population, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

The use of biologics for severe asthma also did not seem related to adverse outcomes from severe COVID-19, Andriana I. Papaioannou, MD, PhD, consultant in respiratory medicine at Attikon University Hospital in Athens, Greece, and colleagues wrote in the study, although they noted that, in general, infected patients with asthma appeared at higher risk for hospitalization.

The researchers collected data on 591 patients aged 18 years and older (mean age, 57 ± 14 years; 63.5% women) with severe asthma treated with omalizumab (Xolair; Genentech, Novartis; n = 219; 37.1%), mepolizumab (Nucala, GSK; n = 358; 60.6%) or benralizumab (Fasenra; AstraZeneca; n = 14; 2.4%) at 23 asthma clinics in Greece. Patients had been treated with biologics for at least 4 months, with a mean duration of therapy of 36 ± 13 months.

Also, 26 (4.4%) of these patients developed a SARS-CoV-2 infection. These patients had been on biologics for less time than those who had not been infected (median, 12 months; interquartile range [IQR], 7-25 vs. 28 months; IQR, 14-41; P < .001).

Nine (34.6%) of the 26 patients infected with SARS-CoV-2 had received omalizumab, 16 (61.5%) had received mepolizumab and one (3.9%) had received benralizumab.

Five of the 26 infected patients experienced deterioration in their asthma control, defined as exacerbation requiring treatment with systemic corticosteroids, and nine (34.6%) required hospitalization for severe COVID-19, which included two of the patients who experienced deteriorations in their asthma control.

The hospitalized patients all were treated with mepolizumab, and eight (88.8%) of them were women. All nine hospitalized patients had clinical and radiological manifestations of pneumonia, and one died in the ICU due to COVID-19 complications.

The hospitalized patients additionally had significantly longer durations of asthma than those patients who were not hospitalized (median, 35 years; IQR, 23.5-41 vs. 10 years; IQR, 6.5-25.5; P = .009).

Two of the infected patients experienced delays of 7 days in their mepolizumab treatment based on the decisions of their physicians, although there was no official guideline for delaying their treatment. Also, two other hospitalized patients received doses on time without any complications.

Overall, patients taking biologics for severe asthma were not at increased risk for SARS-CoV-2 infection compared with the general population, with the 4.4% prevalence in this study appearing comparable to the 1.9% to 6.01% estimated prevalence of infection in Greece during that time. But once infected, these patients were at greater risk for hospitalization due to COVID-19 complications, while some lost asthma control and experienced symptoms of asthma exacerbation.

However, the researchers continued, biologic therapy could be administered as scheduled regardless of SARS-CoV-2 infection without adverse outcomes.

The researchers said lower rates of COVID-19 among patients with asthma could be due to their self-protection measures such as social distancing, lockdown restrictions and hygiene rules, as these patients are aware that viruses can trigger exacerbations.

Also, the researchers noted that the positive impact of biological therapies on asthma control reduces the need for systemic corticosteroids, which predispose patients to SARS-CoV-2 infection. Inhaled corticosteroids may protect patients with asthma from severe infection as well, the researchers continued.

Yet the researchers added that further research is necessary to recognize patients at greater risk for more severe COVID-19, including research into how these patients fared following vaccination.